Thoracic paravertebral teratoma: a case report and literature review

Thoracic paravertebral teratoma: a case report and literature review | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Case Report Thoracic paravertebral teratoma: a case report and literature review Benzhang Tao, Gan Gao, Cheng Chen, Jinfeng Zang, Teng Li, Guangyu Qiao This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-5881727/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Teratomas are among the most common germ cell tumors found in children. They predominantly occur in the sacrococcygeal region and often in the spinal canal, whereas paravertebral teratomas are very rare. Herein, we present a case of a paravertebral teratoma incidentally discovered in an 11-year-old boy. The tumor was located between the diaphragm, parietal pleura, ribs, and intercostal muscles. Complete resection was achieved using the paramedian approach. Postoperative recovery was uneventful, and no tumor residue or recurrence was observed at the 3-month follow-up. This case underscores the importance of considering teratomas in the differential diagnosis of paravertebral masses. conus medullaris diagnosis neurosurgery paravertebral teratoma Figures Figure 1 Figure 2 Figure 3 1 Introduction Teratomas are embryonic tumors comprising tissues from all three germ layers. They are among the most common germ cell tumors, with an incidence of approximately 1 in 20,000–40,000 live births, accounting for 16.6% of all pediatric tumors [1]. These tumors are most frequently localized in the sacrococcygeal region (40%), followed by the ovaries (20%), testes (7%), and mediastinum (3–8%) [1, 2]. Teratomas in the spinal canal, specifically in the conus medullaris, are also relatively common. However, these tumors have rarely been reported in the paravertebral region. Herein, we report a rare case of paravertebral teratoma that was successfully surgically removed. 2 Case report An 11-year-old boy presented with intermittent back pain 6 months after falling from a staircase. He had normal physical examination findings.. Chest computed tomography revealed an oval, slightly hyperdense mass with central fat density and marginal punctate calcification at the twelfth thoracic vertebral level on the right side of the costosternal joint, measuring approximately 18 × 19 mm. No significant bone destruction was observed (Fig. 1 a,b). The lesion was considered lipogenic and suspected to be a teratoma. Thoracic magnetic resonance imaging (MRI) indicated an irregular cystic mixed signal in the soft tissue next to the right side of the region from the eleventh thoracic to the first lumbar vertebrae. The largest cross-section measured 1.4 cm × 2.3 cm × 5.4 cm (anteroposterior, mediolateral, and superoinferior). The lesion showed long T1 and long T2 signals, short T1 and long T2 signals, and low signals on fat-suppression sequences. Punctate long T1 and short T2 signals were apparent, with no significant compression or abnormal signals in the surrounding soft tissue or bone (Fig. 1 c,d,f). Contrast enhancement revealed mild heterogeneous enhancement with prominent rim enhancement (Fig. 1 e). No abnormal signal or enhancement was observed in the spinal cord. The lesion was considered benign, and the suspicion of teratoma was confirmed. The patient underwent surgery under general anesthesia in the prone position. Routine disinfection and draping were performed. A longitudinal skin incision was made 2.5 cm lateral to the midline at the level of the eleventh thoracic to the first lumbar vertebrae, and the tumor was exposed, through layers of dissection, in the intercostal and transverse process spaces. On inspection, the tumor was lobulated and had an incomplete capsule, with the cephalic side closely adhering to the parietal pleura. Upon resection, a cholesteatoid was observed, containing a large amount of hair. After blunt capsule dissection, the tumor was completely excised (Fig. 2 ). Postoperative anti-infective treatment was administered, and early re-examination showed no tumor residue. Histopathological examination confirmed a teratoma (Fig. 3 ). The patient was discharged after 1 week. MRI at the 3-month follow-up showed no tumor recurrence (Fig. 1 g,h). 3 Discussion Although mediastinal and spinal teratomas are common, paravertebral teratomas are extremely rare. Our patient’s tumor was located above the diaphragm, in the paravertebral region, outside the intervertebral foramina, and in the lateral aspects of the vertebral arch outside the parietal pleura. Teratomas rarely develop in this location; schwannomas and paragangliomas are more common [3]. Mediastinal teratomas are usually benign and discovered incidentally after birth or during adolescence [4]. Most commonly, they are located in the anterior mediastinum, accounting for most tumors in this location [5]. Anterior mediastinal teratomas typically present as mature cystic tumors, with fat, calcification, and fluid components on imaging [6]. Posterior mediastinal teratomas are relatively rare, accounting for 3–8% of mediastinal teratomas [7, 8], and differ in location, imaging features, and clinical characteristics. Located between the pericardium and spine, they are commonly close to mediastinal structures, such as the esophagus and thoracic aorta, and appear as cystic or mixed lesions [9]. Most mediastinal teratomas are asymptomatic [10], but as they enlarge, they may cause compressive symptoms, such as cough [2, 11], dyspnea, or dysphagia. Imaging helps clarify the tumor's extent, density, and relationship with surrounding structures [4, 6]. Paravertebral teratomas are located close the paraspinal muscles, sympathetic chain, and spinal canal.They often extend into the neural foramina or spinal cord, potentially causing significant neurological symptoms, such as parethesia, motor dysfunction, or paralysis [12–14]. Their complex anatomical location often presents diagnostic and therapeutic challenges [14]. The primary treatment for teratomas is surgical resection [15]. Posterior mediastinal teratomas are managed using approaches like thoracotomy and video-assisted thoracoscopic surgery. Thoracotomy is preferred for larger tumors or those near vital structures, while thoracoscopy is suited for smaller, benign tumors due to its minimal invasiveness and faster recovery [4,14]. . Paravertebral teratomas are often approached as neurogenic tumors, using neurosurgical approaches such as laminectomy and posterolateral thoracotomy [16]. Laminectomy is preferred for tumors involving the spinal canal. Smaller paravertebral tumors can be completely excised using a posterolateral approach. For large tumors that may involve large vessels, a posterolateral approach combined with thoracotomy may be used [17]. Compared to conus medullaris teratomas, paravertebral teratomas are relatively easier to resect and separate from important paravertebral anatomical structures such as nerves and pleura. Prevention of postoperative complications and long-term follow-up are critical [4, 14]. Most benign paravertebral teratomas have a good prognosis after complete resection, with an extremely low recurrence rate; however, tumors containing undifferentiated components require close follow-up. Monitoring serum markers, such as alpha-fetoprotein and human chorionic gonadotropin, aids in postoperative recurrence risk assessment [18]. In our case, imaging assessments and surgical planning enabled complete tumor resection via a posterolateral incision and laminectomy. Postoperatively, the patient recovered well, with no recurrence during follow-up. This case emphasizes the importance of thorough imaging and precise surgical approaches for managing paravertebral teratomas. 4 Conclusion Paravertebral teratomas are rare, with limited literature available. Herein, we summarize their treatment process and clinical characteristics. This case highlights their occurrence and supports including them in the differential diagnosis of paravertebral masses. The paramedian approach with laminectomy proved effective, being less technically challenging than for conus medullaris teratomas. Declarations Acknowledgments We thank the Department of Neurosurgery, Chinese People’s Liberation Army General Hospital, for their support during this study. Author contributions Benzhang Tao : Conceptualization, Methodology, and Writing – original draft. Gan Gao : Formal analysis, Validation, and Visualization. Cheng Chen : Software, Data curation, and Investigation. Jinfeng Zang and Teng Li : Data curation and Supervision; Guangyu Qiao : Writing – review & editing, and Resources. All authors contributed to the study and have read and approved the submitted version of the manuscript. Funding: This work was supported by the Capital’s Funds for Health Improvement and Research (grant number: CFH2022-2-5022) and The National Key Research and Development Program of China (grant numbers: 2022YFC2703304 and 2022YFA1105501). Competing interests: The authors declare that they have no competing interests. Ethics approval and consent This study was approved by the Research Ethics Committee of the Chinese People’s Liberation Army General Hospital (approval number: S2023-170-01). All procedures followed the principles of the Declaration of Helsinki (1964). Consent to participate: The patient’s guardian provided written informed consent for the publication of his data and related images. Consent to publish: The authors provided written informed consent for the publication of this article. Data statement The data supporting the findings of this study are available from the corresponding author (Guangyu Qiao) upon request. References Salzillo C, Quaranta A, De Biasi G, Cazzato G, Serio G, Vimercati A, Nicolì P, Resta L, Marzullo A (2023) Mature triphyllic cystic teratoma of the posterior mediastinum in a fetus: a case report and literature review. Diseases 11:144. https://doi.org/10.3390/diseases11040144 Ryan E, Shennib H, Gopal S (2019) Giant intrathoracic teratoma presenting with cachexia and severe dyspnea. J Cardiothorac Surg 14:96. https://doi.org/10.1186/s13019-019-0922-y. Gerber TS, Porubsky S (2024) Benign lesions of the mediastinum. Histopathology 84:183–195. https://doi.org/10.1111/his.15088 Vatta F, Gazzaneo M, Bertozzi M, Raffaele A, Avolio L, Riccipetitoni G (2022) Robotics-assisted pediatric oncology surgery-a preliminary single-center report and a systematic review of published studies. Front Pediatr 9:780830. https://doi.org/10.3389/fped.2021.780830. Hari S, Kumar J, Kumar A, Saha S, Chumber S (2008) Posterior mediastinal teratoma. Intern Med J 38:448–449. https://doi.org/10.1111/j.1445-5994.2007.01621.x Priola SM, Priola AM, Cardinale L, Perotto F, Fava C (2006) The anterior mediastinum: anatomy and imaging procedures. Radiol Med 111:295–311. https://doi.org/10.1007/s11547-006-0031-6. Feng Q, Xiao Y, Han F (2020) Posterior mediastinal mature cystic teratoma-known but rare entity. Am J Med Sci 359:308–309. https://doi.org/10.1016/j.amjms.2019.12.007 Qi YU, Zhang C, Liu D, Yang Y, Zhao S (2016) Situs inversus totalis with a mature teratoma of the posterior mediastinum: a case report. Oncol Lett 11:1135–1137. https://doi.org/10.3892/ol.2015.3994. Carter BW, Lichtenberger 3rd JP (2021) Imaging of the posterior/paravertebral mediastinum. Radiol Clin North Am 59:243–249. https://doi.org/10.1016/j.rcl.2020.11.010 Jaiswal R, Rani P, Devenraj V (2014) Asymptomatic posterior mediastinal teratoma diagnosed incidentally. BMJ Case Rep 2014:bcr2013203228. https://doi.org/10.1136/bcr-2013-203228 Sidani AH, Oberson R, Délèze G, Barras MH, Genton N, Laurini R (1991) Infected teratoma of lower posterior mediastinum in a six-year-old boy. Pediatr Radiol 21:438–439. https://doi.org/10.1007/BF02026683. Deckey DG, Fernandez A, Lara NJ, Taylor S, McClendon J, Bennett DM (2021) Pediatric extramedullary epidural spinal teratomas: a case report and review of the literature. Case Rep Orthop 2021:6702972. https://doi.org/10.1155/2021/6702972. Kizmazoglu D, Ince D, Cecen E, Kizmazoglu C, Guleryuz H, Ozer E, Demiral A, Olgun N (2024) Pediatric paravertebral tumors: analysis of 96 patients. Childs Nerv Syst 40:123–133. https://doi.org/10.1007/s00381-023-06064-2 Yoshioka F, Shimokawa S, Masuoka J, Izaki T, Nakahara Y, Kawashima M, Sakata S, Abe T (2018) Extensive spinal epidural immature teratoma in an infant: case report. J Neurosurg Pediatr 22:411–415. https://doi.org/10.3171/2018.4.PEDS17676. Unnikrishnan M, Kundu M, Sandhyamani S, Gadhinglajkar SV (2004) Giant posterior mediastinal benign cystic teratomatous ganglioneurofibro-lipoma in the first decade. Eur J Cardiothorac Surg. 26:823. https://doi.org/10.1016/j.ejcts.2004.05.054 Boah AO, Perin NI (2016) Lateral access to paravertebral tumors. J Neurosurg Spine 24:824–828. https://doi.org/10.3171/2015.6.SPINE1529. Ulaş AB, Aydın Y, Eroğlu A (2018) Comparison of video-assisted thoracoscopic surgery and thoracotomy in the treatment of mediastinal cysts. Turk Gogus Kalp Damar Cerrahisi Derg 26:265–271. https://doi.org/10.5606/tgkdc.dergisi.2018.15233 Kang J, Mashaal H, Anjum F (2024) Mediastinal germ cell tumors. StatPearls Publishing. Treasure Island. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-5881727","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Case Report","associatedPublications":[],"authors":[{"id":406148490,"identity":"0093e664-5a0d-4289-a01e-f55c8f6700b8","order_by":0,"name":"Benzhang Tao","email":"","orcid":"","institution":"Chinese People’s Liberation Army General Hospital","correspondingAuthor":false,"prefix":"","firstName":"Benzhang","middleName":"","lastName":"Tao","suffix":""},{"id":406148491,"identity":"19644187-8d24-47da-9f90-a3bccdffef03","order_by":1,"name":"Gan Gao","email":"","orcid":"","institution":"Chinese People’s Liberation Army General Hospital","correspondingAuthor":false,"prefix":"","firstName":"Gan","middleName":"","lastName":"Gao","suffix":""},{"id":406148492,"identity":"526812c7-bb27-4450-a905-247ba99b56f8","order_by":2,"name":"Cheng Chen","email":"","orcid":"","institution":"Chinese People’s Liberation Army General Hospital","correspondingAuthor":false,"prefix":"","firstName":"Cheng","middleName":"","lastName":"Chen","suffix":""},{"id":406148493,"identity":"45793293-9f3f-4443-b460-3ace999b19b9","order_by":3,"name":"Jinfeng Zang","email":"","orcid":"","institution":"Chinese People’s Liberation Army General Hospital","correspondingAuthor":false,"prefix":"","firstName":"Jinfeng","middleName":"","lastName":"Zang","suffix":""},{"id":406148494,"identity":"c9a60eec-2b55-455f-a384-f8d48cd30320","order_by":4,"name":"Teng Li","email":"","orcid":"","institution":"Chinese People’s Liberation Army General Hospital","correspondingAuthor":false,"prefix":"","firstName":"Teng","middleName":"","lastName":"Li","suffix":""},{"id":406148495,"identity":"ac9c353d-7ab1-487a-8a9e-34220f9ff16f","order_by":5,"name":"Guangyu Qiao","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAAuklEQVRIiWNgGAWjYHAC5gcJBjY8/OwNxGthM/hQkCYj2XOABGskZ3w4bGNww4FI5Xzn1xgY8xic52G4wcD44WMOMTbceGPwmMfgNg/j7AZmyZnbiNBicOMMyJbbPMwyB9iYeYnVIs1jcI6HTSKBWC3newwkZxgc4OEhWovkDbYygw8GyTwSPAebifML3/nDmx8k/LGztz/efPDDR2K0MNzIMICyGBuIUQ8E548/IFLlKBgFo2AUjFgAAKqCOQZF3CdyAAAAAElFTkSuQmCC","orcid":"","institution":"Chinese People’s Liberation Army General Hospital","correspondingAuthor":true,"prefix":"","firstName":"Guangyu","middleName":"","lastName":"Qiao","suffix":""}],"badges":[],"createdAt":"2025-01-22 14:38:18","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-5881727/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-5881727/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":75312089,"identity":"1851faa4-3886-4b0f-bbd7-75fbaac0e223","added_by":"auto","created_at":"2025-02-03 09:11:34","extension":"jpeg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":213403,"visible":true,"origin":"","legend":"\u003cp\u003eImaging findings. (a, b) Preoperative computed tomography images showing an oval hyperdense mass (yellow arrow) with marginal punctate calcification (red arrow). (c–f) Preoperative magnetic resonance images showing the lesion (yellow arrow). (g, h) Magnetic resonance images showing no tumor residue or recurrence after 7 days (g) and 3 months (h).\u003c/p\u003e","description":"","filename":"floatimage1.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-5881727/v1/26c0dbc328beb159e19cbd75.jpeg"},{"id":75310554,"identity":"f8c0da98-001f-4c27-a31b-65da029fd48e","added_by":"auto","created_at":"2025-02-03 09:03:34","extension":"jpeg","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":169483,"visible":true,"origin":"","legend":"\u003cp\u003eIntraoperative findings. Lesion exposure revealed an irregular mass with (a) a cystic component (yellow arrow) and calcifications (asterisk), and (b) abundance of hair (black arrow). The lesion was fully excised, (c) exposing the diaphragm (asterisk).\u003c/p\u003e","description":"","filename":"floatimage2.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-5881727/v1/d81a3b7ca5a632f15fbd8aef.jpeg"},{"id":75310553,"identity":"2bbd8beb-db1c-4530-9cc2-90d0b2a74775","added_by":"auto","created_at":"2025-02-03 09:03:34","extension":"jpeg","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":242345,"visible":true,"origin":"","legend":"\u003cp\u003eHistopathological findings. Photomicrographs showing the multiple tumor components, namely, (a) chondrocyte, vessel, respiratory epithelial cells, and sialisterium (hematoxylin–eosin staining, magnification × 40); and (b) sebaceous gland and hair follicle (hematoxylin–eosin staining, magnification × 200).\u003c/p\u003e","description":"","filename":"floatimage3.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-5881727/v1/a56742940b04a33c02852d68.jpeg"},{"id":77381541,"identity":"0dbe5092-a459-4a4d-a536-5fcca163fdd8","added_by":"auto","created_at":"2025-02-28 04:01:45","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":974321,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-5881727/v1/35345008-e9c9-4810-9221-d1c5aea682ac.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Thoracic paravertebral teratoma: a case report and literature review","fulltext":[{"header":"1 Introduction","content":"\u003cp\u003eTeratomas are embryonic tumors comprising tissues from all three germ layers. They are among the most common germ cell tumors, with an incidence of approximately 1 in 20,000\u0026ndash;40,000 live births, accounting for 16.6% of all pediatric tumors [1]. These tumors are most frequently localized in the sacrococcygeal region (40%), followed by the ovaries (20%), testes (7%), and mediastinum (3\u0026ndash;8%) [1, 2]. Teratomas in the spinal canal, specifically in the conus medullaris, are also relatively common. However, these tumors have rarely been reported in the paravertebral region. Herein, we report a rare case of paravertebral teratoma that was successfully surgically removed.\u003c/p\u003e"},{"header":"2 Case report","content":"\u003cp\u003eAn 11-year-old boy presented with intermittent back pain 6 months after falling from a staircase. He had normal physical examination findings.. Chest computed tomography revealed an oval, slightly hyperdense mass with central fat density and marginal punctate calcification at the twelfth thoracic vertebral level on the right side of the costosternal joint, measuring approximately 18 \u0026times; 19 mm. No significant bone destruction was observed (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003ea,b). The lesion was considered lipogenic and suspected to be a teratoma. Thoracic magnetic resonance imaging (MRI) indicated an irregular cystic mixed signal in the soft tissue next to the right side of the region from the eleventh thoracic to the first lumbar vertebrae. The largest cross-section measured 1.4 cm \u0026times; 2.3 cm \u0026times; 5.4 cm (anteroposterior, mediolateral, and superoinferior). The lesion showed long T1 and long T2 signals, short T1 and long T2 signals, and low signals on fat-suppression sequences. Punctate long T1 and short T2 signals were apparent, with no significant compression or abnormal signals in the surrounding soft tissue or bone (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003ec,d,f). Contrast enhancement revealed mild heterogeneous enhancement with prominent rim enhancement (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003ee). No abnormal signal or enhancement was observed in the spinal cord. The lesion was considered benign, and the suspicion of teratoma was confirmed.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eThe patient underwent surgery under general anesthesia in the prone position. Routine disinfection and draping were performed. A longitudinal skin incision was made 2.5 cm lateral to the midline at the level of the eleventh thoracic to the first lumbar vertebrae, and the tumor was exposed, through layers of dissection, in the intercostal and transverse process spaces. On inspection, the tumor was lobulated and had an incomplete capsule, with the cephalic side closely adhering to the parietal pleura. Upon resection, a cholesteatoid was observed, containing a large amount of hair. After blunt capsule dissection, the tumor was completely excised (Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e). Postoperative anti-infective treatment was administered, and early re-examination showed no tumor residue. Histopathological examination confirmed a teratoma (Fig.\u0026nbsp;\u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e3\u003c/span\u003e). The patient was discharged after 1 week. MRI at the 3-month follow-up showed no tumor recurrence (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003eg,h).\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003e \u003c/p\u003e"},{"header":"3 Discussion","content":"\u003cp\u003eAlthough mediastinal and spinal teratomas are common, paravertebral teratomas are extremely rare. Our patient\u0026rsquo;s tumor was located above the diaphragm, in the paravertebral region, outside the intervertebral foramina, and in the lateral aspects of the vertebral arch outside the parietal pleura. Teratomas rarely develop in this location; schwannomas and paragangliomas are more common [3].\u003c/p\u003e \u003cp\u003eMediastinal teratomas are usually benign and discovered incidentally after birth or during adolescence [4]. Most commonly, they are located in the anterior mediastinum, accounting for most tumors in this location [5]. Anterior mediastinal teratomas typically present as mature cystic tumors, with fat, calcification, and fluid components on imaging [6]. Posterior mediastinal teratomas are relatively rare, accounting for 3\u0026ndash;8% of mediastinal teratomas [7, 8], and differ in location, imaging features, and clinical characteristics. Located between the pericardium and spine, they are commonly close to mediastinal structures, such as the esophagus and thoracic aorta, and appear as cystic or mixed lesions [9]. Most mediastinal teratomas are asymptomatic [10], but as they enlarge, they may cause compressive symptoms, such as cough [2, 11], dyspnea, or dysphagia. Imaging helps clarify the tumor's extent, density, and relationship with surrounding structures [4, 6].\u003c/p\u003e \u003cp\u003eParavertebral teratomas are located close the paraspinal muscles, sympathetic chain, and spinal canal.They often extend into the neural foramina or spinal cord, potentially causing significant neurological symptoms, such as parethesia, motor dysfunction, or paralysis [12\u0026ndash;14]. Their complex anatomical location often presents diagnostic and therapeutic challenges [14].\u003c/p\u003e \u003cp\u003eThe primary treatment for teratomas is surgical resection [15]. Posterior mediastinal teratomas are managed using approaches like thoracotomy and video-assisted thoracoscopic surgery. Thoracotomy is preferred for larger tumors or those near vital structures, while thoracoscopy is suited for smaller, benign tumors due to its minimal invasiveness and faster recovery [4,14].\u003c/p\u003e \u003cp\u003e. Paravertebral teratomas are often approached as neurogenic tumors, using neurosurgical approaches such as laminectomy and posterolateral thoracotomy [16]. Laminectomy is preferred for tumors involving the spinal canal. Smaller paravertebral tumors can be completely excised using a posterolateral approach. For large tumors that may involve large vessels, a posterolateral approach combined with thoracotomy may be used [17]. Compared to conus medullaris teratomas, paravertebral teratomas are relatively easier to resect and separate from important paravertebral anatomical structures such as nerves and pleura.\u003c/p\u003e \u003cp\u003ePrevention of postoperative complications and long-term follow-up are critical [4, 14]. Most benign paravertebral teratomas have a good prognosis after complete resection, with an extremely low recurrence rate; however, tumors containing undifferentiated components require close follow-up. Monitoring serum markers, such as alpha-fetoprotein and human chorionic gonadotropin, aids in postoperative recurrence risk assessment [18].\u003c/p\u003e \u003cp\u003eIn our case, imaging assessments and surgical planning enabled complete tumor resection via a posterolateral incision and laminectomy. Postoperatively, the patient recovered well, with no recurrence during follow-up. This case emphasizes the importance of thorough imaging and precise surgical approaches for managing paravertebral teratomas.\u003c/p\u003e"},{"header":"4 Conclusion","content":"\u003cp\u003eParavertebral teratomas are rare, with limited literature available. Herein, we summarize their treatment process and clinical characteristics. This case highlights their occurrence and supports including them in the differential diagnosis of paravertebral masses. The paramedian approach with laminectomy proved effective, being less technically challenging than for conus medullaris teratomas.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAcknowledgments\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe thank the Department of Neurosurgery, Chinese People\u0026rsquo;s Liberation Army General Hospital, for their support during this study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eBenzhang Tao\u003c/strong\u003e\u003cstrong\u003e:\u003c/strong\u003e Conceptualization, Methodology, and Writing \u0026ndash; original draft. \u003cstrong\u003eGan Gao\u003c/strong\u003e\u003cstrong\u003e:\u003c/strong\u003e Formal analysis, Validation, and Visualization. \u003cstrong\u003eCheng Chen\u003c/strong\u003e\u003cstrong\u003e:\u003c/strong\u003e Software, Data curation, and Investigation. \u003cstrong\u003eJinfeng Zang\u003c/strong\u003e and \u003cstrong\u003eTeng Li\u003c/strong\u003e\u003cstrong\u003e:\u003c/strong\u003e Data curation and Supervision; \u003cstrong\u003eGuangyu Qiao\u003c/strong\u003e\u003cstrong\u003e:\u003c/strong\u003e Writing \u0026ndash; review \u0026amp; editing, and Resources. All authors contributed to the study and have read and approved the submitted version of the manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding:\u0026nbsp;\u003c/strong\u003eThis work was supported by the Capital\u0026rsquo;s Funds for Health Improvement and Research (grant number: CFH2022-2-5022) and The National Key Research and Development Program of China (grant numbers: 2022YFC2703304 and 2022YFA1105501).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests:\u0026nbsp;\u003c/strong\u003eThe authors declare that they have no competing interests.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthics approval and consent\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was approved by the Research Ethics Committee of the Chinese People\u0026rsquo;s Liberation Army General Hospital\u0026nbsp;(approval number: S2023-170-01). All procedures followed the principles of the Declaration of Helsinki (1964).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent to participate:\u0026nbsp;\u003c/strong\u003eThe patient\u0026rsquo;s guardian provided written informed consent for the publication of his data and related images.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent to publish:\u0026nbsp;\u003c/strong\u003eThe authors\u0026nbsp;provided written informed consent for the publication of\u0026nbsp;this article.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData statement\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe data supporting the findings of this study are available from the corresponding author (Guangyu Qiao) upon request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cbr\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eSalzillo C, Quaranta A, De Biasi G, Cazzato G, Serio G, Vimercati A, Nicol\u0026igrave; P, Resta L, Marzullo A (2023) Mature triphyllic cystic teratoma of the posterior mediastinum in a fetus: a case report and literature review. 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J Neurosurg Spine 24:824\u0026ndash;828. https://doi.org/10.3171/2015.6.SPINE1529.\u003c/li\u003e\n\u003cli\u003eUlaş AB, Aydın Y, Eroğlu A (2018) Comparison of video-assisted thoracoscopic surgery and thoracotomy in the treatment of mediastinal cysts. Turk Gogus Kalp Damar Cerrahisi Derg 26:265\u0026ndash;271. https://doi.org/10.5606/tgkdc.dergisi.2018.15233\u003c/li\u003e\n\u003cli\u003eKang J, Mashaal H, Anjum F (2024) Mediastinal germ cell tumors. StatPearls Publishing. Treasure Island.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"conus medullaris, diagnosis, neurosurgery, paravertebral, teratoma","lastPublishedDoi":"10.21203/rs.3.rs-5881727/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-5881727/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003eTeratomas are among the most common germ cell tumors found in children. They predominantly occur in the sacrococcygeal region and often in the spinal canal, whereas paravertebral teratomas are very rare. Herein, we present a case of a paravertebral teratoma incidentally discovered in an 11-year-old boy. The tumor was located between the diaphragm, parietal pleura, ribs, and intercostal muscles. Complete resection was achieved using the paramedian approach. Postoperative recovery was uneventful, and no tumor residue or recurrence was observed at the 3-month follow-up. This case underscores the importance of considering teratomas in the differential diagnosis of paravertebral masses.\u003c/p\u003e","manuscriptTitle":"Thoracic paravertebral teratoma: a case report and literature review","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-02-03 09:03:29","doi":"10.21203/rs.3.rs-5881727/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"6a538a1c-14c5-4efa-bdbc-fb61955a8577","owner":[],"postedDate":"February 3rd, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2025-02-28T03:53:38+00:00","versionOfRecord":[],"versionCreatedAt":"2025-02-03 09:03:29","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-5881727","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-5881727","identity":"rs-5881727","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}