It is a tumor of brachial cleft cells that contain ectoderm, endoderm, mesoderm. Note that dermoid cyst is a teratoma made out of ectodermal derivatives (teeth, skin, hair). Usually found in anterior mediastinum, 15% are malignant and they invade the surrounding tissues. Evaluation is by CT scan, X-ray shows teeth or calicifications, AFP, CEA are tumor markers. Treatment is Surgical resection with preoperative chemotherapy if malignant. This gross picture shows mass found in the mediastinum on routine imaging and was removed, note the mixed tissue with teeth.