American Board of Surgery Qualifying Exam (ABS QE) Practice Test

Which mediastinal tumor type is primarily treated with surgery?

1. Bronchiogenic cyst

2. Teratoma

3. Pericardial cyst

4. Lymphoma

The correct answer is: Teratoma

Surgery is the primary treatment modality for teratomas due to their potential for being cancerous or causing complications if left untreated. Teratomas are germ cell tumors that can contain elements from all three germ layers, including hair, teeth, and other tissues, which makes them quite distinctive. When teratomas are located in the mediastinum, they can cause symptoms based on their size and location by compressing adjacent structures. Surgical removal is typically recommended to ensure complete excision of the tumor, which provides definitive treatment and can alleviate symptoms caused by mass effect on surrounding organs. In contrast, bronchiogenic cysts and pericardial cysts are often managed conservatively, particularly if they are asymptomatic, as they may not require surgical intervention unless they cause obstructive symptoms or other complications. Lymphoma, on the other hand, is primarily treated with chemotherapy and radiation rather than surgery, unless there is a compelling reason for surgical intervention, such as diagnosis or if the tumor is causing significant problems that cannot be managed with medical therapy alone. Thus, teratomas are the mediastinal tumor type for which surgery is the most appropriate and often the first-line approach.