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de Souto Medeiros MR, da Silva Barros CC, Rolim LSA, Pinto LP, Miguel MCDC, da Silveira ÉJD. Hamartomas, choristomas, and teratomas of the oral cavity: A 49-years cross-sectional study in an oral diagnostic service. JOURNAL OF STOMATOLOGY, ORAL AND MAXILLOFACIAL SURGERY 2024; 125:101765. [PMID: 38218332 DOI: 10.1016/j.jormas.2024.101765] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Revised: 09/06/2023] [Accepted: 01/10/2024] [Indexed: 01/15/2024]
Abstract
BACKGROUND To investigate the incidence and demographic profile of hamartomatous, choristomatous, and teratoid lesions in a Brazilian population over a 49 years-period. METHODS A retrospective cross-sectional study was performed, and data regarding demographic and clinical aspects were obtained from the medical records of a Brazilian referral center (1970-2019). The collected data were submitted to descriptive analysis and Pearson's chi-square, Fisher's exact, and Kruskal-Wallis tests (p ≤ 0.05). RESULTS In a total of 16,412 medical records analyzed, 300 (1.83 %) were hamartomatous, 2 (0.01 %) choristomatous, and 1 (0.01 %) teratoid lesions. Hamartomas were most diagnosed in females and adults. Statistical significance was observed between hamartoma and age group (p < 0.001). Odontoma was the most frequent hamartomatous lesion. In choristomatous and teratoid lesions, there was no occurrence in males. The jaws were the most affected anatomical site by hamartoma. Choristomas were observed on the mandible and tongue, while a teratoid lesion was seen on the floor of the mouth. CONCLUSIONS Low occurrence of choristomatous and teratoid lesions over hamartomatous lesions and a heterogeneous occurrence profile regarding sex, age group, and anatomic site were observed. Hamartomas are relatively common and benign conditions that may cause damage and require special care during dental treatment. Thus, the dentist needs to be able to identify and treat them appropriately. Likewise, although choristomas and teratomas present no risk to patients and have a lower occurrence than hamartomas, they also require treatment.
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Affiliation(s)
- Maurília Raquel de Souto Medeiros
- Postgraduate Program in Dental Sciences, Department of Dentistry, Federal University of Rio Grande do Norte, Av. Salgado Filho, 1787, Lagoa Nova. CEP, Natal, RN 59056-000, Brazil
| | - Caio César da Silva Barros
- Postgraduate Program in Dental Sciences, Department of Dentistry, Federal University of Rio Grande do Norte, Av. Salgado Filho, 1787, Lagoa Nova. CEP, Natal, RN 59056-000, Brazil
| | - Larissa Santos Amaral Rolim
- Postgraduate Program in Dental Sciences, Department of Dentistry, Federal University of Rio Grande do Norte, Av. Salgado Filho, 1787, Lagoa Nova. CEP, Natal, RN 59056-000, Brazil
| | - Leão Pereira Pinto
- Postgraduate Program in Dental Sciences, Department of Dentistry, Federal University of Rio Grande do Norte, Av. Salgado Filho, 1787, Lagoa Nova. CEP, Natal, RN 59056-000, Brazil
| | - Márcia Cristina da Costa Miguel
- Postgraduate Program in Dental Sciences, Department of Dentistry, Federal University of Rio Grande do Norte, Av. Salgado Filho, 1787, Lagoa Nova. CEP, Natal, RN 59056-000, Brazil
| | - Éricka Janine Dantas da Silveira
- Postgraduate Program in Dental Sciences, Department of Dentistry, Federal University of Rio Grande do Norte, Av. Salgado Filho, 1787, Lagoa Nova. CEP, Natal, RN 59056-000, Brazil.
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Anjum S, Siddiqui HF, Arshad S. A fetus with a mass in the oral cavity: A rare case of large oral immature teratoma. SAGE Open Med Case Rep 2024; 12:2050313X241275027. [PMID: 39280334 PMCID: PMC11402092 DOI: 10.1177/2050313x241275027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2024] [Accepted: 07/23/2024] [Indexed: 09/18/2024] Open
Abstract
Oral teratoma is a congenital neoplastic lesion with an incidence of 2%-9% of all teratomas. It comprises variable amounts of all three germ cell layers. The lesion is graded on histology depending upon the presence of immature components. The most common sites of presentation are the sacrococcygeal area and head and neck with slight female predominance. Our report is based on a case that was received for histopathological evaluation. It consisted of a 20-week fetus with a huge mass protruding from oral orifice measuring 10.8 × 6.7 cm. Histological examination of the tumor revealed immature teratoma-oropharynx.
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Affiliation(s)
- Saba Anjum
- Histopathology Section, Department of Pathology, Ziauddin University Hospital, Karachi, Pakistan
| | | | - Sidra Arshad
- Department of Pathology, Aga Khan University Hospital, Karachi, Pakistan
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Dorra C, Nadia R, Selima J, Maya C, Achraf C, Chiraz M. A rare etiology of infantile dyspnea: Oropharyngeal teratoma. Int J Surg Case Rep 2024; 122:110062. [PMID: 39121721 PMCID: PMC11363839 DOI: 10.1016/j.ijscr.2024.110062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2024] [Revised: 07/14/2024] [Accepted: 07/19/2024] [Indexed: 08/12/2024] Open
Abstract
INTRODUCTION AND IMPORTANCE Oropharyngeal teratoma is a rare congenital tumor that grows slowly and can be suspected prenatally. It entails the obstruction of upper airway and upper digestive tract. Clinical examination is always completed by imaging particularly the MRI. CASE PRESENTATION We present a case of an eight- month -old infant who presented an oropharyngeal mass which caused intermittent dyspnea and feeding difficulties. DISCUSSION The treatment is only surgical and histopathological examination confirms the diagnosis. CONCLUSION Early diagnosis is key to successful management of oropharyngeal teratomas.
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Affiliation(s)
- Chiboub Dorra
- ENT Department, Habib Thameur Hospital, Tunis, Tunisia
| | | | - Jouini Selima
- ENT Department, Habib Thameur Hospital, Tunis, Tunisia.
| | - Cherif Maya
- ENT Department, Habib Thameur Hospital, Tunis, Tunisia
| | - Chedly Achraf
- Cytopathology Department, Habib Thameur Hospital, Tunis, Tunisia
| | - Mbarek Chiraz
- ENT Department, Habib Thameur Hospital, Tunis, Tunisia
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Zhu Y, Huang S, Wang Y, Zhang F. Prenatally Diagnosed Congenital Oral Teratoma Successfully Treated in a Neonate. J Oral Maxillofac Surg 2024; 82:590-594. [PMID: 38341184 DOI: 10.1016/j.joms.2024.01.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Revised: 01/10/2024] [Accepted: 01/17/2024] [Indexed: 02/12/2024]
Abstract
Teratomas are congenital malformations that rarely occur in the oral cavity. In the case reported here, fetal magnetic resonance imaging performed at 30 weeks of gestation informed the decision-making of the multidisciplinary management team, who closely followed the pregnancy until the scheduled cesarean delivery at 38 weeks of gestation. After delivery, tracheal intubation was performed to ensure airway patency, and tumor resection was scheduled immediately after ruling out contraindications to surgery based on preoperative examinations, allowing for safe excising of the tumor. Postoperative follow-up at 3 months showed no abnormalities.
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Affiliation(s)
- Yumeng Zhu
- Resident, Department of Stomatology, Children's hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, Zhejiang, China
| | - Shuhui Huang
- Resident, Department of Stomatology, Children's hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, Zhejiang, China
| | - Yunyi Wang
- Resident, Department of Stomatology, Children's hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, Zhejiang, China
| | - Feng Zhang
- Department Head, Department of Stomatology, Children's hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, Zhejiang, China.
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Li YL, Zhen L, Li DZ. Prenatal Diagnosis of Oral Teratoma by Ultrasound. J Med Ultrasound 2024; 32:76-78. [PMID: 38665348 PMCID: PMC11040491 DOI: 10.4103/jmu.jmu_47_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Revised: 07/03/2022] [Accepted: 08/30/2022] [Indexed: 11/05/2022] Open
Abstract
A pregnant woman had a normal second-trimester anatomic survey at 22 weeks gestation. She was revealed to have a fetal oral mass with polyhydramnios and invisible stomach bubble by ultrasound at 28 weeks. A 50 mm × 36 mm × 42 mm, solid mass was found in the fetal mouth, filling the entire oral cavity. Fetal magnetic resonance imaging showed a homogeneous solid mass in the oral cavity compressing the hypopharynx. At 33 weeks, preterm labor occurred because of the continuation of increased amniotic fluid volume, and a female infant was vaginally delivered. The infant died shortly after tracheal intubation attempt failed. Autopsy confirmed the prenatal sonographic finding. The final pathologic diagnosis was oral immature teratoma. Our study indicates that although oral teratomas are rare, they are readily apparent at prenatal sonographic examinations. Respiratory compromise is the frequent complication of oral teratomas, which is associated with high perinatal mortality.
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Affiliation(s)
- Yan-Lin Li
- Prenatal Diagnostic Center, Guangzhou Women and Children’s Medical Center, Guangzhou, Guangdong, China
| | - Li Zhen
- Prenatal Diagnostic Center, Guangzhou Women and Children’s Medical Center, Guangzhou, Guangdong, China
| | - Dong-Zhi Li
- Prenatal Diagnostic Center, Guangzhou Women and Children’s Medical Center, Guangzhou, Guangdong, China
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Nguyen PTA, Lavisha P, Lynn KH, Jitendrakumar VS. Case report: Congenital palatal teratoma (epignathus) leading to neonatal airway obstruction. Int J Surg Case Rep 2023; 109:108518. [PMID: 37517249 PMCID: PMC10407423 DOI: 10.1016/j.ijscr.2023.108518] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Revised: 07/03/2023] [Accepted: 07/15/2023] [Indexed: 08/01/2023] Open
Abstract
INTRODUCTION AND IMPORTANCE Congenital teratomas arising from the oropharynx, also known as epignathus, are exceedingly rare tumours occurring in 1:35,000-200,000 live births. Although histologically benign, these tumours are often difficult to diagnose antenatally and can cause life-threatening airway obstruction in the newborn. CASE PRESENTATION We present a case of a full-term female infant presenting at birth with respiratory distress and stridor. Clinical examination and magnetic resonance imaging showed a large multilobulated nasopharyngeal mass causing severe airway compromise. The infant underwent excision biopsy with partial debulking of the tumour surrounding the airway, and was successfully extubated thereafter to room air. Histopathological examination confirmed the diagnosis of mature teratoma. CLINICAL DISCUSSION The pathophysiology of epignathus is thought to be aberrant proliferation of pluripotent cells in the notochord during early embryogenesis. Antenatally, elevated maternal alpha-fetoprotein or polyhydramnios may be clue to diagnosis. The mainstay of treatment is airway clearance with surgical resection, which can be curative or at least minimizes the risk of malignancy. CONCLUSION This case highlights the importance of early recognition and multidisciplinary management of the neonatal airway, in order to improve outcome.
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Affiliation(s)
- Pham Tu Anh Nguyen
- Department of Paediatric Medicine, KK Women's and Children's Hospital, 100 Bukit Timah Road, Singapore 229899, Singapore.
| | - Punjabi Lavisha
- Department of Pathology and Laboratory Medicine, KK Women's and Children's Hospital, 100 Bukit Timah Road, Singapore 229899, Singapore.
| | - Koh Huiting Lynn
- Department of Otolaryngology, KK Women's and Children's Hospital, 100 Bukit Timah Road, Singapore 229899, Singapore
| | - Vora Shrenik Jitendrakumar
- Department of Neonatology, KK Women's and Children's Hospital, 100 Bukit Timah Road, Singapore 229899, Singapore.
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Patel S, Kunnath AJ, Gallant J, Belcher RH. Surgical Management and Outcomes of Pediatric Congenital Head and Neck Teratomas: A Scoping Review. OTO Open 2023; 7:e66. [PMID: 37565058 PMCID: PMC10410334 DOI: 10.1002/oto2.66] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Revised: 06/01/2023] [Accepted: 06/25/2023] [Indexed: 08/12/2023] Open
Abstract
Objective To perform a scoping review to characterize postoperative outcomes of pediatric patients (ages 0-18) with a history of congenital head and neck teratomas. Data Sources PubMed, EMBASE, Web of Science, Cochrane, Clinicaltrails.gov. Review Methods A search of multiple databases was performed. Studies were included if they detailed the surgical management and outcomes of pediatric patients with a history of congenital head and neck teratomas. Results One hundred and eight studies totaling 137 patients were identified. The median gestational age at birth was 37 weeks. Respiratory distress, prompting emergent endotracheal intubation or tracheostomy, was present in most patients (58%). The ex utero intrapartum treatment (EXIT) procedure was utilized for 21 (15%) patients. The teratomas were resected after a median duration of 4 days from birth. The most common postsurgical complications were vocal cord paralysis (3%), hemorrhage (2%), and tracheomalacia (2%). Death occurred perioperatively in 2 patients (2%). Twenty-six patients (19%) required additional surgery, and 5 patients (4%) needed adjuvant chemotherapy. Patients were monitored for a median duration of 24 months with a recurrence rate of 6%. Four recurrent cases (50%) had intracranial extension, and 88% of the recurrent cases were mature teratomas at initial histopathological diagnosis. Conclusion Most patients with congenital head and neck teratomas require emergent airway management perinatally. Excisional and surgical complications are rare, and most patients are cured of their disease with a single operation. Recurrent teratomas tend to have an intracranial extension and are likely to be of mature pathology at the time of initial diagnosis.
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Affiliation(s)
- Siddharth Patel
- Vanderbilt University Medical Scholars ProgramNashvilleTennesseeUSA
- Meharry Medical CollegeNashvilleTennesseeUSA
| | | | - Jean‐Nicolas Gallant
- Department of Otolaryngology–Head & Neck SurgeryVanderbilt University Medical CenterNashvilleTennesseeUSA
| | - Ryan H. Belcher
- Department of Otolaryngology–Head & Neck SurgeryVanderbilt University Medical CenterNashvilleTennesseeUSA
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Lawrence A, Gener M, Jiang S, Arganbright J. Oropharyngeal Teratoma: Five-Month-Old Presenting With Failure to Thrive and Severe Obstructive Sleep Apnea. Cureus 2023; 15:e42578. [PMID: 37641749 PMCID: PMC10460287 DOI: 10.7759/cureus.42578] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/26/2023] [Indexed: 08/31/2023] Open
Abstract
Oropharyngeal teratomas are an extremely rare congenital tumor. They are often diagnosed prenatally and can cause significant airway obstruction and feeding difficulties at birth. We present a five-month-old female that was diagnosed with a palatal teratoma that presented with failure to thrive, difficulty feeding, and eventually with severe obstructive sleep apnea. We present a five-month-old term, otherwise healthy female who became stridulous after an episode of the respiratory syncytial virus at one month old. At three months old, an otolaryngologist diagnosed mild laryngomalacia with no mass identified, and no surgical intervention was recommended. Due to continued poor weight gain, at four months old, a nasogastric tube was placed. She was subsequently admitted for further workup. She had severe stridor, a failure to thrive, and was in the 0.07th percentile for weight. Workup revealed severe obstructive sleep apnea and a palatal mass obstructing her left oropharynx. A biopsy and debulking of the mass was performed in the operating room. Pathology resulted as a mature teratoma with evidence of glial and intestinal tissue. There are no pathognomonic characteristics found on imaging to diagnose teratomas, and diagnosis is made with pathologic identification of two of the three germ cell layers. Although most teratomas are benign, there is potential for malignant transformation involving any of the represented germ cell layers. Many teratomas are diagnosed prenatally and can be quite large, often requiring Ex Utero Intrapartum Treatment (EXIT) procedure at birth to establish a safe airway. Overall, this case highlights the importance of a thorough head and neck exam, including a bilateral flexible laryngoscopy, when evaluating an infant with airway obstruction. Providers evaluating these patients should consider oropharyngeal masses, such as teratoma, as part of the differential to ensure accurate and timely diagnosis.
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Affiliation(s)
- Anna Lawrence
- Otolaryngology - Head and Neck Surgery, Children's Mercy Hospital, Kansas City, USA
| | - Melissa Gener
- Pathology, Children's Mercy Hospital, Kansas City, USA
| | - Shao Jiang
- Plastic Surgery, Children's Mercy Hospital, Kansas City, USA
| | - Jill Arganbright
- Otolaryngology - Head and Neck Surgery, Children's Mercy Hospital, Kansas City, USA
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Suttle TK, Els T. Massive mature cystic teratoma of the head and neck, masquerading as a glial choristoma, causing respiratory compromise of a neonate. BMJ Case Rep 2023; 16:e252587. [PMID: 37105594 PMCID: PMC10151894 DOI: 10.1136/bcr-2022-252587] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/29/2023] Open
Abstract
Glial choristoma of the head and neck is a rare, benign congenital malformation consisting of a mass of heterotopic glial cells. In cases involving the upper aerodigestive tract, this can present with upper airway obstruction. In the acute setting, this can lead to diagnostic challenges due to the broad differential, as well as the additional difficulties in obtaining appropriate imaging and tissue samples due to the potential risk of airway compromise. We present a case of a neonate born with a large heterogenous mass involving the upper aerodigestive tract and multiple deep neck spaces which resulted in upper airway compromise requiring emergency surgical intervention in the form of a paediatric tracheostomy. We will discuss the histological findings which initially suggested a glial choristoma, work-up and treatment of this patient with the aim of supplementing the limited existing clinical knowledge of this congenital anomaly and understanding the implications of a paediatric tracheostomy in our setting.
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Affiliation(s)
- Tessa Kirsty Suttle
- Otorhinolaryngology, Livingstone Tertiary Hospital Complex, Port Elizabeth, South Africa
| | - Timothy Els
- Head of Clinical Unit, Otorhinolaryngology, Livingstone Tertiary Hospital Complex, Port Elizabeth, South Africa
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Meneses-Parra AL, Tarazona-Bueno RE, Aragón-Mendoza RL, Altman-Restrepo M. Teratoma nasofaríngeo inmaduro con diagnóstico prenatal: reporte de un caso y revisión de la literatura. REVISTA COLOMBIANA DE OBSTETRICIA Y GINECOLOGÍA 2023; 74:68-86. [PMID: 37093940 PMCID: PMC10174717 DOI: 10.18597/rcog.3906] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Accepted: 01/16/2023] [Indexed: 03/30/2023]
Abstract
Objetivos: reportar el caso de una gestante con diagnóstico de feto con teratoma nasofaríngeo inmaduro y realizar una revisión describiendo el pronóstico de esta patología.
Materiales y métodos: se reporta el caso de una gestante de 27 años, atendida en la Unidad de Ginecología y Obstétrica de un centro de referencia en Bogotá (Colombia), por hallazgo durante el control prenatal de un feto con evidencia de polihidramnios secundario a teratoma nasofaríngeo. Se realizó una búsqueda bibliográfica en las bases de datos Medline vía PubMed, Scopus, SciELO y ScienceDirect, restringiendo tipo de idioma (inglés y español) y por fecha de publicación (enero de 2001 a enero de 2021). Se incluyeron reportes de caso y series de casos que abarcaran el pronóstico de esta patología.
Resultados: la búsqueda recuperó 168 títulos, de los cuales 55 cumplieron con los criterios de inclusión. En total se reportó el resultado perinatal de 58 fetos con diagnóstico de teratoma nasofaríngeo inmaduro detectado en etapa prenatal. En los casos identificados, la mortalidad perinatal fue del 25,4 % y el porcentaje de óbito fue cercano al 3,6 %.
Conclusiones: el teratoma nasofaríngeo inmaduro es una patología poco frecuente. La literatura disponible sugiere que el pronóstico fetal depende del grado de compromiso de las estructuras intracraneales y de la posibilidad de resección de la lesión. Se requieren más estudios que evalúen el pronóstico de los fetos con teratoma nasofaríngeo inmaduro.
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Cervical mature teratoma in pediatric. Radiol Case Rep 2022; 17:4675-4678. [PMID: 36204400 PMCID: PMC9530406 DOI: 10.1016/j.radcr.2022.08.106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Revised: 08/25/2022] [Accepted: 08/28/2022] [Indexed: 11/20/2022] Open
Abstract
Cervical teratomas are one of the rare tumors. Relating to the size of the tumor, they present as a huge neck mass with solid and cystic components. Furthermore, they are able to induce a hyperextension of the neck, neonatal respiratory distress, and possible malignancy. The computed tomography scan examination of this case revealed that there was a mass. It was a component of a teratoma and pathological anatomy which supported the finding. Thus, this study provided a case of a fully excised and cured cervical mature teratoma occurred in an infant. Surgical management must be undergone as thorough as feasible in order to prevent recurrences and the development of the cancer.
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Eswaran S, Kumar P, Kumar S. An Unusual Lesion of Epignathus with Duplicate Tongue and Ranula in a Neonate. Indian J Otolaryngol Head Neck Surg 2022; 74:2617-2619. [PMID: 36452617 PMCID: PMC9702138 DOI: 10.1007/s12070-020-02302-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Accepted: 11/30/2020] [Indexed: 11/29/2022] Open
Abstract
We report a rare case of epignathus (oropharyngeal teratoma) in a neonate, who presented with a midline mass covered with skin and multiple hairs protruding from the Palate and associated with bifid tongue and ranula. With the characteristic presentation, diagnosis of oro/oropharyngeal teratoma was made and a massive internet search revealed very few reported cases of "epignathus". It is unfortunate that the survival of such neonates is only moderate. Prenatal scans and follow up in an institution can prepare the multidisciplinary team to save the child. EXIT procedure to excise the mass or secure the airway, with future repair of the palate is the treatment option available. This case report emphasizes the rare clinical presentation of the disease and the prenatal diagnosis of such a condition can help in prompt decision making and management.
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Affiliation(s)
| | | | - Sunil Kumar
- Lady Hardinge Medical College, New Delhi, India
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Ali IM, Yaşar M, Abdi AA, Dırken ES. Successful surgıcal management of a giant neck teratoma in a newborn Baby: A case report. Ann Med Surg (Lond) 2022; 82:104694. [PMID: 36268334 PMCID: PMC9577653 DOI: 10.1016/j.amsu.2022.104694] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Revised: 09/08/2022] [Accepted: 09/09/2022] [Indexed: 11/17/2022] Open
Affiliation(s)
- Ismail Mohamed Ali
- Department of Otolaryngology–Head and Neck Surgery, Mogadishu Somalia Turkish Training and Research Hospital, Mogadishu, Somalia
- Corresponding author. Mogadishu, Somalia.
| | - Mehmet Yaşar
- Department of Otolaryngology–Head and Neck Surgery, Mogadishu Somalia Turkish Training and Research Hospital, Mogadishu, Somalia
| | - Abdihakım Artan Abdi
- Department of Otolaryngology–Head and Neck Surgery, Mogadishu Somalia Turkish Training and Research Hospital, Mogadishu, Somalia
| | - Esın Seren Dırken
- Department of Pathology, Mogadishu Somalia Turkish Training and Research Hospital, Mogadishu, Somalia
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Li D, Gao H, Zheng W, Jin C, Huang Y, Pan S. Case report: Fetal cervical immature teratoma and copy number variations. Front Oncol 2022; 12:843268. [PMID: 36046039 PMCID: PMC9423720 DOI: 10.3389/fonc.2022.843268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2021] [Accepted: 07/19/2022] [Indexed: 11/30/2022] Open
Abstract
Fetal cervical teratoma is a rare congenital neck tumor. Here, we report a case of a fetus with an anterior solid neck tumor that was confirmed to have an immature teratoma by histology. A duplication was found at chromosome 14q24.1-q24.3 of the fetus in chromosome microarray (CMA) and whole exome sequencing (WES), which was a copy number variation (CNV) and a probably new-onset. Ultrasound coupled with magnetic resonance imaging (MRI) can be considered to be a relatively reliable diagnostic tool, whereas ex-utero intrapartum therapy or resection of the tumor mass on placental support may improve the chances of the newborn’s survival. Strangely, the same duplication occurred on her next fetus that was found with complex congenital heart malformations. CNV at chromosome 14q24.1-q24.3 needs to be paid more attention.
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Affiliation(s)
- Dianjie Li
- Department of Gynaecology and Obstetrics, Zhujiang Hospital, Southern Medical University, Guangzhou, China
| | - Hong Gao
- Department of Urology, Shenzhen Hospital, University of Chinese Academy of Sciences, Shenzhen, China
| | - Wanting Zheng
- Department of Gynaecology and Obstetrics, Shantou Central Hospital, Shantou, China
| | - Chunzhu Jin
- Department of Gynaecology and Obstetrics, Zhujiang Hospital, Southern Medical University, Guangzhou, China
| | - Yuxin Huang
- Department of Gynaecology and Obstetrics, Zhujiang Hospital, Southern Medical University, Guangzhou, China
- *Correspondence: Yuxin Huang, ; Shilei Pan,
| | - Shilei Pan
- Department of Gynaecology and Obstetrics, Zhujiang Hospital, Southern Medical University, Guangzhou, China
- *Correspondence: Yuxin Huang, ; Shilei Pan,
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Yan C, Shentu W, Gu C, Cao Y, Chen Y, Li X, Wang H. Prenatal Diagnosis of Fetal Oral Masses by Ultrasound Combined With Magnetic Resonance Imaging. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2022; 41:597-604. [PMID: 33904194 DOI: 10.1002/jum.15733] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Revised: 03/19/2021] [Accepted: 04/13/2021] [Indexed: 06/12/2023]
Abstract
OBJECTIVES To analyze the imaging manifestations of common fetal oral masses by ultrasound combined with magnetic resonance imaging (MRI) and to discuss their differential diagnoses. METHODS A retrospective study of 6 fetuses with oral masses was performed at a tertiary referral center. The imaging features of prenatal ultrasonography and MRI in the diagnosis of fetal oral masses were analyzed. RESULTS Histopathological examination and/or postpartum ultrasound revealed lymphangioma malformation in 2 fetuses, and mucosal retention cyst, mature teratoma, immature teratoma, and cranial meningocele in 1 fetus, respectively. The teratoma had a characteristic sonographic appearance. In our study, the 4 cases of cystic masses did not have an abnormal vessel architecture. Supplemental MRI revealed a mass effect at the level of the hypopharynx, and in 2 cases with polyhydramnios, the mass obstructed the fetuses' upper airway. Thus, ex-utero intrapartum therapy surgery was performed to secure the newborn's airway. CONCLUSIONS Oral fetal tumors represent rare congenital malformations. This study shows that a prenatal diagnosis of oral masses is feasible by ultrasound examination. MRI can further confirm the results of ultrasonography and clearly show the relationship between the mass and the hypopharynx. Ultrasonography combined with MRI could, to a large extent, facilitate early detection and appropriate treatment and improve outcome.
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Affiliation(s)
- Can Yan
- Department of Medical Ultrasonic, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Weihui Shentu
- Department of Medical Ultrasonic, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Congmin Gu
- Institute of Pathology, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Yaxian Cao
- Department of Radiology, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Yunyu Chen
- Department of Medical Ultrasonic, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Xiaofei Li
- Department of Medical Ultrasonic, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Hongying Wang
- Department of Medical Ultrasonic, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
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Morales CZ, Barrette LX, Vu GH, Kalmar CL, Oliver E, Gebb J, Feygin T, Howell LJ, Javia L, Hedrick HL, Adzick NS, Jackson OA. Postnatal outcomes and risk factor analysis for patients with prenatally diagnosed oropharyngeal masses. Int J Pediatr Otorhinolaryngol 2022; 152:110982. [PMID: 34794813 DOI: 10.1016/j.ijporl.2021.110982] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Revised: 10/26/2021] [Accepted: 11/09/2021] [Indexed: 11/16/2022]
Abstract
OBJECTIVES To describe our experience treating prenatally diagnosed oropharyngeal masses in a novel, multidisciplinary collaboration. To identifying outcomes and risk factors associated with adverse postnatal outcomes. METHODS This is a sixty-two patient case series at an academic referral center. Patients with prenatally diagnosed oropharyngeal masses were identified through a programmatic database and confirmed in the electronic health record. RESULTS Sixty-two patient with prenatally diagnosed oropharyngeal mass were identified, with prenatal imaging at our institution confirming this diagnosis in fifty-seven patients, short term outcomes analysis conducted on forty-four patients, and long-term outcomes analysis conducted on seventeen patients. The most common pathology was lymphatic malformations (n = 27, 47.4%), followed by teratomas (n = 22, 38.6%). The median mass volume from all available patient imaging (n = 57) was 60.54 cm3 (range 1.73-742.5 cm3). Thirteen pregnancies were interrupted, six infants expired, and thirteen cases had an unknown fetal outcome. Confirmed mortality was 6/57 patients with imaging-confirmed oropharyngeal masses (10.5%). Fourteen (56%) of the surviving patients (n = 25) were delivered by Ex Utero Intrapartum Treatment (EXIT) procedure and the median NICU stay was thirty-six days (range: 3-215 days). There was no association between airway compression/deviation/displacement, stomach size, polyhydramnios, or mass size and mortality. Seventeen patients had more than one year of follow-up (mean 5.3 ± 2.4 years). These seventeen patients underwent general anesthesia a total of ninety-two times (mean 5.4 ± 4.3) and had a total of twenty-three mass-related surgeries. The great majority of patients required an artificial airway at birth, feeding support, and speech/swallow therapy. CONCLUSIONS Oropharyngeal mass involvement of key anatomic structures-the neck, upper thorax, orbit, and ear, has a greater association with mortality than mass size. Regardless of the size and involved structures, oropharyngeal masses are associated with a high burden of intensive medical care and surgical care beginning at or before birth.
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Affiliation(s)
- Carrie Z Morales
- Division of Plastic and Reconstructive Surgery, Children's Hospital of Philadelphia, Leonard and Madlyn Abramson Pediatric Research Center, 3615 Civic Center Blvd, Philadelphia, PA, 19104, USA
| | - Louis-Xavier Barrette
- Division of Plastic and Reconstructive Surgery, Children's Hospital of Philadelphia, Leonard and Madlyn Abramson Pediatric Research Center, 3615 Civic Center Blvd, Philadelphia, PA, 19104, USA
| | - Giap H Vu
- Division of Plastic and Reconstructive Surgery, Children's Hospital of Philadelphia, Leonard and Madlyn Abramson Pediatric Research Center, 3615 Civic Center Blvd, Philadelphia, PA, 19104, USA
| | - Christopher L Kalmar
- Division of Plastic and Reconstructive Surgery, Children's Hospital of Philadelphia, Leonard and Madlyn Abramson Pediatric Research Center, 3615 Civic Center Blvd, Philadelphia, PA, 19104, USA
| | - Edward Oliver
- Department of Radiology, Children's Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA, 19104, USA
| | - Juliana Gebb
- Center for Fetal Diagnosis and Treatment, Children's Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA, 19104, USA; Division of Pediatric General, Thoracic and Fetal Surgery, Children's Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA, 19104, USA
| | - Tamara Feygin
- Department of Radiology, Children's Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA, 19104, USA
| | - Lori J Howell
- Center for Fetal Diagnosis and Treatment, Children's Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA, 19104, USA; Division of Pediatric General, Thoracic and Fetal Surgery, Children's Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA, 19104, USA
| | - Luv Javia
- Division of Otolaryngology, Children's Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA, 19104, USA
| | - Holly L Hedrick
- Center for Fetal Diagnosis and Treatment, Children's Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA, 19104, USA; Division of Pediatric General, Thoracic and Fetal Surgery, Children's Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA, 19104, USA
| | - N Scott Adzick
- Center for Fetal Diagnosis and Treatment, Children's Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA, 19104, USA; Division of Pediatric General, Thoracic and Fetal Surgery, Children's Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA, 19104, USA
| | - Oksana A Jackson
- Division of Plastic and Reconstructive Surgery, Children's Hospital of Philadelphia, Leonard and Madlyn Abramson Pediatric Research Center, 3615 Civic Center Blvd, Philadelphia, PA, 19104, USA.
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17
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Large mandibular mass in a newborn. J Am Dent Assoc 2021; 153:1090-1095. [PMID: 34656291 DOI: 10.1016/j.adaj.2021.07.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Revised: 07/12/2021] [Accepted: 07/16/2021] [Indexed: 11/24/2022]
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18
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Barrette LX, Morales CZ, Oliver ER, Gebb JS, Feygin T, Lioy J, Howell LJ, Hedrick HL, Jackson OA, Adzick NS, Javia LR. Risk factor analysis and outcomes of airway management in antenatally diagnosed cervical masses. Int J Pediatr Otorhinolaryngol 2021; 149:110851. [PMID: 34311168 DOI: 10.1016/j.ijporl.2021.110851] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Revised: 06/01/2021] [Accepted: 07/20/2021] [Indexed: 12/12/2022]
Abstract
PURPOSE To investigate antenatally-determined imaging characteristics associated with invasive airway management at birth in patients with cervical masses, as well as to describe postnatal management and outcomes. STUDY DESIGN A retrospective analysis of 52 patients with antenatally diagnosed neck masses was performed using single-center data from January 2008 to January 2019. Antenatal imaging, method of delivery, management, and outcomes data were abstracted from the medical record and analyzed. RESULTS Antenatal diagnosis of neck masses in this cohort consisted of 41 lymphatic malformations (78.8%), 6 teratomas (11.5%), 3 hemangiomas (5.8%), 1 hemangioendothelioma (1.9%), and 1 giant foregut duplication cyst (1.9%). Mean gestational age at time of diagnostic imaging was 29 weeks 3 days (range: 19w4d - 37w). Overall, 22 patients (42.3%) required invasive airway management at birth, specifically 18 patients (34.6%) required endotracheal intubation and 4 (7.7%) required tracheostomy. 15 patients (28.8%) underwent ex-utero intrapartum treatment (EXIT) for the purposes of securing an airway. Polyhydramnios, tracheal deviation and compression, and anterior mass location on antenatal imaging were significantly associated with incidence of invasive airway intervention at birth, EXIT procedure, and tracheostomy during the neonatal hospitalization (p < 0.025; Fisher's exact test). Logistic regression analysis demonstrated statistically significant association between increasing antenatally-estimated mass volume and incidence of invasive airway management at birth (p = 0.02). Post-natal cervical mass management involved surgical excision (32.7%), sclerotherapy (50%), and adjuvant therapy with rapamycin (17.3%). Demise in the neonatal period occurred in 4 (7.7%) patients. CONCLUSION This series documents the largest single-center experience of airway management in antenatally diagnosed cervical masses. Fetal imaging characteristics may help inform the appropriate method of delivery, airway management strategy at birth, and prenatal counseling.
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Affiliation(s)
- Louis-Xavier Barrette
- Division of Otolaryngology, Children's Hospital of Philadelphia, The Perelman School of Medicine at the University of Pennsylvania, 3401 Civic Center Blvd, Philadelphia, PA, 19104, USA
| | - Carrie Z Morales
- Division of Plastic and Reconstructive Surgery, Children's Hospital of Philadelphia, The Perelman School of Medicine at the University of Pennsylvania, Leonard and Madlyn Abramson Pediatric Research Center, 3615 Civic Center Blvd, Philadelphia, PA, 19104, USA
| | - Edward R Oliver
- Department of Radiology, Children's Hospital of Philadelphia, The Perelman School of Medicine at the University of Pennsylvania, 3401 Civic Center Blvd, Philadelphia, PA, 19104, USA
| | - Juliana S Gebb
- Center for Fetal Diagnosis and Treatment, Children's Hospital of Philadelphia, The Perelman School of Medicine at the University of Pennsylvania, 3401 Civic Center Blvd, Philadelphia, PA, 19104, USA; Division of Pediatric General, Thoracic and Fetal Surgery, Children's Hospital of Philadelphia, The Perelman School of Medicine at the University of Pennsylvania, 3401 Civic Center Blvd, Philadelphia, PA, 19104, USA
| | - Tamara Feygin
- Department of Radiology, Children's Hospital of Philadelphia, The Perelman School of Medicine at the University of Pennsylvania, 3401 Civic Center Blvd, Philadelphia, PA, 19104, USA
| | - Janet Lioy
- Division of Neonatology, Children's Hospital of Philadelphia, The Perelman School of Medicine at the University of Pennsylvania, 3401 Civic Center Blvd, Philadelphia, PA, 19104, USA
| | - Lori J Howell
- Center for Fetal Diagnosis and Treatment, Children's Hospital of Philadelphia, The Perelman School of Medicine at the University of Pennsylvania, 3401 Civic Center Blvd, Philadelphia, PA, 19104, USA; Division of Pediatric General, Thoracic and Fetal Surgery, Children's Hospital of Philadelphia, The Perelman School of Medicine at the University of Pennsylvania, 3401 Civic Center Blvd, Philadelphia, PA, 19104, USA
| | - Holly L Hedrick
- Center for Fetal Diagnosis and Treatment, Children's Hospital of Philadelphia, The Perelman School of Medicine at the University of Pennsylvania, 3401 Civic Center Blvd, Philadelphia, PA, 19104, USA; Division of Pediatric General, Thoracic and Fetal Surgery, Children's Hospital of Philadelphia, The Perelman School of Medicine at the University of Pennsylvania, 3401 Civic Center Blvd, Philadelphia, PA, 19104, USA
| | - Oksana A Jackson
- Division of Plastic and Reconstructive Surgery, Children's Hospital of Philadelphia, The Perelman School of Medicine at the University of Pennsylvania, Leonard and Madlyn Abramson Pediatric Research Center, 3615 Civic Center Blvd, Philadelphia, PA, 19104, USA
| | - N Scott Adzick
- Center for Fetal Diagnosis and Treatment, Children's Hospital of Philadelphia, The Perelman School of Medicine at the University of Pennsylvania, 3401 Civic Center Blvd, Philadelphia, PA, 19104, USA; Division of Pediatric General, Thoracic and Fetal Surgery, Children's Hospital of Philadelphia, The Perelman School of Medicine at the University of Pennsylvania, 3401 Civic Center Blvd, Philadelphia, PA, 19104, USA
| | - Luv R Javia
- Division of Otolaryngology, Children's Hospital of Philadelphia, The Perelman School of Medicine at the University of Pennsylvania, 3401 Civic Center Blvd, Philadelphia, PA, 19104, USA.
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Goel A, Kaur A, Dias R, Shah H. Non-operating room anaesthesia for residual neonatal epignathus: Small pill, big thrill…. Indian J Anaesth 2021; 65:422-423. [PMID: 34211208 PMCID: PMC8202799 DOI: 10.4103/ija.ija_1420_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Revised: 12/30/2020] [Accepted: 01/23/2021] [Indexed: 11/09/2022] Open
Affiliation(s)
- Akhil Goel
- Department of Paediatric Anaesthesia, Seth GS Medical College and KEM Hospital, Mumbai, Maharashtra, India
| | - Amrit Kaur
- Department of Paediatric Anaesthesia, Seth GS Medical College and KEM Hospital, Mumbai, Maharashtra, India
| | - Raylene Dias
- Department of Paediatric Anaesthesia, Seth GS Medical College and KEM Hospital, Mumbai, Maharashtra, India
| | - Harick Shah
- Department of Paediatric Anaesthesia, Seth GS Medical College and KEM Hospital, Mumbai, Maharashtra, India
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20
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Nastos C, Paspala A, Stamelos M, Mavroeidi I, Proikas K, Thomopoulou G, Psyrri A, Pikoulis E. Primary thyroid teratoma in adults: A case report and systematic review of the literature. Mol Clin Oncol 2021; 15:169. [PMID: 34295469 DOI: 10.3892/mco.2021.2331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Accepted: 04/08/2021] [Indexed: 11/05/2022] Open
Abstract
Extragonadal germ cell tumors are uncommon in adults and only 2-5% of teratomas develop in extragonadal sites. Primary thyroid teratomas represent <0.1% of all primary thyroid gland neoplasms. In the present report, a case of primary thyroid teratoma in a 65-year-old female is described. Furthermore, the current literature regarding patients who were diagnosed with primary thyroid teratoma and underwent surgical resection was systematically reviewed. A total of 15 studies of 27 patients (age range, 17-65 years). Growing mass or neck swelling were the primary symptoms in 14 patients (51.8%). Only one (5.5%) patient was preoperatively diagnosed with malignant thyroid teratoma. All patients underwent thyroidectomy, but 6 cases had more advanced surgery, including lymph node dissection. A total of 12 patients received a combination of adjuvant chemoradiation postoperatively, 10 (45.4%) patients reported recurrence of disease and 8 (29.6%) were postoperatively diagnosed with distant metastases. A total of 9 (39.1%) patients died due to progression of the disease. In conclusion, primary thyroid teratomas are rare and difficult to diagnose preoperatively. In particular, malignant cases are very aggressive tumors with a considerably poor prognosis, even after surgical resection combined with adjuvant chemoradiation.
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Affiliation(s)
- Constantinos Nastos
- Third Department of Surgery, Attikon University Hospital, National and Kapodistrian University of Athens, 12462 Athens, Greece
| | - Anna Paspala
- Third Department of Surgery, Attikon University Hospital, National and Kapodistrian University of Athens, 12462 Athens, Greece
| | - Mathew Stamelos
- Third Department of Surgery, Attikon University Hospital, National and Kapodistrian University of Athens, 12462 Athens, Greece
| | - Ioanna Mavroeidi
- Endocrine Unit, 2nd Propaedeutic Department of Internal Medicine and Research Institute, Attikon University Hospital, National and Kapodistrian University of Athens, 12462 Athens, Greece
| | - Konstantinos Proikas
- ENT Department, Attikon University Hospital, National and Kapodistrian University of Athens, 12462 Athens, Greece
| | - Georgia Thomopoulou
- Department of Cytopathology, Attikon University Hospital, National and Kapodistrian University of Athens, 12462 Athens, Greece
| | - Amanda Psyrri
- Department of Internal Medicine, Section of Medical Oncology, School of Medicine, Attikon University Hospital, National and Kapodistrian University of Athens, 12462 Athens, Greece
| | - Emmanuil Pikoulis
- Third Department of Surgery, Attikon University Hospital, National and Kapodistrian University of Athens, 12462 Athens, Greece
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21
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Jain P, Prasad A, Prasad A, Jain S. A Large Cervical Immature Cystic Teratoma in a New-Born-Simulating Lymphatic Malformation. Indian J Med Paediatr Oncol 2021. [DOI: 10.4103/ijmpo.ijmpo_120_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
AbstractCervical teratomas are rare and challenging tumors. Although most are benign in nature, there location near vital neck structures can cause significant morbidity. Sometimes, making a diagnosis can be a challenge, especially when it is purely cystic and closely resembles lymphatic malformation.
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Affiliation(s)
- Prashant Jain
- Department of Pediatric Surgery, BLK Superspeciality Hospital, New Delhi, India
| | - Ashish Prasad
- Department of Pediatric Surgery, BLK Superspeciality Hospital, New Delhi, India
| | - Aparna Prasad
- Department of Neonatology, BLK Superspeciality Hospital, New Delhi, India
| | - Sarika Jain
- Department of Radiodiagnosis, DODA Imaging, New Delhi, India
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22
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Zhu P, Li XY. Management of oropharyngeal teratoma: Two case reports and a literature review. J Int Med Res 2021; 49:300060521996873. [PMID: 33641494 PMCID: PMC7917885 DOI: 10.1177/0300060521996873] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Pharyngeal teratomas are very rare congenital tumours derived from pluripotent stem cells. Surgical resection is the main treatment to avoid breathing and feeding difficulties. This current case report describes two newborn infants with congenital oropharyngeal teratomas. In one of the infants, the tumour presented along with a cleft tongue and cleft palate. Prenatal diagnosis by ultrasonography did not identify the tumours because the masses were small and there was no polyhydramnios. Both cases were treated surgically and histological examination of the masses in both cases confirmed the diagnosis of a congenital epignathus. There were no complications such as infection, bleeding or residual recurrence following surgery. After 1-year follow-up, there was no recurrence of the epignathus in either case. Oropharyngeal teratoma is a very rare congenital tumour that may cause upper airway obstruction and feeding difficulties in the newborn, so it should be treated surgically in a timely manner.
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Affiliation(s)
- Peng Zhu
- Department of Otorhinolaryngology, Shanghai Children's Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Xiao-Yan Li
- Department of Otorhinolaryngology, Shanghai Children's Hospital, Shanghai Jiao Tong University, Shanghai, China
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23
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Large Neck Teratoma in a Newborn with Respiratory Distress Syndrome. ACTA ACUST UNITED AC 2021; 42:105-108. [PMID: 33894120 DOI: 10.2478/prilozi-2021-0009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Neonatal tumours in the neck region are a rare finding. Teratomas typically comprise all three germ cell layers with tissues usually foreign to the anatomic site of origin. Head and neck teratomas account a smaller part of congenital teratomas. They can cause major airway obstruction due to the external compression that oropharyngeal or neck masses produce. In addition, there can be an intrinsic lesion in the larynx or trachea. We describe a premature, 30-gestational week-old newborn with large subcutaneous neck mass. Pre-delivery ultrasound showed heterogeneous tumor structure and displaced larynx. The intubation was successful. The newborn developed respiratory distress syndrome immediately after birth which rendered the surgical removal of the neck tumor impossible. An autopsy was done, and the histopathology revealed mature teratoma comprising muscle, brain, salivary and pulmonary tissues, as well as well-developed hyaline membranes in the alveoli. The combination of the respiratory distress syndrome and the neck tumor compression proved fatal. Prenatal diagnosis, therapeutic options and ex utero intrapartum treatment (EXIT) procedures are discussed for the diagnosis and management of this very rare tumor.
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24
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Role of prenatal imaging in the diagnosis and management of fetal facio-cervical masses. Sci Rep 2021; 11:1385. [PMID: 33446872 PMCID: PMC7809128 DOI: 10.1038/s41598-021-80976-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Accepted: 12/29/2020] [Indexed: 12/01/2022] Open
Abstract
Congenital facio-cervical masses can be a developmental anomaly of cystic, solid, or vascular origin, and have an inseparable relationship with adverse prognosis. This retrospective cross-sectional study aimed at determining on the prenatal diagnosis of congenital facio-cervical masses, its management and outcome in a large tertiary referral center. We collected information on prenatal clinical data, pregnancy outcomes, survival information, and final diagnosis. Out of 130 cases of facio-cervical masses, a total of 119 cases of lymphatic malformations (LMs), 2 cases of teratoma, 2 cases of thyroglossal duct cyst, 4 cases of hemangioma, 1 case of congenital epulis, and 2 cases of dermoid cyst were reviewed. The accuracy of prenatal ultrasound was 93.85% (122/130). Observations of diameters using prenatal ultrasound revealed that the bigger the initial diameter is, the bigger the relative change during pregnancy. Magnetic resonance imaging (MRI) revealed that 2 cases of masses were associated with airway compression. In conclusion, ultrasound has a high overall diagnostic accuracy of fetal face and neck deformities. Prenatal US can enhance the management of ambulatory monitoring and classification. Furthermore, MRI provided a detailed assessment of fetal congenital malformations, as well as visualization of the trachea, presenting a multi-dimensional anatomical relationship.
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25
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Simonini C, Strizek B, Berg C, Gembruch U, Mueller A, Heydweiller A, Geipel A. Fetal teratomas - A retrospective observational single-center study. Prenat Diagn 2020; 41:301-307. [PMID: 33242216 DOI: 10.1002/pd.5872] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Revised: 10/26/2020] [Accepted: 11/23/2020] [Indexed: 12/12/2022]
Abstract
OBJECTIVE Evaluation of course and outcome of pregnancies with prenatally diagnosed fetal teratomas of various locations in a single center between 2002 and 2019. METHODS Retrospective observational single-center study including prenatally suspected or diagnosed fetal teratomas. Focus was put on ultrasound findings during pregnancy. Complications, need for intervention and outcomes were compared according to tumor location. RESULTS 79 cases of fetal teratomas were seen at our center between 2002 and 2019. Most frequent tumor locations were the sacrococcygeal region (59.5%), neck (20.2%) and oropharynx (7.6%). Complications mainly included polyhydramnios and cardiac compromise. Need for intervention during pregnancy was significantly higher in pericardial teratomas. Preterm birth before 37 and early preterm birth before 32 weeks occurred in 72.7% and 29.1%, respectively. Major causes of perinatal death were tumor bleeding in sacrococcygeal teratomas (SCTs) and respiratory failure in cervical and oropharyngeal teratomas. CONCLUSION There is a high need for intervention in pregnancies complicated by fetal teratomas. Pericardiocentesis in pericardial teratomas is often inevitable to reduce the risk of intrauterine demise. Amniotic fluid drainage in associated severe polyhydramnios helps to reduce the risk of preterm birth, a major cause of additional morbidity and mortality. MRI in supplement to prenatal ultrasound is useful in fetal teratomas of the neck and oropharynx in order to plan delivery.
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Affiliation(s)
- Corinna Simonini
- Department of Obstetrics and Prenatal Medicine, University Hospital Bonn, Bonn, Germany
| | - Brigitte Strizek
- Department of Obstetrics and Prenatal Medicine, University Hospital Bonn, Bonn, Germany
| | - Christoph Berg
- Department of Obstetrics and Prenatal Medicine, University Hospital Bonn, Bonn, Germany
| | - Ulrich Gembruch
- Department of Obstetrics and Prenatal Medicine, University Hospital Bonn, Bonn, Germany
| | - Andreas Mueller
- Department of Neonatology and Pediatric Intensive Care, University Hospital Bonn, Bonn, Germany
| | | | - Annegret Geipel
- Department of Obstetrics and Prenatal Medicine, University Hospital Bonn, Bonn, Germany
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26
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Chapman MC, Soares BP, Li Y, Shum DJ, Glenn OA, Glastonbury CM, Courtier JL. Congenital Oral Masses: An Anatomic Approach to Diagnosis. Radiographics 2020; 39:1143-1160. [PMID: 31283464 DOI: 10.1148/rg.2019180128] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Although congenital oral masses are rare, they are readily detectable during fetal US screening. Most congenital oral masses are benign, but some may cause mechanical airway obstruction, resulting in poor outcomes at delivery. The radiologist's ability to describe these abnormalities and their physiologic sequelae accurately can have a substantial effect on perinatal treatment. Furthermore, despite being rare, congenital oral lesions encountered at screening and at follow up fetal MRI provide the opportunity to make a specific diagnosis by following a simple anatomic approach. This article describes an anatomic algorithm as the framework for accurate diagnosis of congenital oral lesions. The imaging appearance of the most common congenital oral cavity neoplasms is outlined, including vascular anomalies, epulides, choristomas, congenital lingual thyroid anomalies, lingual hamartomas, and epignathi, and other conditions that mimic these at US. Also reviewed are perinatal management of masses that affect the fetal airway and the imaging features key to optimizing delivery outcomes. Online supplemental material is available for this article. ©RSNA, 2019.
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Affiliation(s)
- Molly C Chapman
- From the Department of Radiology and Biomedical Imaging, University of California, San Francisco, 505 Parnassus Avenue, San Francisco, CA (M.C.C., Y.L., D.J.S., O.A.G., C.M.G., J.L.C.) and the Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD (B.P.S.)
| | - Bruno P Soares
- From the Department of Radiology and Biomedical Imaging, University of California, San Francisco, 505 Parnassus Avenue, San Francisco, CA (M.C.C., Y.L., D.J.S., O.A.G., C.M.G., J.L.C.) and the Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD (B.P.S.)
| | - Yi Li
- From the Department of Radiology and Biomedical Imaging, University of California, San Francisco, 505 Parnassus Avenue, San Francisco, CA (M.C.C., Y.L., D.J.S., O.A.G., C.M.G., J.L.C.) and the Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD (B.P.S.)
| | - Dorothy J Shum
- From the Department of Radiology and Biomedical Imaging, University of California, San Francisco, 505 Parnassus Avenue, San Francisco, CA (M.C.C., Y.L., D.J.S., O.A.G., C.M.G., J.L.C.) and the Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD (B.P.S.)
| | - Orit A Glenn
- From the Department of Radiology and Biomedical Imaging, University of California, San Francisco, 505 Parnassus Avenue, San Francisco, CA (M.C.C., Y.L., D.J.S., O.A.G., C.M.G., J.L.C.) and the Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD (B.P.S.)
| | - Christine M Glastonbury
- From the Department of Radiology and Biomedical Imaging, University of California, San Francisco, 505 Parnassus Avenue, San Francisco, CA (M.C.C., Y.L., D.J.S., O.A.G., C.M.G., J.L.C.) and the Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD (B.P.S.)
| | - Jesse L Courtier
- From the Department of Radiology and Biomedical Imaging, University of California, San Francisco, 505 Parnassus Avenue, San Francisco, CA (M.C.C., Y.L., D.J.S., O.A.G., C.M.G., J.L.C.) and the Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD (B.P.S.)
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Tavares TS, da Costa AAS, Freire-Maia FB, Souza LN, Zarzar PM, Martins-Júnior PA, Aguiar MCF, Mesquita RA, Caldeira PC. Unusual exophytic gingival lesion in a newborn treated with diode laser. Oral Surg Oral Med Oral Pathol Oral Radiol 2020; 130:e74-e79. [PMID: 32107185 DOI: 10.1016/j.oooo.2020.01.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2019] [Revised: 08/19/2019] [Accepted: 01/19/2020] [Indexed: 11/25/2022]
Abstract
Gingival lesions rarely occur in newborns. However, when present, they commonly worry the parents and impair the infant's feeding, thus affecting growth. Such lesions are usually nonneoplastic in nature, although malignancies may develop; therefore, specimens must be submitted for histopathologic examination. A 2-month-old girl presented with a 10-mm nodule on the anterior lower alveolar ridge in association with natal tooth extraction and neonatal tooth eruption. The lesion was excised with high-power laser under local anesthesia, and a histopathologic diagnosis of a peripheral ossifying fibroma was made. In addition to peripheral ossifying fibromas being rare in newborns, the use of high-power lasers for surgical procedures in newborns have been proven to be safe, comfortable, and efficient.
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Affiliation(s)
- Thalita Soares Tavares
- Department of Oral Pathology and Surgery, School of Dentistry, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | | | | | - Leandro Napier Souza
- Department of Oral Pathology and Surgery, School of Dentistry, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Patrícia Maria Zarzar
- Department of Child and Adolescent Oral Health, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Paulo Antônio Martins-Júnior
- Department of Child and Adolescent Oral Health, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Maria Cássia Ferreira Aguiar
- Department of Oral Pathology and Surgery, School of Dentistry, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Ricardo Alves Mesquita
- Department of Oral Pathology and Surgery, School of Dentistry, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Patrícia Carlos Caldeira
- Department of Oral Pathology and Surgery, School of Dentistry, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil.
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Ravelli A, Napolitano M, Rustico M, Riccipetitoni G, Di Leo G, Righini A, Sardanelli F. Prenatal MRI of neck masses with special focus on the evaluation of foetal airway. Radiol Med 2019; 124:917-925. [PMID: 31175537 DOI: 10.1007/s11547-019-01049-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2018] [Accepted: 05/24/2019] [Indexed: 11/30/2022]
Abstract
BACKGROUND Prenatal magnetic resonance imaging is the best tool to visualize foetal airway. OBJECTIVE To evaluate the performance of MRI in the assessment of foetal airway status in the presence of a neck mass. MATERIALS AND METHODS Two paediatric radiologists with 12- and 2-year experience in foetal imaging retrospectively analysed 23 foetal MRI examinations, performed between 2001 and 2016, after a second-level ultrasound suspicious for presence of a neck mass. Postnatal imaging, postoperative report, histology, autopsy, and clinical outcomes were the reference standard to calculate sensitivity, specificity, accuracy, positive predictive value (PPV), and negative predictive value (NPV) of prenatal MRI in detecting airway patency. We used the Cohen к statistics to estimate the interobserver agreement. We also assessed MRI performance in the diagnosis of the mass nature. RESULTS We obtained data about postnatal airway status in 19 of 23 patients; prenatal MRI demonstrated a sensitivity of 9/9 [100%, 95% confidence interval (CI) 66-100%], specificity 8/10 (80%, 44-98%), accuracy 17/19 (89%, 67-99%), PPV 9/11 (82%, 48-98%), and NPV 8/8 (100%, 63-100%); the interobserver agreement was perfect. Prenatal MRI correctly identified 21 of 23 masses (к = 0.858); the interobserver agreement was almost perfect (к = 0.851). CONCLUSION Prenatal MRI demonstrated high accuracy in assessing foetal airway status and diagnosing mass nature, allowing proper delivery planning.
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Affiliation(s)
- Anna Ravelli
- Department of Pediatric Radiology and Neuroradiology, V. Buzzi Children's Hospital - ASST Fatebenefratelli-Sacco, Via Castelvetro 32, 20154, Milan, Italy.
| | - Marcello Napolitano
- Department of Pediatric Radiology and Neuroradiology, V. Buzzi Children's Hospital - ASST Fatebenefratelli-Sacco, Via Castelvetro 32, 20154, Milan, Italy
| | - Mariangela Rustico
- Department of Obstetrics and Gynecology, V. Buzzi Children's Hospital - ASST Fatebenefratelli-Sacco, Via Castelvetro 32, 20154, Milan, Italy
| | - Giovanna Riccipetitoni
- Department of Pediatric Surgery, V. Buzzi Children's Hospital - ASST Fatebenefratelli-Sacco, Via Castelvetro 32, 20154, Milan, Italy
| | - Giovanni Di Leo
- Radiology Unit, IRCCS Policlinico San Donato, Via Morandi 30, 20097, San Donato Milanese, Milan, Italy
| | - Andrea Righini
- Department of Pediatric Radiology and Neuroradiology, V. Buzzi Children's Hospital - ASST Fatebenefratelli-Sacco, Via Castelvetro 32, 20154, Milan, Italy
| | - Francesco Sardanelli
- Radiology Unit, IRCCS Policlinico San Donato, Via Morandi 30, 20097, San Donato Milanese, Milan, Italy.,Department of Biomedical Sciences for Health, Università degli Studi di Milano, Via Morandi 30, 20097, San Donato Milanese, Milan, Italy
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ElSherbiny Hamed M, El-Din MHN, Abdelazim IA, Shikanova S, Karimova B, Kanshaiym S. Prenatal Diagnosis and Immediate Successful Management of Isolated Fetal Epignathus. J Med Ultrasound 2019; 27:198-201. [PMID: 31867194 PMCID: PMC6905252 DOI: 10.4103/jmu.jmu_125_18] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2018] [Revised: 02/27/2019] [Accepted: 03/26/2019] [Indexed: 12/03/2022] Open
Abstract
Epignathus or enigmatic teratoma is rare congenital tumor, arising from the sphenoid region of the palate or pharynx. A 30-year-old pregnant woman presented at 34 weeks + 2 days’ gestation with a well-defined solid mass measuring 6.47 cm × 5.7 cm arising from the fetal oral cavity. The color flow mapping showed that the mass was well vascularized, especially in its center, and its blood supply was originated from the fetal oral cavity. The newborn has no chromosomal abnormalities or other associated anomalies and/or intracranial extension immediately and successfully managed after delivery to highlight the importance of prenatal diagnosis and the importance of multidisciplinary team management.
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Affiliation(s)
| | | | - Ibrahim A Abdelazim
- Department of Obstetrics and Gynecology, Ain Shams University, Cairo, Egypt.,Department of Obstetrics and Gynecology, Ahmadi Hospital, Kuwait Oil Company, Ahmadi, Kuwait, Egypt
| | - Svetlana Shikanova
- Department of Obstetrics and Gynecology №1, Marat Ospanov, West Kazakhstan State Medical University, Aktobe, Kazakhstan
| | - Bakyt Karimova
- Department of Obstetrics and Gynecology №1, Marat Ospanov, West Kazakhstan State Medical University, Aktobe, Kazakhstan
| | - Sakiyeva Kanshaiym
- Department of Obstetrics and Gynecology №1, Marat Ospanov, West Kazakhstan State Medical University, Aktobe, Kazakhstan
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Gaffuri M, Torretta S, Iofrida E, Cantarella G, Borzani IM, Ciralli F, Calderini E, Leva E, Iurlaro E, Mosca F, Pignataro L. Multidisciplinary management of congenital giant head and neck masses: Our experience and review of the literature. J Pediatr Surg 2019; 54:733-739. [PMID: 30955589 DOI: 10.1016/j.jpedsurg.2018.09.018] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2018] [Revised: 09/23/2018] [Accepted: 09/25/2018] [Indexed: 10/28/2022]
Abstract
BACKGROUND Large fetal head and neck (HN) masses can be life-threatening at birth and postnatally owing to airway obstruction. The two most frequent congenital masses that may obstruct the airway are lymphatic malformation (LM) and teratoma. The aim of this paper was to evaluate the results of our experience in the management of giant congenital HN masses and to conduct a literature review. METHODS The study involved a consecutive series of 13 newborns (7 females) affected by giant HN masses. Prenatal diagnosis was achieved by means of ultrasound (US) and fetal magnetic resonance imaging (MRI). Delivery was performed by means of EXIT procedure in case of radiological evidence of airway obstruction. In the postnatal period all feasible therapeutic options (surgery, sclerotherapy, medical therapy) were discussed and adopted by a multidisciplinary team. Twelve patients underwent surgery and one received Rapamycin for one month, with consequent surgical resection owing to increasing size of the mass. RESULTS The histopathological diagnosis was LM in 11 cases and teratoma in 2 cases. Airway obstruction was solved in 11 cases; 2 LM patients required a tracheotomy because of persistent airway obstruction. Major complications were flap necrosis (one patient) and facial nerve palsy (2 cases). Recurrence occurred in 5 patients. CONCLUSIONS The management of congenital HN masses is always challenging and necessarily requires an interdisciplinary approach. Current therapeutic options include surgery, sclerotherapy, medical therapy or a combination of them. When they are large enough to obstruct the airway, a patient-centered approach should guide timing and modality of treatment. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Michele Gaffuri
- Department of Otolaryngology and Head and Neck Surgery, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Milan, Italy; Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Milan, Italy.
| | - Sara Torretta
- Department of Otolaryngology and Head and Neck Surgery, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Milan, Italy; Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Milan, Italy
| | - Elisabetta Iofrida
- Department of Otolaryngology and Head and Neck Surgery, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Milan, Italy; Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Milan, Italy
| | - Giovanna Cantarella
- Department of Otolaryngology and Head and Neck Surgery, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Milan, Italy; Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Milan, Italy
| | - Irene Maria Borzani
- Radiology Unit Pediatric Division, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Fabrizio Ciralli
- Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Milan, Italy; Neonatal Intensive Care Unit, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Edoardo Calderini
- Pediatric Intensive Care Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Ernesto Leva
- Department of Pediatric Surgery, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Enrico Iurlaro
- Department of Obstetrics and Gynecology 'L. Mangiagalli', Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - Fabio Mosca
- Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Milan, Italy; Neonatal Intensive Care Unit, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Lorenzo Pignataro
- Department of Otolaryngology and Head and Neck Surgery, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Milan, Italy; Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Milan, Italy
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Abstract
RATIONALE Teratomas are extremely rare in the thyroid gland. A cervical teratoma presenting as a cystic or mixed thyroid lesion can be easily confused with a thyroglossal duct cyst. It is difficult for pediatricians to differentiate between these 2 types of lesions. PATIENTS CONCERNS A 2-year-old girl who presented a growing thyroid mass for 14 months showed a mass in her left thyroid lobe under contrast-enhanced computed tomography (CT). DIAGNOSIS AND INTERVENTIONS Ultrasonography found a mass of 5 × 3.5 cm within the left lobe of the thyroid gland, and the sonogram revealed areas with echo-free and mixed-echo patterns. There was no accumulation of technetium-99m pertechnetate on the thyroid scintigraphy (cold thyroid nodule). CT scan showed a mass (5.0 × 3.0 × 2.5 cm in size) that extended from the left thyroid lobe to the anterior mediastinum with no evident enhancement and clear margins that contained calcifications. Complete excision without intraoperative capsule disruption was achieved. Histologically, the thyroid mass was diagnosed as a mature teratoma. OUTCOMES The postoperative course was uneventful after follow-ups for 2 years, and the patient had no inflammatory signs or evidence of recurrence. LESSONS Thyroid teratoma is rare in infants and is usually benign; however, some thyroid teratomas are malignant and inclined to relapse. The authors emphasize that thyroid teratomas in children should be included in the differential diagnosis of cystic lesions located in the head and neck area. Complete resection is essential for good outcomes. In addition, long-term follow-ups are warranted to follow the complications of the malignant or recurrent disease.
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Harbarger CF, Flowers W. Large Nasopharyngeal and Neck Mass in an Infant. EAR, NOSE & THROAT JOURNAL 2019; 99:101-102. [PMID: 32162548 DOI: 10.1177/0145561318824226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- Claude F Harbarger
- Department of Otolaryngology, University of Mississippi Medical Center, Jackson, MA, USA
| | - William Flowers
- Department of Otolaryngology, University of Mississippi Medical Center, Jackson, MA, USA
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Abstract
OBJECTIVE The purpose of this study is to determine which MRI parameters of fetal head and neck masses predict high-morbidity neonatal outcomes, including ex utero intrapartum treatment (EXIT) procedure. MATERIALS AND METHODS This retrospective study (2004-2016) included parameters of polyhydramnios (based on largest vertical pocket), mass effect on the trachea, mass midline extension, and morphologic grade and size of masses. The morbid cohort included those requiring an EXIT procedure, difficult intubation at delivery, or lethal outcome. Predictive modeling with a multivariable logistic regression and ROC analysis was then performed. RESULTS Of 36 fetuses, five were delivered by EXIT procedures, there was one neonatal death within 12 hours after delivery, and another neonate required multiple intubation attempts. The remaining 29 fetuses were delivered at outside institutions with no interventions or neonatal morbidity. The largest vertical pocket and mass effect on the trachea were selected as independent predictors by the logistic regression. The cross-validated ROC AUC was 0.951 (95% CI, 0.8795-1). CONCLUSION The largest vertical pocket measurement and mass effect on the trachea were the most contributory MRI parameters that predicted significant morbidity in fetuses with masses of the face and neck, along with other significant parameters. These parameters predict significant morbid neonatal outcomes, including the need for EXIT procedures.
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36
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Abstract
Pediatric patients present emergently with a wide variety of infectious, inflammatory, congenital, traumatic, and neoplastic conditions. Imaging plays a crucial role in distinguishing among the potential diagnoses, as often, history and physical exam is limited in these young sick patients. Understanding the imaging appearance of the range of conditions which are commonly encountered and their potential complications, facilitates appropriate and expedient management. The radiologist must recognize the benefits of the various imaging modalities available and help the clinician choose among the possibilities depending on the clinical status of the patient.
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Affiliation(s)
- Jennifer Vaughn
- Boston Children's Hospital, Department of Radiology, Boston, MA.
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37
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Diakité C, Bénateau H, Dakpé S, Guerreschi P, Galinier P, Veyssière A. Management of nasopharyngeal teratomas associated with cleft palate. Int J Oral Maxillofac Surg 2018; 48:291-297. [PMID: 30243829 DOI: 10.1016/j.ijom.2018.07.024] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2018] [Revised: 05/29/2018] [Accepted: 07/11/2018] [Indexed: 12/29/2022]
Abstract
Nasopharyngeal teratomas are rare tumours, responsible for a high birth mortality rate from acute respiratory distress. Palatine localization can lead to an embryopathogenic mechanical obstacle responsible for a cleft palate. The aim of this study was to update current knowledge concerning the management of this rare pathological association. We conducted a multicentre, retrospective study by case analysis. The inclusion criteria were patients of any age under care for a nasopharyngeal teratoma associated with a velopalatine cleft. The diagnosis of the teratoma was confirmed by histological analysis. Seven cases were included in the study: three cases from the University Hospital of Lille, one from the University Hospital of Caen, one from of the University Hospital of Toulouse, and two from of the University Hospital of Amiens. Approximately 30% of patients experienced acute respiratory distress at birth, necessitating oro- or nasotracheal intubation. The surgical excision was performed in the first 5 months of life for all patients and in a single operative time for 70%. There was no recurrence. Therapeutic management of nasopharyngeal teratomas associated with cleft palate at birth is multidisciplinary and is based on surgical excision. In the absence of other associated pathologies, the prognosis is favourable.
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Affiliation(s)
- C Diakité
- Department of Maxillofacial and Plastic Surgery, Caen University Hospital, 14000 Caen, France.
| | - H Bénateau
- Department of Maxillofacial and Plastic Surgery, Caen University Hospital, 14000 Caen, France
| | - S Dakpé
- Department of Maxillofacial Surgery, Amiens University Hospital, 80000 Amiens, France
| | - P Guerreschi
- Department of Plastic Surgery, Lille University Hospital, 59000 Lille, France
| | - P Galinier
- Department of Pediatric Surgery, Toulouse University Hospital, 31000 Toulouse, France
| | - A Veyssière
- Department of Maxillofacial and Plastic Surgery, Caen University Hospital, 14000 Caen, France
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Carvalho CHPD, Nonaka CFW, Elias CTV, Matheus RDCS, Dias RMB, Souza LBD, Pinto LP. Giant Epignathus Teratoma Discovered at Birth: A Case Report and 7-Year Follow-Up. Braz Dent J 2018; 28:256-261. [PMID: 28492758 DOI: 10.1590/0103-6440201701368] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2016] [Accepted: 06/20/2017] [Indexed: 05/13/2023] Open
Abstract
Teratomas are tumors composed by tissues derived from the three germ cell layers, and they are relatively uncommon in head and neck. The term epignathus has been applied to teratomas from the oropharynx. This paper reports the case of a giant epignathus teratoma discovered at birth, which was successfully managed and followed up for 7 years. A newborn boy presented a polypoid tumor mass exteriorizing through the mouth over a length of 9 cm, with some surface areas resembling skin and others exhibiting hair. Computed tomography showed that the mass arose deep from the left hemiface. Alpha-fetoprotein (AFP) levels were high (316,000 ng/mL). Surgery was performed and microscopic analysis confirmed the diagnosis of mature teratoma. Because of residual tumor and high AFP levels, the patient was submitted to chemotherapy, resulting in complete regression of the lesion and normalization of AFP levels. Surgical repair of a cleft palate was performed at 5 years of age. At 7 years of age, the patient was in good general health and showed no clinical signs of recurrence. Although epignathus is a rare condition, it should be diagnosed in the fetus as early as possible. Prenatal care provides unquestionable benefits, providing the early diagnosis of anomalies that can jeopardize the life of the fetus and contributing to the indication of cases that require treatment before birth.
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Affiliation(s)
| | | | | | | | | | - Lélia Batista de Souza
- Department of Oral Pathology, Dental School, UFRN - Universidade Federal do Rio Grande do Norte, Natal, RN, Brazil
| | - Leão Pereira Pinto
- Department of Oral Pathology, Dental School, UFRN - Universidade Federal do Rio Grande do Norte, Natal, RN, Brazil
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Al-Naimi A, Ali SS, Zarroug AE. Oropharyngeal teratoma in association with a diaphragmatic hernia. JOURNAL OF PEDIATRIC SURGERY CASE REPORTS 2018. [DOI: 10.1016/j.epsc.2017.10.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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40
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Oral Mass of a Fetus Incidentally Found during Second Trimester: Ultrasound Survey and Postnatal Prognosis of the Baby. Case Rep Obstet Gynecol 2018; 2018:6590710. [PMID: 29545959 PMCID: PMC5818921 DOI: 10.1155/2018/6590710] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2017] [Accepted: 12/28/2017] [Indexed: 11/23/2022] Open
Abstract
Ultrasound (USG) and magnetic resonance imaging (MRI) can be used to detect and evaluate the face and neck tumors during the in-utero period. We reported and discussed an oral mass which was diagnosed incidentally at mid-trimester exam and managed successfully.
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Olivares E, Castellow J, Khan J, Grasso S, Fong V. Massive fetal cervical teratoma managed with the ex utero intrapartum treatment (EXIT) procedure. Radiol Case Rep 2018; 13:389-391. [PMID: 29904479 PMCID: PMC5999839 DOI: 10.1016/j.radcr.2017.12.011] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2017] [Accepted: 12/09/2017] [Indexed: 12/18/2022] Open
Abstract
Teratomas are rare congenital tumors typically comprising all 3 germ cell layers. Cervical teratomas arise in the neck and represent a minority of all teratomas. These are associated with high morbidity and mortality because of their propensity to cause airway obstruction. Demonstration on prenatal magnetic resonance imaging is uncommon, especially for a tumor of this size. Fetuses diagnosed with large neck masses are managed through cesarean section with the ex utero intrapartum treatment procedure to secure the airway, such as in our case of a large cervical teratoma in the female fetus of a 30-year-old mother who went into preterm labor.
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Affiliation(s)
- Emily Olivares
- School of Medicine, Eastern Virginia Medical School, Norfolk, VA, USA
| | - Justin Castellow
- Department of Pediatrics, Children's Hospital of the King's Daughters, Norfolk, VA 23507, USA
| | - Jamil Khan
- Department of Pediatrics, Children's Hospital of the King's Daughters, Norfolk, VA 23507, USA
| | - Susanne Grasso
- Department of Radiology, Eastern Virginia Medical School, PO Box 1980, Norfolk, VA 23501, USA
| | - Victor Fong
- Department of Radiology, Eastern Virginia Medical School, PO Box 1980, Norfolk, VA 23501, USA
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Alharbi ST, Alsaadi AS, Yosuph AU, Abdulhameed FD, Arkoubi MM. Diagnostic imaging and surgical management of a congenital cervical teratoma. J Taibah Univ Med Sci 2017; 13:83-86. [PMID: 31435307 PMCID: PMC6694921 DOI: 10.1016/j.jtumed.2017.05.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2017] [Revised: 05/22/2017] [Accepted: 05/31/2017] [Indexed: 12/03/2022] Open
Abstract
Congenital cervical teratomas are rare tumours arising from the neck and consist of three major tissue layers of an embryo: the ectoderm, endoderm, and mesoderm. A great majority of cervical teratomas are benign tumours. However, the clinical significance of these tumours arises from the complications they can cause during pregnancy due to the postnatal mass effect on the airway and oesophagus of the neonate. Diagnosis of a congenital cervical teratoma is possible during an early prenatal ultrasound evaluation. The appearance depends on the size of the tumour, but it is typically a large neck mass with solid and cystic components that causes hyperextension of the neck and is frequently associated with polyhydramnios. In the postnatal period, ultrasound helps in differentiating cervical teratoma from other common congenital cervical masses. MRI is the modality of choice to evaluate the consistency of the tumour, surrounding soft tissue extent of the tumour, and any mass effect on other cervical structures. In our case report, we present a case of a full-term baby that was delivered with a large cervical mass. MRI was helpful in demonstrating the complex content of the mass, surrounding soft tissue extension, and mass effect on other major cervical structures. The clear demarcation of the mass facilitated complete surgical removal without complications.
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Affiliation(s)
- Sara T Alharbi
- Radiology Department, Madinah Maternity and Children Hospital, Almadinah Almunawwarah, KSA
| | - Ali S Alsaadi
- Radiology Department, Madinah Maternity and Children Hospital, Almadinah Almunawwarah, KSA
| | - Azza U Yosuph
- Radiology Department, Madinah Maternity and Children Hospital, Almadinah Almunawwarah, KSA
| | - Fatma D Abdulhameed
- Pediatric Surgery Department, Madinah Maternity and Children Hospital, Almadinah Almunawwarah, KSA
| | - Maher M Arkoubi
- Radiology Department, Madinah Maternity and Children Hospital, Almadinah Almunawwarah, KSA
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Teratoma of the neonatal head and neck: A 41-year experience. Int J Pediatr Otorhinolaryngol 2017; 97:66-71. [PMID: 28483254 DOI: 10.1016/j.ijporl.2017.02.011] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2017] [Accepted: 02/11/2017] [Indexed: 11/23/2022]
Abstract
OBJECTIVE To review our institution's experience with the presentation, evaluation, and management of teratoma of the head and neck in the neonatal population. DESIGN Retrospective case series (November 1970 through September 2011). SETTING Tertiary care children's hospital. PATIENTS 14 patients (12 boys and 2 girls). INTERVENTION Detailed review of presentation, diagnostic approaches, surgical management, and outcomes. MAIN OUTCOME MEASURES Anatomic sites, use of pre and post-natal imaging, use of EXIT (ex utero intrapartum treatment) procedure, presenting symptoms, surgical approaches, additional therapeutic modalities, and outcomes are reviewed. RESULTS Seven patients were diagnosed prenatally, while the remaining 7 patients were diagnosed at birth or shortly thereafter. The tumor emanated from the neck in 9 patients, the nasopharynx/oropharynx in 3 patients, the external nose in 1 patient and the face in 1 patient. Nine patients had associated upper airway obstruction. Four underwent an EXIT procedure, with 3 requiring intubation and 1 requiring tracheostomy. All patients underwent surgical resection. One patient demonstrated recurrence at follow-up. CONCLUSIONS Teratoma of the head and neck, though rare, is an important part of the differential diagnosis of neck masses in children, particularly in the perinatal period. The ability to make this diagnosis prenatally with high-resolution fetal ultrasound and MRI (magnetic resonance imaging) permits planning for airway and tumor management prior to delivery. An EXIT procedure should be considered when airway compromise by tumor compression is suspected. Early surgical excision is the treatment of choice and recurrence is rare when a complete resection is achieved.
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Tonni G, Granese R, Martins Santana EF, Parise Filho JP, Bottura I, Borges Peixoto A, Giacobbe A, Azzerboni A, Araujo Júnior E. Prenatally diagnosed fetal tumors of the head and neck: a systematic review with antenatal and postnatal outcomes over the past 20 years. J Perinat Med 2017; 45:149-165. [PMID: 27508950 DOI: 10.1515/jpm-2016-0074] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/29/2016] [Accepted: 06/19/2016] [Indexed: 12/19/2022]
Abstract
AIM The aim of this study was to review prenatally diagnosed tumors of the head and neck in the fetus and to report antenatal and postnatal outcomes. METHODS PubMed/Medline, EMBASE/SCOPUS, Cochrane database and Google Scholar were reviewed over the last 20 years. No language or article type restriction was used. RESULTS A total of 1940 record were retrieved. Of the 713 records screened, 566 full-text articles were assessed for eligibility. After 445 articles were excluded for specified reasons, 111 studies met the research criteria and were included for qualitative analysis. Overall, 306 cases of fetal tumors of the head and neck were reviewed. Maternal age was an independent factor. The mean maternal age was 28.2 years and gestational age at prenatal diagnosis was 27.1 weeks. Conventional 2D ultrasound was the standard diagnostic procedure in 27.9% of cases and was implemented in 27.3% of cases by 3D ultrasound and fetal magnetic resonance imaging (MRI). Diagnostic evaluation of intracranial spreading and high-airway obstructions was greatly enhanced by fetal MRI. The more common type of fetal tumor was hemangioma/lymphangioms (42.1%), followed by teratomas (29.7%), tumors of the gingiva (10.1%) and lymphatic venous malformations (9.1%), respectively. Fetal karyotyping was performed only in 9.8% of cases; within fetuses undergoing karyotype, chromosomal abnormalities accounted for 20% of cases. The most common pregnancy complication was polyhydramnios (26.3%). Ex utero intrapartum treatment (EXIT) procedure was performed in 30.1% of cases while surgical excision was used in 22.9% during postnatal life. The survival rate was 35.35%. CONCLUSION Fetal tumors of the head and neck are rare congenital malformations. Two-dimensional ultrasound is diagnostic in almost all cases; however, MRI may be an important diagnostic adjunct in targeted cases and help patient selection for immediate intubation at the time of delivery. EXIT procedure and surgical removal of the tumor was associated with good prognosis.
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Moreddu E, Pereira J, Vaz R, Lena G, Triglia JM, Nicollas R. Combined endonasal and neurosurgical resection of a congenital teratoma with pharyngeal, intracranial and orbital extension: Case report, surgical technique and review of the literature. Int J Pediatr Otorhinolaryngol 2015; 79:1991-4. [PMID: 26590006 DOI: 10.1016/j.ijporl.2015.10.056] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2015] [Revised: 10/28/2015] [Accepted: 10/29/2015] [Indexed: 11/26/2022]
Abstract
OBJECTIVES This study reports a patient with a large teratoma involving the oropharynx, the nasopharynx and the left orbit, with intracranial extension. This case represents one of the first reported instances of such an association. A literature review reporting head and neck teratomas with intracranial involvement is also presented. CASE REPORT The authors describe a case of a neonate presenting with a huge teratoma causing respiratory distress due to upper airway obstruction. The child was operated on at 3 months of age with a combined neurosurgical and endonasal endoscopic-assisted approach. After more than 1-year follow-up, the child has no recurrence and no complications of surgery. DISCUSSION This type of teratoma is very rare and surgical morbidity is common. The diagnosis may be apparent before birth, which will facilitate the planning of respiratory management. The combined neurosurgical and otolaryngologic approach for a neonatal teratoma has not previously been described. Using an endoscopic-assisted approach for intranasal tumors removal in neonates and infants is a very rare surgical challenge. CONCLUSION Large nasopharyngeal teratomas of infancy with sinonasal and intracranial extension may be managed using a combined endoscopic-assisted endonasal and neurosurgical procedure.
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Affiliation(s)
- Eric Moreddu
- Department of Pediatric Otolaryngology, Head and Neck Surgery, La Timone Children's Hospital, Aix-Marseille University, 264 rue Saint Pierre, F-13385 Marseille Cedex 5, France.
| | - Josue Pereira
- Department of Neurosurgery, Hospital S João, Porto, Portugal.
| | - Rui Vaz
- Department of Neurosurgery, Hospital S João, Porto, Portugal.
| | - Gabriel Lena
- Department of Pediatric Neurosurgery, La Timone Children's Hospital, Aix-Marseille University, 264 rue Saint Pierre, F-13385 Marseille Cedex 5, France.
| | - Jean-Michel Triglia
- Department of Pediatric Otolaryngology, Head and Neck Surgery, La Timone Children's Hospital, Aix-Marseille University, 264 rue Saint Pierre, F-13385 Marseille Cedex 5, France.
| | - Richard Nicollas
- Department of Pediatric Otolaryngology, Head and Neck Surgery, La Timone Children's Hospital, Aix-Marseille University, 264 rue Saint Pierre, F-13385 Marseille Cedex 5, France.
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Alexander VRC, Manjaly JG, Pepper CM, Ifeacho SN, Hewitt RJ, Hartley BEJ. Head and neck teratomas in children--A series of 23 cases at Great Ormond Street Hospital. Int J Pediatr Otorhinolaryngol 2015; 79:2008-14. [PMID: 26611341 DOI: 10.1016/j.ijporl.2015.07.042] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2015] [Revised: 07/29/2015] [Accepted: 07/30/2015] [Indexed: 11/18/2022]
Abstract
OBJECTIVE Head and neck teratomas are rare and malignant change is rarer still. This is a report detailing all of the teratomas treated by the ear, nose and throat or craniofacial teams over the last 28 years at our institution. Examining the common presenting and radiological features as well as our success rates compared to the current literature. METHOD A retrospective review of all cases presenting to our institution with a head and neck teratoma were analysed. Data regarding the following characteristics were collected: antenatal history, clinical features, biological serum makers, radiological and pathological characteristics. Surgical treatment, rates of reoccurrence and the degree of post-operative follow up were also analysed. RESULTS 23 cases in total were included: 8 cervical, 6 nasopharyngeal, 5 thyroid, 2 thymus, 2 temporal. One had malignant change. The majority of children presented at birth with respiratory distress, 5 cases were picked up antenatally and one case presented at 10 years of age. All were treated surgically; with complete excision in 20 patients. No clinical recurrence occurred but further surgery was performed for radiologically suspected residual disease in one case. DISCUSSION This is the largest detailed case series in literature in regard to head and neck teratomas. Illustrating that this is frequently a benign disease process disease in the head and neck region and has an excellent long term prognosis following surgery. In the situation of incomplete resection careful meticulous follow up with radiological imaging and a multidisciplinary team approach is a safe and viable alternative.
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Affiliation(s)
| | | | | | - Sonna N Ifeacho
- Great Ormond Street Hospital, Great Ormond Street, London WC1N 3JH, UK.
| | - Richard J Hewitt
- Great Ormond Street Hospital, Great Ormond Street, London WC1N 3JH, UK.
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Deeney S, Somme S. Prenatal consultation for foetal anomalies requiring surgery. Women Birth 2015; 29:e1-7. [PMID: 26321230 DOI: 10.1016/j.wombi.2015.08.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2015] [Revised: 08/07/2015] [Accepted: 08/09/2015] [Indexed: 01/19/2023]
Abstract
BACKGROUND During prenatal screening of pregnant women, foetal anomalies requiring surgery may be diagnosed. Healthcare providers should have a basic knowledge of these diseases, including their workup, comorbidities, prognosis, treatment options and any considerations that need to be made in planning for birth. AIM This article aims to provide this information by summarising the most recent literature for some of the most commonly diagnosed foetal anomalies requiring surgical correction. METHODS English language studies on prenatal diagnostic modalities, abdominal wall defects, congenital diaphragmatic hernias, surgical conditions leading to airway compromise, hydrops fetalis, intestinal obstruction and abdominal cysts were retrieved from the PubMed database. FINDINGS The most recent and relevant literature is summarised regarding the above listed paediatric conditions. The incidence and prevalence (when available), prognosis, workup, common comorbidities, foetal interventions and special birth considerations (when applicable), and postnatal surgical treatment options are reviewed. CONCLUSIONS Healthcare providers will occasionally encounter foetal anomalies which may require surgery while performing prenatal screening. They may need to provide early counselling to expectant parents to inform their expectations. When indicated, referrals should be made to a foetal care centre for prenatal consultation. For conditions which may cause danger or distress to the foetus in the immediate postnatal period, preparations should be made to ensure sufficient resources are available at the location of birth.
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Affiliation(s)
- Scott Deeney
- Department of Pediatric Surgery, Children's Hospital Colorado, Aurora, CO, USA.
| | - Stig Somme
- Department of Pediatric Surgery, Children's Hospital Colorado, Aurora, CO, USA
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Doğer E, Ceylan Y, Çakıroğlu AY, Çalışkan E. Prenatal diagnosis and management of a fetal neck mass. J Turk Ger Gynecol Assoc 2015; 16:118-20. [PMID: 26097396 DOI: 10.5152/jtgga.2014.59834] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2013] [Accepted: 10/17/2013] [Indexed: 11/22/2022] Open
Abstract
We report the case of a benign mesenchymal spindle-cell tumor located on fetal neck, diagnosed during prenatal ultrasound and magnetic resonance investigation. A 30-year-old woman (gravida 2, para 1) was referred to our perinatology unit for evaluation of a fetal neck mass that had been identified on ultrasonography at 29 weeks gestation. A right lateral neck mass was observed (size: 42×40 mm) that extended from the preauricular region to right clavicula. Fetal MRI revealed a solid heterogeneous mass arising from the right lateral neck and there was no invasion around tissue and no extension of the mass into the chest. At 37 weeks after birth, we observed that the mass was subcutaneous and there was no invasion to the surrounding tissue. The trachea was not compressed and there was no extension of the mass into the chest. Then, the neck mass was completely resected after birth without any complications. Histopathological examination of tumor was consistent with mesenchymal spindle-cell tumor. Immunohistochemical staining with CD34 and actin was positive; however, caldesmone, epithelial membrane antigen (EMA), and S-100 was negative. Fetal MRI performed during the pregnancy for investigation of fetal neck masses detected on ultrasound gives compatible results observed in the neonate after birth and maintains adequate findings for follow-up and planning of treatment.
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Affiliation(s)
- Emek Doğer
- Department of Obstetrics and Gynecology, Kocaeli University Faculty of Medicine, Kocaeli, Turkey
| | - Yasin Ceylan
- Department of Obstetrics and Gynecology, Kocaeli University Faculty of Medicine, Kocaeli, Turkey
| | - Ahmet Yiğit Çakıroğlu
- Department of Obstetrics and Gynecology, Kocaeli University Faculty of Medicine, Kocaeli, Turkey
| | - Eray Çalışkan
- Department of Obstetrics and Gynecology, Kocaeli University Faculty of Medicine, Kocaeli, Turkey
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Sellami M, Mnejja M, Ayadi L, Charfeddine I, Boudawara T, Hammami B, Ghorbel A. Congenital teratoma of the neck: A case report and literature review. ACTA ACUST UNITED AC 2015. [DOI: 10.1016/j.ejenta.2014.10.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Zielinski R, Respondek-Liberska M. Retrospective chart review of 44 fetuses with cervicofacial tumors in the sonographic assessment. Int J Pediatr Otorhinolaryngol 2015; 79:363-8. [PMID: 25600283 DOI: 10.1016/j.ijporl.2014.12.027] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2014] [Revised: 12/18/2014] [Accepted: 12/22/2014] [Indexed: 12/30/2022]
Abstract
OBJECTIVES The aim of this retrospective study was to review and analyze ultrasonography examinations and follow-up of fetuses with cervicofacial tumors to develop bases for counseling specialist involved in perinatal treatment. METHODS The study consisted of case series with chart review of 44 fetuses with cervicofacial tumors diagnosed in utero by ultrasonography. The study was carried in Department of Diagnosis and Prevention of Congenital Malformations, Medical University of Lodz in years 1998-2013. The analysis of the fetuses with cervicofacial tumors included assessment of fetal sonographic features, neonatal survival and in utero as well as perinatal treatments. The obtained data were analyzed by the standard statistical tests and the Pearson's Chi square test, statistical significance at p=0.05. RESULTS Cervicofacial tumors were detected at mean 19±7 weeks of gestation. Eighty-two percent of the fetuses were males. Lymphatic malformations followed by teratomas were the most common fetal tumors in the cervicofacial region. In most cases, fetuses with cervicofacial tumors had other abnormalities. Mortality rate in our case series was 43%. In utero treatment was introduced in 6 fetuses. In 4 neonates prenatal sonographic assessment revealed upper airway patency and EXIT procedure (ex-utero intrapartum treatment) was introduced. CONCLUSION Prenatal sonographic detection of cervicofacial tumor, in case of lymphatic malformations possibly as early as in the first trimester, in case of craniofacial teratomas, cervical teratomas, hemangiomas and thyroid tumors possibly as early as in the second trimester, and in case of epignathi possibly in the third trimester, permits planning further course of pregnancy as well as EXIT procedure before delivery.
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Affiliation(s)
- Rafal Zielinski
- Department of Pediatric Otorhinolaryngology, Medical University of Lodz, Poland.
| | - Maria Respondek-Liberska
- Department of Diagnosis and Prevention of Congenital Malformations, Polish Mother Memorial Hospital, Chair of Morphology and Embryology, Medical University of Lodz, Poland
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