Mature teratomas typically occur in young patients (mean age, 27 years), with approximately equal frequency in men and women (> 90% of malignant germ cell tumors occur in men). Histologic examination of mature teratomas reveals malignant transformation in less than 1% of cases and is usually characterized by the malignant degeneration of the squamous epithelium [
1]. Although the actual mechanism of development is unclear, it is believed that these lesions consist of primordial germ cells which stray into midline extragonadal areas in the migration during embryonic development [
4]. Most patients with germ cell tumors in the mediastinum are asymptomatic, so these neoplasms are usually discovered by accident during routine chest X-ray examinations [
3]. Patients may present with chest, back, or shoulder pain; dyspnea; fever; pleural effusion; cough; and bulging of the chest wall. Less commonly, tumors become infected or may rupture into adjacent organs, such as the lung, bronchial tree, or pleural and pericardial space [
2,
5]. Symptoms can also derive from the pressure exerted on the surrounding tissue (vena cava syndrome), and occasionally fluid examination from the cystic mass shows physiological activity. Some authors [
6,
7] have suggested that exocrine secretion by pancreatic tissue and leakage of digestive enzymes from intestinal or salivary tissue are due to non-infective inflammation around the mass. Others [
8] believe that exocrine pancreatic function may be an aid to pre-operative or intra-operative diagnosis. Anyway, these findings have not had an impact on survival or on the therapeutic pathway. For cases of pure mature cystic teratomas, complete surgical removal alone is the treatment of choice, with optimal results and acceptable operative risk.