Dear Dr. Roach: I had a CT scan due to broken ribs from a very recent fall. The scan revealed a large teratoma near my heart. I am 69 and was previously unaware of this formation. No suggestion has been given to me regarding further investigation or treatment of the teratoma. I am assuming it may have been present at birth and does not cause any problem. But now I am wondering if it should be monitored. Can a teratoma grow or migrate in the body? Any information on teratoma will be appreciated.
Dear S.S.: A teratoma is a type of tumor of germ cells, the cells that become eggs or sperm. They can occur within the testis or ovary, but also can occur outside the gonads. When they do, they usually are found in the midline of the body. A frequent place is the anterior superior mediastinum, in between the lungs and below the breastbone. Teratomas usually are benign tumors, but some types can act like cancers.
Your tumor is unlikely to have been there since birth. Nobody knows whether the germ cell that became a teratoma properly went into the gonads during development, or whether the cell left the gonad and then became a tumor. It is clear, however, that men with teratoma outside the gonads are at higher risk for developing testicular cancer later on.
Teratomas, being derived from germ cells, are capable of creating any tissue. Teeth and hair are sometimes found inside teratomas.
I am very surprised you havenít been recommended for surgical removal. Surgery is usually successful at curing teratoma. They certainly can grow, and occasionally become very large. I would certainly recommend seeing an oncologist (cancer specialist). Thoracic (chest) surgeons operate on this area. It may be that the position is difficult, but a surgeon should still evaluate you, in my opinion.
Dear Dr. Roach: My wife drinks in excess of 3 liters of diet soda a day, sometimes even more. She has colitis, for which she takes Lialda, and on her last visit to her primary care physician, her blood work revealed borderline bad levels in her liver. The doctor seems to think she needs to stop ďdrinking alcohol,Ē but I have been married to her for more than 30 years, and I know itís not drinking that is causing this. We both consume only moderate amounts of alcohol. Could it be the chemicals in diet soda?
Dear F.J.R.: Three liters a day is a lot of diet soda, and that much caffeine probably isnít good for her. However, I donít think it is likely to be affecting her liver. Mesalamine (Lialda and others) rarely can cause abnormal liver tests ó specifically, high levels of the same enzymes that might lead a doctor to suspect alcohol use.
You didnít tell me what kind of colitis your wife has, but ulcerative colitis, a form of inflammatory bowel disease, is associated with several kinds of liver problems, including fatty liver and primary sclerosing cholangitis, which is potentially severe. I donít think either alcohol or diet soda should be blamed until she has had a more careful workup. I think a visit with her gastroenterologist would be wise.
Email questions to ToYourGoodHealth@med.cornell.edu.