Mediastinal teratoma in children: A case series of misdiagnoses in a high-endemic tuberculosis setting.

INTRODUCTION AND IMPORTANCE: Mediastinal teratoma is a rare extragonadal teratoma that frequently manifests with non-specific symptoms and is commonly misdiagnosed, particularly in Indonesia, where tuberculosis (TB) is endemic.

CASE PRESENTATION: Herein, we present two cases of children aged 19 months and 17 years old who were referred with chronic nonspecific symptoms of cough, tachypnea, chest pain, and hemoptysis. Both children were initially diagnosed with TB and both completed anti-tuberculosis treatment. After visiting several healthcare facilities, a mediastinal mass was finally diagnosed and they all underwent thoracotomy without any further complication. The histopathology findings revealed mature teratoma. All patients had satisfactory outcomes at follow-up visits.

CLINICAL DISCUSSIONS: Patients presented with non-specific symptoms are often clinically diagnosed with TB. However, primary healthcare doctors should consider other differential diagnoses when a child has non-specific respiratory symptoms, especially when chest X-ray findings are nonspecific and TB workup is negative.

CONCLUSIONS: The diagnosis of mediastinal masses is still challenging in Indonesia, as the diagnosis requires a vast array of work-up examinations, therefore, early recognition and referral are crucial for management.