1
|
Ziyaee F, Forooghi M, Geramizadeh B, Fatemian H, Ghasemian M. Large congenital cervical mass in a neonate: prenatal diagnosis and postnatal management of teratoma: a case report. J Med Case Rep 2024; 18:254. [PMID: 38755694 PMCID: PMC11100164 DOI: 10.1186/s13256-024-04535-x] [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] [Received: 01/31/2024] [Accepted: 03/20/2024] [Indexed: 05/18/2024] Open
Abstract
INTRODUCTION Cervical teratomas are rare congenital neoplasms that can cause neonatal airway obstruction if large. CASE PRESENTATION The female Persian neonate displayed respiratory distress at birth, with a 7 cm × 8 cm cystic solid mass identified on the left side of the neck. Antenatal ultrasonography revealed polyhydramnios. Despite initial stabilization, the infant required intubation and mechanical ventilation due to persistent respiratory distress. Imaging confirmed a cystic mass compressing the trachea, ruling out cystic hygroma. Surgical resection on postnatal day 17 revealed a 10 cm × 10 cm solid cystic structure, histologically identified as an immature teratoma. CONCLUSION Despite risks of poor fetal and postnatal outcome from large cervical teratomas, early surgical resection after airway stabilization can result in recovery. Proper multidisciplinary management of respiratory distress from such tumors is paramount.
Collapse
Affiliation(s)
- Fateme Ziyaee
- Department of Pediatric Surgery, Shiraz University of Medical Sciences, Shiraz, Iran.
- Department of Pediatric Gastroenterology, Shiraz University of Medical Sciences, Shiraz, Iran.
| | - Mehdi Forooghi
- Department of Pediatric Surgery, Shiraz University of Medical Sciences, Shiraz, Iran
- School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Bita Geramizadeh
- Shiraz Transplant Research Center (STRC), Shiraz University of Medical Sciences, Shiraz, Iran
- Department of Pathology, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Hossein Fatemian
- School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran.
| | - Mehdi Ghasemian
- School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| |
Collapse
|
2
|
Cruz-Martínez R, Gil-Pugliese S, Villalobos-Gómez R, Martínez-Rodríguez M, Márquez-Dávila A, López-Briones H, Chávez-González E, Méndez-González A, Pineda-Alemán H, Rebolledo-Fernández C, Barrios-Prieto E, Fajardo-Dueñas S. Fetal Laryngoscopy and Endoscopic Tracheal Intubation to Avoid ex utero Intrapartum Treatment in the Management of Fetuses with Suspected Airway Obstruction. Fetal Diagn Ther 2023; 50:472-479. [PMID: 37544292 DOI: 10.1159/000533348] [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: 04/12/2023] [Accepted: 07/19/2023] [Indexed: 08/08/2023]
Abstract
INTRODUCTION Large congenital neck tumors can cause neonatal death due to airway obstruction. The aim of this study was to report outcomes of the first cohort of fetuses with neck masses and suspected airway obstruction managed with fetal laryngoscopy (FL) and fetal endoscopic tracheal intubation (FETI) to secure fetal airways and avoid ex utero intrapartum treatment (EXIT) procedure. METHODS A prospective observational cohort of consecutive fetuses with neck masses that were candidates for an EXIT procedure due to suspicion of laryngeal and/or tracheal occlusion on ultrasonographic (US) or magnetic resonance imaging (MRI) examination were recruited for FL in a tertiary referral center in Queretaro, Mexico. FETI was performed if the obstruction was confirmed by FL. Maternal and perinatal outcomes were evaluated. RESULTS Between January 2012 and March 2023, 35 cases with neck masses were evaluated. Airway obstruction was suspected in 12/35 (34.3%), either by US in 10/35 (28.6%) or by fetal MRI in 2/35 (5.7%). In all cases, FL was successfully performed at the first attempt at a median gestational age (GA) of 36+5 (range, 33+5-39+6) weeks+days, with a median surgical time of 22.5 (12-35) min. In 4 cases, airway patency was confirmed during FL and an EXIT procedure was avoided. In 8/12 cases (66.7%), airway obstruction was confirmed during fetoscopy and FETI was successfully performed at a median GA of 36+3 (33+2-38+5) weeks+days, with a median surgical time of 25.0 (range, 12-45) min. No case required an EXIT procedure. All patients underwent conventional cesarean delivery with no maternal complications and all neonates were admitted to the neonatal intensive care unit with a correctly positioned endotracheal tube (ETT) immediately after delivery. Three neonatal deaths (37.5%) were reported due to postnatal unplanned extubation, failed ETT replacement, and tumoral bleeding. CONCLUSION In fetuses with neck masses and suspected airway obstruction, FL and FETI are feasible and could replace EXIT procedures with good maternal and perinatal outcomes.
Collapse
Affiliation(s)
- Rogelio Cruz-Martínez
- Fetal Medicine and Surgery Research Center, Fetal Medicine Mexico Institute, Guadalajara, Mexico
- Department of Fetal Surgery, Hospital de Especialidades del Niño y la Mujer "Dr. Felipe Núñez-Lara", Queretaro, Mexico
| | - Savino Gil-Pugliese
- Fetal Medicine and Surgery Research Center, Fetal Medicine Mexico Institute, Guadalajara, Mexico
| | - Rosa Villalobos-Gómez
- Fetal Medicine and Surgery Research Center, Fetal Medicine Mexico Institute, Guadalajara, Mexico
| | - Miguel Martínez-Rodríguez
- Fetal Medicine and Surgery Research Center, Fetal Medicine Mexico Institute, Guadalajara, Mexico
- Department of Fetal Surgery, Hospital de Especialidades del Niño y la Mujer "Dr. Felipe Núñez-Lara", Queretaro, Mexico
| | - Alejandra Márquez-Dávila
- Fetal Medicine and Surgery Research Center, Fetal Medicine Mexico Institute, Guadalajara, Mexico
| | - Hugo López-Briones
- Fetal Medicine and Surgery Research Center, Fetal Medicine Mexico Institute, Guadalajara, Mexico
| | - Eréndira Chávez-González
- Fetal Medicine and Surgery Research Center, Fetal Medicine Mexico Institute, Guadalajara, Mexico
- Department of Biomedical Sciences, University Center in Tonalá of the University of Guadalajara, Guadalajara, Mexico
| | - Antonio Méndez-González
- Fetal Medicine and Surgery Research Center, Fetal Medicine Mexico Institute, Guadalajara, Mexico
| | - Hugo Pineda-Alemán
- Fetal Medicine and Surgery Research Center, Fetal Medicine Mexico Institute, Guadalajara, Mexico
| | - Carlos Rebolledo-Fernández
- Department of Fetal Surgery, Hospital de Especialidades del Niño y la Mujer "Dr. Felipe Núñez-Lara", Queretaro, Mexico
| | - Ernesto Barrios-Prieto
- Fetal Medicine and Surgery Research Center, Fetal Medicine Mexico Institute, Guadalajara, Mexico
- Department of Maternal-Fetal Medicine, Nuevo Hospital Civil de Guadalajara "Dr. Juan I. Menchaca", Guadalajara, Mexico
| | - Sergio Fajardo-Dueñas
- Department of Maternal-Fetal Medicine, Nuevo Hospital Civil de Guadalajara "Dr. Juan I. Menchaca", Guadalajara, Mexico
| |
Collapse
|
3
|
Zambrano E, Reyes-Múgica M. Pediatric germ cell tumors. Semin Diagn Pathol 2023; 40:52-62. [PMID: 36127222 DOI: 10.1053/j.semdp.2022.09.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Accepted: 09/07/2022] [Indexed: 02/04/2023]
Affiliation(s)
- Eduardo Zambrano
- Department of Pathology, University of Pittsburgh School of Medicine, UPMC Children's Hospital of Pittsburgh, 4401 Penn Avenue, B-260, Pittsburgh, PA, 15224, USA
| | - Miguel Reyes-Múgica
- Department of Pathology, University of Pittsburgh School of Medicine, UPMC Children's Hospital of Pittsburgh, 4401 Penn Avenue, B-260, Pittsburgh, PA, 15224, USA.
| |
Collapse
|
4
|
Mayer M, Delgado A, Kokose B, Kopolo M, Notununu N, Mntonintshi E, Dhlomo N, Namugenyi K, Mdunge S. Outcome of a large cervicofacial teratoma diagnosed at birth. JOURNAL OF PEDIATRIC SURGERY CASE REPORTS 2022. [DOI: 10.1016/j.epsc.2022.102396] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022] Open
|
5
|
Joseph R, Abdoun O, Abdelrahim EM, Babiker AK, Mohammed AH. Congenital Epignathus Associated With a Tricuspid Incompetence. Cureus 2022; 14:e27135. [PMID: 36017281 PMCID: PMC9392956 DOI: 10.7759/cureus.27135] [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] [Accepted: 07/21/2022] [Indexed: 11/25/2022] Open
Abstract
Teratomas are germinal cell neoplasms containing tissues from all germinal layers (ectoderm, mesoderm, and endoderm); however, they may show varying stages of maturity. We present a case of a 10-month-old Sudanese male patient who presented to the Khartoum Teaching Dental Hospital with a tumor occupying the hard palate since birth, causing reduced oral intake and failure to thrive. CT images showed soft and hard tissue masses originating from the hard palate and extending to the oral cavity. The treatment was initiated with nutritional support and consultation with pediatric physicians. The oral teratoma was successfully treated with surgery. The patient was regularly followed up and he fully recovered eventually.
Collapse
|
6
|
Hall J, Aly FZ, Comer J, Gebhard MP, Schrepfer T. A Rare Case of Ectopic Colonic Mucosa Presenting With Airway Compromise in a Neonate. Cureus 2022; 14:e27031. [PMID: 35989776 PMCID: PMC9388194 DOI: 10.7759/cureus.27031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/30/2022] [Indexed: 11/05/2022] Open
|
7
|
Srikanthan A, Scott S, Desai V, Reichert L. Neonatal Airway Abnormalities. CHILDREN 2022; 9:children9070944. [PMID: 35883928 PMCID: PMC9322467 DOI: 10.3390/children9070944] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Revised: 06/14/2022] [Accepted: 06/18/2022] [Indexed: 02/03/2023]
Abstract
Neonatal airway abnormalities are commonly encountered by the neonatologist, general pediatrician, maternal fetal medicine specialist, and otolaryngologist. This review article discusses common and rare anomalies that may be encountered, along with discussion of embryology, workup, and treatment. This article aims to provide a broad overview of neonatal airway anomalies to arm those caring for these children with a broad differential diagnosis and basic knowledge of how to manage basic and complex presentations.
Collapse
Affiliation(s)
| | - Samantha Scott
- Albany Medical College, Albany, NY 12208, USA; (A.S.); (S.S.); (V.D.)
| | - Vilok Desai
- Albany Medical College, Albany, NY 12208, USA; (A.S.); (S.S.); (V.D.)
- Department of Otolaryngology, Albany Medical Center, Albany, NY 12208, USA
| | - Lara Reichert
- Albany Medical College, Albany, NY 12208, USA; (A.S.); (S.S.); (V.D.)
- Department of Otolaryngology, Albany Medical Center, Albany, NY 12208, USA
- Correspondence:
| |
Collapse
|
8
|
Quinn K, Gilna GP, Chamyan G, Tirado Y, Carrillo Iregui A, Khatib Z, Fernandez-Castro C, Reyes C, Brady AC, Hogan AR, Thorson CM. Ex Utero Intrapartum Treatment procedure for congenital cervical germ cell tumor. JOURNAL OF PEDIATRIC SURGERY CASE REPORTS 2021. [DOI: 10.1016/j.epsc.2021.102004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
|
9
|
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.
Collapse
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
| |
Collapse
|
10
|
Shah R, Weil BR, Weldon CB, Amatruda JF, Frazier AL. Neonatal Malignant Disorders: Germ Cell Tumors. Clin Perinatol 2021; 48:147-165. [PMID: 33583501 DOI: 10.1016/j.clp.2020.11.010] [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: 11/28/2022]
Abstract
Germ cell tumors (GCTs) comprise a wide spectrum of benign and malignant tumors. Neonatal GCTs are predominantly teratomas (mature or immature), which are typically cured with surgery alone. Relapses are infrequent even in the setting of microscopic residual disease; therefore, negative surgical margins at the cost of significant morbidity are not recommended. In neonates with metastatic malignant disease or malignant disease for which upfront surgical resection is not feasible without significant morbidity, an initial biopsy followed by neoadjuvant chemotherapy and delayed surgical resection is recommended. Carboplatin-based regimens should be considered when chemotherapy is indicated.
Collapse
Affiliation(s)
- Rachana Shah
- Division of Oncology, Department of Pediatrics, Cancer and Blood Disease Institute, Children's Hospital Los Angeles, University of Southern California, Keck School of Medicine, 4650 Sunset Boulevard, MS#54, Los Angeles, CA 90027, USA.
| | - Brent R Weil
- Department of Surgery, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA; Department of Pediatric Oncology, Children's Cancer and Blood Disorders Center, Children's Hospital Dana-Farber Cancer Center, Harvard Medical School, 450 Brookline Avenue, Boston, MA 02215, USA
| | - Christopher B Weldon
- Department of Surgery, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA; Department of Pediatric Oncology, Children's Cancer and Blood Disorders Center, Children's Hospital Dana-Farber Cancer Center, Harvard Medical School, 450 Brookline Avenue, Boston, MA 02215, USA
| | - James F Amatruda
- Division of Oncology, Department of Pediatrics, Cancer and Blood Disease Institute, Children's Hospital Los Angeles, University of Southern California, Keck School of Medicine, 4650 Sunset Boulevard, MS#54, Los Angeles, CA 90027, USA
| | - A Lindsay Frazier
- Department of Pediatric Oncology, Children's Cancer and Blood Disorders Center, Children's Hospital Dana-Farber Cancer Center, Harvard Medical School, 450 Brookline Avenue, Boston, MA 02215, USA
| |
Collapse
|
11
|
Shamshirsaz AA, Aalipour S, Stewart KA, Nassr AA, Furtun BY, Erfani H, Sundgren NC, Cortes MS, Donepudi RV, Lee TC, Mehta DK, Kravitz ES, Asl NM, Espinoza J, Belfort MA. Perinatal characteristics and early childhood follow up after ex-utero intrapartum treatment for head and neck teratomas by prenatal diagnosis. Prenat Diagn 2021; 41:497-504. [PMID: 33386645 DOI: 10.1002/pd.5894] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Revised: 11/09/2020] [Accepted: 12/14/2020] [Indexed: 12/13/2022]
Abstract
BACKGROUND Ex utero intrapartum treatment (EXIT) is utilized for safe delivery when a baby has a compromised airway. The purpose of this retrospective study was to examine the indications and outcomes of 11 children presenting with airway occluding oropharyngeal and cervical teratomas. METHODS Study of all children with an airway occluding teratoma delivered via EXIT (2001-2018) in our unit. Primary outcomes included survival and tracheostomy at discharge. Data are reported using descriptive statistics as median (range) and rate (%). RESULTS We performed 45 EXIT procedure performed between January 2001 and April 2018. Of these, eleven were for cervical and/or upper airway teratoma. Ten (91%) cases had associated polyhydramnios, two (18%) developed nonimmune hydrops, and eight (72%) delivered preterm. Six (45.5%) were performed as an emergency. Estimated blood loss was 1000 ml (500, 1000). The neonatal mortality rate was 18% (2/11) and 33% (3/9) of the survivors were discharged with a tracheostomy. CONCLUSION EXIT is a reasonable option for delivery of babies with an occlusive upper airway mass. Neonatal survival depends on individualized factors but may be as high as 82% in those with teratoma.
Collapse
Affiliation(s)
- Alireza A Shamshirsaz
- Division of Fetal Therapy and Surgery, Department of Obstetrics and Gynecology, Baylor College of Medicine and Texas Children's Hospital, Houston, Texas, USA
| | - Soroush Aalipour
- Division of Fetal Therapy and Surgery, Department of Obstetrics and Gynecology, Baylor College of Medicine and Texas Children's Hospital, Houston, Texas, USA
| | - Kelsey A Stewart
- Department of Obstetrics and Gynecology, University of Minnesota, Minneapolis, Minnesota, USA
| | - Ahmed A Nassr
- Division of Fetal Therapy and Surgery, Department of Obstetrics and Gynecology, Baylor College of Medicine and Texas Children's Hospital, Houston, Texas, USA.,Department of Obstetrics and Gynecology, Women's Health Hospital, Assiut University, Egypt
| | - Betul Y Furtun
- Division of Pediatric Cardiology, Department of Pediatrics, Baylor College of Medicine and Texas Children's Hospital, Houston, Texas, USA
| | - Hadi Erfani
- Division of Fetal Therapy and Surgery, Department of Obstetrics and Gynecology, Baylor College of Medicine and Texas Children's Hospital, Houston, Texas, USA
| | - Nathan C Sundgren
- Division of Neonatology, Department of Pediatrics, Baylor College of Medicine and Texas Children's Hospital, Houston, Texas, USA
| | - Magdalena S Cortes
- Division of Fetal Therapy and Surgery, Department of Obstetrics and Gynecology, Baylor College of Medicine and Texas Children's Hospital, Houston, Texas, USA
| | - Roopali V Donepudi
- Division of Fetal Therapy and Surgery, Department of Obstetrics and Gynecology, Baylor College of Medicine and Texas Children's Hospital, Houston, Texas, USA
| | - Timothy C Lee
- Division of Pediatric Surgery, Department of Surgery, Baylor College of Medicine and Texas Children's Hospital, Houston, Texas, USA
| | - Deepak K Mehta
- Department of Otolaryngology-Head and Neck Surgery, Baylor College of Medicine and Texas Children's Hospital, Houston, Texas, USA
| | - Elizabeth S Kravitz
- Division of Fetal Therapy and Surgery, Department of Obstetrics and Gynecology, Baylor College of Medicine and Texas Children's Hospital, Houston, Texas, USA
| | - Nazli M Asl
- Division of Fetal Therapy and Surgery, Department of Obstetrics and Gynecology, Baylor College of Medicine and Texas Children's Hospital, Houston, Texas, USA
| | - Jimmy Espinoza
- Division of Fetal Therapy and Surgery, Department of Obstetrics and Gynecology, Baylor College of Medicine and Texas Children's Hospital, Houston, Texas, USA
| | - Michael A Belfort
- Division of Fetal Therapy and Surgery, Department of Obstetrics and Gynecology, Baylor College of Medicine and Texas Children's Hospital, Houston, Texas, USA
| |
Collapse
|
12
|
Kapoor A, Kapoor A, Kapoor R, Kapoor A, Kapoor S. Prenatal Sonographic and MRI Assessment of Early Fetal Neck Immature Teratoma. JOURNAL OF FETAL MEDICINE 2021. [DOI: 10.1007/s40556-020-00272-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
|
13
|
Endonasal Transpterygoid Surgery for Adult Mature Teratoma in the Sphenoid Bone. J Craniofac Surg 2020; 32:e12-e14. [PMID: 32833816 DOI: 10.1097/scs.0000000000006884] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
ABSTRACT Teratomas are germline tumors commonly composed of multiple cell types derived from embryonic germ cell layers. Teratomas in head and neck region are exceptionally rare and present during the neonatal and infantile period. We describe a male adult with a mature teratoma originating from sphenoid body. A 24-year-old male patient presented with left-sided intermitted headache and facial numbness. Radiographic imaging showed a 3 cm × 2.3 cm mass with heterogeneous density in the sphenoid region. The endoscopic sphenoid sinus opening surgery was performed through endonasal transpterygoid approach. The final pathologic diagnosis was confirmed as mature teratoma. The patient has been followed-up for 18 months without recurrence. We suggest endonasal transpterygoid approach could be an effective and safe treatment for patients with mature teratoma in the sphenoid bone.
Collapse
|
14
|
Niedzielski A, Marciniak A, Markiewicz M, Mielnik-Niedzielska G. Pharyngeal teratomas in children. JOURNAL OF PEDIATRIC SURGERY CASE REPORTS 2020. [DOI: 10.1016/j.epsc.2020.101395] [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
|
15
|
Garg V, Singhal R, Ratre B, Deganwa M. Oral teratoma in a neonate: A case report of anesthetic challenge. Saudi J Anaesth 2020; 14:520-523. [PMID: 33447198 PMCID: PMC7796743 DOI: 10.4103/sja.sja_299_20] [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: 04/09/2020] [Accepted: 04/27/2020] [Indexed: 11/13/2022] Open
Abstract
Congenital teratoma of oral cavity in a neonate is a rare condition associated with compromised airway and challenges anesthesiologist in airway management. In this report, we describe a scenario of neonate with multiple oral teratoma, cleft palate, and bifid tongue who presented with respiratory distress for surgical excision of mass. The compromised airway can be successfully managed by appropriate prior planning and effective communication between anesthesiologist and surgical team.
Collapse
|
16
|
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
| |
Collapse
|
17
|
Masmejan S, Baud D, Ryan G, Van Mieghem T. Management of fetal tumors. Best Pract Res Clin Obstet Gynaecol 2019; 58:107-120. [PMID: 30770283 DOI: 10.1016/j.bpobgyn.2019.01.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2018] [Revised: 01/07/2019] [Accepted: 01/08/2019] [Indexed: 12/28/2022]
Abstract
In this review article, we discuss the most common fetal tumors, their prenatal management, and outcomes. Overall, the most important outcome predictors are tumor histology, size, vascularity, and location. Very large lesions, lesions causing cardiac failure, and hydrops and lesions obstructing the fetal airway have the poorest outcome, as they may cause fetal death or complications at the time of delivery. Fetal therapy has been developed to improve outcomes for the most severe cases and can consist of transplacental therapy (sirolimus for rhabdomyomas or steroids for hemangiomas and microcystic lung lesions) or surgical intervention (shunting of cystic masses, tumor ablation, occlusion of blood flow or airway exploration, and protection). Given the rarity of fetal tumors, patients should be referred to expert centers where care can be optimized and individualized to allow the best possible outcomes.
Collapse
Affiliation(s)
- Sophie Masmejan
- Fetal Medicine Unit, Department of Obstetrics and Gynaecology, Mount Sinai Hospital and University of Toronto, Toronto, Canada; Obstetrics Unit, Mother-Child Department, University Hospital Lausanne, Switzerland
| | - David Baud
- Obstetrics Unit, Mother-Child Department, University Hospital Lausanne, Switzerland
| | - Greg Ryan
- Fetal Medicine Unit, Department of Obstetrics and Gynaecology, Mount Sinai Hospital and University of Toronto, Toronto, Canada
| | - Tim Van Mieghem
- Fetal Medicine Unit, Department of Obstetrics and Gynaecology, Mount Sinai Hospital and University of Toronto, Toronto, Canada.
| |
Collapse
|
18
|
Diagnosis and Surgical Management of Congenital Intranasal Teratoma in a Newborn: A Rare Case Report. Case Rep Otolaryngol 2018; 2018:1403912. [PMID: 29850332 PMCID: PMC5933031 DOI: 10.1155/2018/1403912] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2018] [Revised: 03/26/2018] [Accepted: 04/04/2018] [Indexed: 12/28/2022] Open
Abstract
Teratomas are the most common germ cell tumors of childhood. Head and neck teratomas, however, account for less than five percent of all teratomas. Considered rare at an incidence of 1 in 20,000 to 40,000 live births, they may occur in the cervical region, nasopharynx, brain, orbit, or oropharynx. Teratoma presenting as an isolated intranasal mass is extremely rare. In this report, we describe a case of a mature teratoma arising from the roof of the nasal cavity presenting as an isolated intranasal mass, the first of its kind from our literature review. The tumor was resected endoscopically with no recurrence detected.
Collapse
|
19
|
Wolter NE, Siegele B, Cunningham MJ. Cystic cervical teratoma: A diagnostic and management challenge. Int J Pediatr Otorhinolaryngol 2017; 95:97-100. [PMID: 28576544 DOI: 10.1016/j.ijporl.2017.02.016] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2016] [Revised: 02/08/2017] [Accepted: 02/11/2017] [Indexed: 02/07/2023]
Abstract
Cervical teratomas are relatively rare congenital tumors pathologically defined by their three germ cell layer composition. Classically they manifest as solid or mixed solid-cystic lesions. Purely cystic teratomas pose a diagnostic challenge due to their clinical and radiologic similarity to lymphatic vascular malformations. Sclerotherapy, rather than operative excision, may be offered as therapy. We present an unusual cystic neck mass to highlight this dilemma.
Collapse
Affiliation(s)
- Nikolaus E Wolter
- Department of Otolaryngology and Communication Enhancement, Boston Children's Hospital, Boston, MA, USA.
| | - Bradford Siegele
- Department of Pathology, Boston Children's Hospital, Boston, MA, USA
| | - Michael J Cunningham
- Department of Otolaryngology and Communication Enhancement, Boston Children's Hospital, Boston, MA, USA; Department of Otolaryngology, Harvard Medical School, Boston, MA, USA
| |
Collapse
|
20
|
Sequence of Surgical Reconstruction in a Child With Cleft Lip and Palate Associated With Congenital Facial Teratomas. J Craniofac Surg 2017; 28:1030-1034. [PMID: 28207469 DOI: 10.1097/scs.0000000000003536] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
We describe a case of left homolateral complete cleft lip/palate associated with a congenital left maxillary teratoma and left orbital teratoma. The patient required step-by-step reconstruction that first included resection of the 2 teratomas in consideration of cleft lip repair, cleft palate repair, and correction of the left periorbital anomalies, which were performed later. After performing all the necessary procedures, complete resection of the tumors and correction of the anomalies associated with the lip, palate, and left orbit were achieved. The rare occurrence of this type of association and its devastating effect on a patient's growth, aesthetics, and function of craniofacial elements require careful surgical planning to enable restoration of the anatomy and proper functional development. At follow-up, the patient showed significant improvement in the functional and aesthetic aspects.
Collapse
|
21
|
Abstract
A cleft palate results from incomplete fusion of the lateral palatine processes, the median nasal septum and the median palatine process. This case report describes a rare case of congenital teratoma originating from the nasal septum that may have interfered with the fusion of the palatal shelves during embryonic development, resulting in a cleft palate. An infant girl was born at 40 weeks of gestation weighing 3020 g with a complete cleft palate associated with a large central nasopharyngeal tumour. Computed tomography (CT) of the head showed a well defined mass of mixed density. The tumour was attached to the nasal septum in direct contact with the cleft palate. A biopsy confirmed the teratoma. Tumour resection was performed at 5 months, soft palate reconstruction at 7 months and hard palate closure at 14 months. There was no sign of local recurrence 1 year later. Most teratomas are benign and the prognosis is usually good. However, recurrence is not rare if germ cell carcinomatous foci are present within the teratoma. For these reasons, we advocate the use of a two-stage procedure in which closure of the cleft palate is postponed until histological examination confirms complete excision of the teratoma.
Collapse
Affiliation(s)
- Alexis Veyssière
- a Department of Maxillofacial and Plastic Surgery , Caen University Hospital , France>
| | - Libor Streit
- b Department of Plastic and Aesthetic Surgery , St Anne University Hospital , Brno , Czech Republic
| | - Hamady Traoré
- a Department of Maxillofacial and Plastic Surgery , Caen University Hospital , France>
| | - Hervé Bénateau
- a Department of Maxillofacial and Plastic Surgery , Caen University Hospital , France>
| |
Collapse
|
22
|
Abstract
Cervical teratomas are rare germ cell tumors affecting the fetus that are associated with significant morbidity and mortality due to an increased risk of airway obstruction at delivery. These tumors can commonly produce polyhydramnios that results from the fetus' impaired ability to swallow amniotic fluid. Improved rates of prenatal diagnosis through comprehensive evaluations and imaging have dramatically impacted the perinatal management of infants with this condition. Here, we report a patient diagnosed with polyhydramnios whose fetus was discovered to have a giant cervical teratoma on imaging studies. The child underwent surgical resection after having the airway secured under the uteroplacental support as part of an ex utero intrapartum treatment procedure performed at 37 weeks. The following gross pathological and magnetic resonance images demonstrate this condition and its currently accepted treatment.
Collapse
|
23
|
Peiró JL, Sbragia L, Scorletti F, Lim FY, Shaaban A. Management of fetal teratomas. Pediatr Surg Int 2016; 32:635-47. [PMID: 27112491 DOI: 10.1007/s00383-016-3892-3] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/31/2016] [Indexed: 10/21/2022]
Abstract
Fetal teratomas are the most common tumors diagnosed prenatally. The majority of these tumors are benign and cured by complete resection of the mass during the neonatal period. Prenatal diagnosis has improved the perinatal management of these lesions and especially for the teratomas that might benefit from fetal intervention. A comprehensive prenatal evaluation including conventional ultrasounds, Doppler, echocardiography and fetal MRI, is essential for an effective counseling and perinatal management. Antenatal counseling helps the parents to better understand the natural history, fetal intervention, and perinatal management of these tumors, which differ dramatically depending on their size and location. Fetal surgical debulking improves survival in cases of sacrococcygeal teratoma with cardiac decompensation. Additionally, the use of an EXIT procedure reduces the morbidity and mortality if a complicated delivery in cases of cervical and mediastinal teratomas. Here, we offer an overview of all fetal teratomas and their recommended management, with emphasis on in utero treatment options.
Collapse
Affiliation(s)
- Jose L Peiró
- Cincinnati Fetal Center, Pediatric General and Thoracic Surgery Division, Cincinnati Children's Hospital Medical Center (CCHMC), University of Cincinnati, 3333 Burnet Avenue, MLC 11025, Cincinnati, OH, 45229-3039, USA.
| | - Lourenço Sbragia
- Cincinnati Fetal Center, Pediatric General and Thoracic Surgery Division, Cincinnati Children's Hospital Medical Center (CCHMC), University of Cincinnati, 3333 Burnet Avenue, MLC 11025, Cincinnati, OH, 45229-3039, USA
| | - Federico Scorletti
- Cincinnati Fetal Center, Pediatric General and Thoracic Surgery Division, Cincinnati Children's Hospital Medical Center (CCHMC), University of Cincinnati, 3333 Burnet Avenue, MLC 11025, Cincinnati, OH, 45229-3039, USA
| | - Foong Y Lim
- Cincinnati Fetal Center, Pediatric General and Thoracic Surgery Division, Cincinnati Children's Hospital Medical Center (CCHMC), University of Cincinnati, 3333 Burnet Avenue, MLC 11025, Cincinnati, OH, 45229-3039, USA
| | - Aimen Shaaban
- Cincinnati Fetal Center, Pediatric General and Thoracic Surgery Division, Cincinnati Children's Hospital Medical Center (CCHMC), University of Cincinnati, 3333 Burnet Avenue, MLC 11025, Cincinnati, OH, 45229-3039, USA
| |
Collapse
|
24
|
Huge congenital cervical immature teratoma mimicking lymphatic malformation in a 7-day-old male neonate. JOURNAL OF PEDIATRIC SURGERY CASE REPORTS 2016. [DOI: 10.1016/j.epsc.2016.03.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
|
25
|
Abstract
For congenital teratomas, oropharyngeal cavity is one of the rarest sites (2% of all teratomas). They are rarely picked up by prenatal ultrasonography. Postnatally, newborns present with respiratory distress and at this point role of pediatricians is very crucial in establishing secure airway after which they need to be carefully evaluated and surgically managed. We present a female neonate with palatal teratoma which was treated successfully with surgery.
Collapse
Affiliation(s)
- Shreesh S Kolekar
- Department of Surgery, Krishna Institute of Medical Sciences, Karad, Maharastra, India
| | - Tejas Chincholi
- Department of Surgery, Krishna Institute of Medical Sciences, Karad, Maharastra, India
| | - Nitin Nangare
- Department of Surgery, Krishna Institute of Medical Sciences, Karad, Maharastra, India
| | - Ritvij Patankar
- Department of Surgery, Krishna Institute of Medical Sciences, Karad, Maharastra, India
| |
Collapse
|
26
|
Werner H, Lopes J, Belmonte S, Ribeiro G, Araujo Júnior E. Virtual bronchoscopy through the fetal airways in a case of cervical teratoma using magnetic resonance imaging data. Congenit Anom (Kyoto) 2016; 56:46-7. [PMID: 26754467 DOI: 10.1111/cga.12131] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2015] [Accepted: 08/31/2015] [Indexed: 11/28/2022]
Affiliation(s)
- Heron Werner
- Radiologia, Clínica de Diagnóstico por Imagem (CPDI), Rio de Janeiro, RJ, Brazil
| | - Jorge Lopes
- Department of Arts & Design, Pontifícia Universidade Católica (PUC Rio), Rio de Janeiro, RJ, Brazil
| | - Simone Belmonte
- Department of Arts & Design, Pontifícia Universidade Católica (PUC Rio), Rio de Janeiro, RJ, Brazil
| | - Gerson Ribeiro
- Department of Arts & Design, Pontifícia Universidade Católica (PUC Rio), Rio de Janeiro, RJ, Brazil
| | - Edward Araujo Júnior
- Department of Obstetrics, São Paulo Federal University (UNIFESP), São Paulo, SP, Brazil
| |
Collapse
|
27
|
Surgical management of immature teratoma involving the oral cavity and orbit in a neonate. J Craniofac Surg 2015; 25:e578-80. [PMID: 25376141 DOI: 10.1097/scs.0000000000001171] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Teratomas are congenital germ cell tumors composed of elements from 1 or more of the embryonic germ layers and contain tissues usually foreign to the anatomic site of origin. In the head and neck region, these lesions are rare, and 90% of head and neck teratomas present during the neonatal and infantile periods. Besides, in neonates, it carries serious risk for respiratory distress as well as feeding problems due to oral cavity and airway obstruction.Here, an unusual case of intraoral teratoma involving the orbit in a newborn who underwent immediate surgical excision successfully is described.
Collapse
|
28
|
Bhalla VK, Beatty J, Harper JG, Biddinger P, Pipkin WL. Pseudostratified Epithelium and Gastric-type Oxyntic Mucosa Present on a Mature Cystic Teratoma of the Scapula: A First Report. Am Surg 2014. [DOI: 10.1177/000313481408000812] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Varun K. Bhalla
- Department of General Surgery Georgia Regents University Augusta, Georgia
| | - John Beatty
- Department of General Surgery Georgia Regents University Augusta, Georgia
| | | | - Paul Biddinger
- Department of Pathology Georgia Regents University Augusta, Georgia
| | - Walter L. Pipkin
- Division of Pediatric Surgery Georgia Regents University Augusta, Georgia
| |
Collapse
|
29
|
Manjuladevi M, Kilpadi KA, Jose J, Kothari A. Missed nasopharyngeal teratoma: A cause for recurrent respiratory distress in a neonate. Indian J Anaesth 2014; 58:338-41. [PMID: 25024484 PMCID: PMC4091007 DOI: 10.4103/0019-5049.135079] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Affiliation(s)
- M Manjuladevi
- Department of Anesthesia and Critical Care, St. John's Medical College and Hospital, Bengaluru, Karnataka, India
| | - Kshma A Kilpadi
- Department of Anesthesia and Critical Care, St. John's Medical College and Hospital, Bengaluru, Karnataka, India
| | - Jiby Jose
- Department of Anesthesia and Critical Care, St. John's Medical College and Hospital, Bengaluru, Karnataka, India
| | - Apoorwa Kothari
- Department of Anesthesia and Critical Care, St. John's Medical College and Hospital, Bengaluru, Karnataka, India
| |
Collapse
|
30
|
Barthod G, Teissier N, Bellarbi N, Viala P, Oury JF, Dray G, Vuillard E, Michel J, Van Den Abbeele T. Fetal airway management on placental support: limitations and ethical considerations in seven cases. J OBSTET GYNAECOL 2014; 33:787-94. [PMID: 24219714 DOI: 10.3109/01443615.2013.823924] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
The aim of this study was to evaluate the paediatric and maternal outcome after ex utero intrapartum treatment (EXIT). A retrospective review was carried out of the medical charts (gestational age, circumstances of diagnosis, multidisciplinary prenatal decision, date of surgery, paediatric and maternal outcome) of all the fetuses eligible for/delivered via the EXIT procedure in our paediatrics and obstetrics tertiary care and teaching centre, between October 2004 and May 2011. Seven fetuses with cervical teratoma, epignathus tumour or congenital high airway obstruction syndrome (CHAOS) were included in our study. Two pregnancies were terminated and five fetuses were delivered alive. The airway was secured in all five cases (two endotracheal intubations and three tracheostomies). No maternal complications were observed. On average, babies were delivered at 32 gestational weeks, and spent 31 days in the intensive care unit. All but one baby were ventilated for 18 days. Long-term paediatric outcome was favourable. It is concluded that airway management by the EXIT procedure has become an efficient technique. A multidisciplinary prenatal assessment is essential in order to select appropriate cases.
Collapse
Affiliation(s)
- G Barthod
- Department of Paediatric ENT, Robert Debré Hospital, AP-HP, Paris VII University Denis Diderot , Sorbonne Paris Cité
| | | | | | | | | | | | | | | | | |
Collapse
|
31
|
Sahoo NK, Choudhary AK, Srinivas V, Kapil Tomar. Dermoid cysts of maxillofacial region. Med J Armed Forces India 2014; 71:S389-94. [PMID: 26843755 DOI: 10.1016/j.mjafi.2013.11.004] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2012] [Accepted: 11/23/2013] [Indexed: 11/16/2022] Open
Abstract
The dermoid cyst is an uncommon clinicopathological lesion of developmental origin. The term dermoid cyst is used to describe 3 cysts that are closely related histologically: dermoid cyst, epidermoid cyst, and teratoma. Epidermoid and dermoid cysts are benign nature, which may occur anywhere in the body, but most predominantly in the ovary and scrotal regions. Only about 7% are found in the head and neck. The occurrence of such cysts in the oral cavity is extremely rare, with approximately 1.6% located in this area. The floor of the mouth is one of the most commonly affected area, however, these cysts can also be found in the tongue, lips, buccal mucosa and jaw bones. There is always a difficulty of making a correct diagnosis of these lesions with clinical examinations and conventional radiography. To achieve a diagnosis and to develop correct surgical strategy specialized imaging examinations such as ultrasonography (US), computed tomography (CT), Magnetic Resonance Imaging (MRI) and histopathological examination should be carried out. Treatment comprises total surgical excision the approach remains dictated logically by the cyst's location. Ample understanding and vigilance about this slow growing painless mass is essential not only because of the symptoms it produces but also due to its malignant potential. When dermoid cysts occur on the floor of the mouth, they may enlarge to such an extent that they can interfere with deglutition and produce respiratory obstruction. Early diagnosis and treatment are essential for these cystic entities.
Collapse
Affiliation(s)
- N K Sahoo
- Professor & Head, Dept of Dental Surgery, Armed Forces Medical College, Pune 411040, India
| | - A K Choudhary
- Graded Specialist (Oral & Maxillofacial Surgery), 1 Corps Dental Unit, C/o 56 APO, India
| | - V Srinivas
- Professor & Head, Dept of Pathology, Armed Forces Medical College, Pune 411040, India
| | - Kapil Tomar
- Graded Specialist (Oral & Maxillofacial Surgery), NIDS, Mumbai, India
| |
Collapse
|
32
|
Taghavi K, Beasley S. The ex utero intrapartum treatment (EXIT) procedure: application of a new therapeutic paradigm. J Paediatr Child Health 2013; 49:E420-7. [PMID: 23662685 DOI: 10.1111/jpc.12223] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/09/2012] [Indexed: 12/15/2022]
Abstract
The ex utero intrapartum treatment (EXIT) procedure is a term given to a technique that can transform a potentially fatal neonatal emergency to a controlled intervention with an improved outcome. It has revolutionised the care of prenatally diagnosed congenital malformations in which severe upper airway obstruction is anticipated. An extended period of utero-placental circulation can be utilised to avoid profound cardiopulmonary compromise. Its therapeutic applications have been broadened to include fetuses with congenital diaphragmatic hernia after tracheal plugging, high-risk intrathoracic masses, severe cardiac malformations and conjoined twins. It requires the co-ordination of a highly skilled and experienced multidisciplinary team. The recent enthusiasm for the EXIT procedure needs to be balanced against maternal morbidity. Specific indications and guidelines are likely to be refined as a consequence of ongoing advances in fetal intervention and antenatal imaging.
Collapse
|
33
|
Multidisciplinary examination for prenatal diagnosis of posterior cervical teratoma in early second trimester. Taiwan J Obstet Gynecol 2013; 52:270-2. [PMID: 23915864 DOI: 10.1016/j.tjog.2013.04.021] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/09/2011] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVE Cervical teratomas represent approximately 3% of all congenital teratomas, which occur in approximately 1 in 20,000-40,000 live births. In this report, we present a case of congenital posterior cervical teratoma diagnosed by a two-dimensional (2D) ultrasound in the early second trimester. CASE REPORT A 28-year-old woman, gravid 1, para 0, came to our prenatal clinic at 20 weeks of gestation for her first prenatal visit. Results of an ultrasound revealed a fetus with multiple cystic septal mass with internally calcified spots measuring approximately 3 cm over the left fetal neck. Because no other abnormality was noted at that time, magnetic resonance imaging (MRI) and amniocentesis were scheduled on the following day. At the same time, results of a 4D ultrasound revealed the mass size to be same as that measured by the 2D ultrasound; however, the location was defined on the left posterior neck and MRI showed there was no invasion to the intracranial area. The parents opted to continue the pregnancy. In the following prenatal cares, no polyhydramnios was found and the fetal body weight was within the normal growth curve. The baby was delivered by cesarean section at 38 weeks of gestation with Apgar scores of 8 (at 1 minute) and 9 (at 5 minutes). The baby was scheduled for surgical intervention 3 days after birth. Finally, results of a pathological analysis revealed the mass to be a benign cystic teratoma. CONCLUSION Prenatal diagnosis of cervical teratoma is very crucial, allowing early detection of masses that obstruct the airway. Therefore, a multidisciplinary examination and follow-up are recommended for early prenatal diagnosis.
Collapse
|
34
|
Werner H, Lopes dos Santos JR, Fontes R, Belmonte S, Daltro P, Gasparetto E, Marchiori E, Campbell S. Virtual bronchoscopy for evaluating cervical tumors of the fetus. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2013; 41:90-94. [PMID: 22461324 DOI: 10.1002/uog.11162] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 03/21/2012] [Indexed: 05/31/2023]
Abstract
We report on four cases of fetal cervical tumor, comprising three lymphangiomas and one teratoma, evaluated by ultrasound and magnetic resonance imaging (MRI) between 26 and 37 weeks' gestation. The aim was to investigate the use of virtual bronchoscopy to evaluate fetal airway patency in each case. A three-dimensional (3D) model of the airway was created from overlapping image layers generated by MRI. The files obtained were manipulated using 3D modeling software, allowing the virtual positioning of observation cameras, adjustment of lighting parameters and creation of simulated 3D movies for analysis of a virtual path through the model. In all fetuses, fetal airway patency was clearly demonstrated by virtual bronchoscopy and this was confirmed postnatally. MRI with virtual bronchoscopy could become a useful tool for studying fetal airway patency in cases of cervical tumor.
Collapse
Affiliation(s)
- H Werner
- Clínica de Diagnóstico por Imagem, Rio de Janeiro, Brazil.
| | | | | | | | | | | | | | | |
Collapse
|
35
|
Abstract
Germ cell tumors (GCTs) arise from the 'germline' - the primordial germ cells which are destined to become either the egg or the sperm. GCTs can be challenging to understand because their intrinsic pluripotency results in a wide spectrum of histologies and biologic behaviors. However, the histology of GCTs in the fetus and neonate is more restricted and the clinical spectrum more narrow than when these tumors occur later in life. GCTs in the fetus and neonate are predominately mature and immature teratomas, usually curable with surgery alone. And, given the efficacy of cisplatin-based regimens in GCTs, cure is likely even for those patients whose tumors contain the more malignant histologies, which in the neonate is usually yolk sac tumor. Recent advances in understanding the underlying aberrations in germline development continue to shed light on the genesis of these tumors and possible new avenues for treatment.
Collapse
Affiliation(s)
- A Lindsay Frazier
- Harvard Medical School, Department of Pediatric Oncology, Children's Hospital Dana-Farber Cancer Care, Boston MA 02115, USA.
| | - Christopher Weldon
- Harvard Medical School, Children's Hospital Dana-Farber Cancer Care, Boston MA 02115, USA
| | | |
Collapse
|
36
|
Cleft palate associated with cervico-facial teratoma: report of two cases and review of the literature. Int J Pediatr Otorhinolaryngol 2012; 76:1225-7. [PMID: 22673350 DOI: 10.1016/j.ijporl.2012.05.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2012] [Revised: 05/07/2012] [Accepted: 05/11/2012] [Indexed: 11/23/2022]
Abstract
We report two original cases of association of cleft palate and lateral cervico-facial teratoma. We discuss the embryological explanation. The first child presented a cleft palate associated with two cervico-facial localisations of teratoma. The other had Pierre Robin sequence associated with lateropharyngeal teratoma with an extra sub maxillary localisation. Most reported cases were of midline teratomas, leading different authors to advance a mechanical origin to the cleft. Our cases are different: we could hardly find reported cases of associate lateral tumours and cleft palate, which would suggest two different embryologic mechanisms, or at least a combination of more complicated phenomenons.
Collapse
|
37
|
Abstract
Teratomas are the benign tumours, which may occur anywhere in the body. Development of these lesions in the oral cavity is extremely rare. In the oral cavity, they usually arise in the midline, in the floor of mouth. Infrequently, they may be seen in the tongue proper. We hereby, present a case of swelling tongue in 56 years female diagnosed as teratoma.
Collapse
Affiliation(s)
- S Gupta
- Pandit Bhagwat Dayal Sharma Post Graduate Institute of Medical Sciences. Haryana, India
| | - S Singh
- Pandit Bhagwat Dayal Sharma Post Graduate Institute of Medical Sciences. Haryana, India
| | - M Gill
- Pandit Bhagwat Dayal Sharma Post Graduate Institute of Medical Sciences. Haryana, India
| | - R Goyal
- Pandit Bhagwat Dayal Sharma Post Graduate Institute of Medical Sciences. Haryana, India
| | - S Hasija
- Pandit Bhagwat Dayal Sharma Post Graduate Institute of Medical Sciences. Haryana, India
| | - R Sen
- Pandit Bhagwat Dayal Sharma Post Graduate Institute of Medical Sciences. Haryana, India
| |
Collapse
|
38
|
Abstract
Pediatric germ cell tumors represent a diverse group of tumors that present from in utero through adolescence at many nongonadal locations, from the neck to the sacrococcygeal region. Surgical resection remains the central element of management, and accurate surgical staging is essential to properly ascertain the correct risk-based treatment. The management for all benign tumors (mature and immature teratomas) and select completely resectable malignant tumors is surgery alone. Modern-day chemotherapy is extremely effective in infants and children with unresectable and metastatic disease and these children have a very high survival rate. The use of neoadjuvant chemotherapy allows vital organ preservation and there is no role for resection of vital structures at the time of initial presentation.
Collapse
Affiliation(s)
- Frederick J Rescorla
- Riley Hospital for Children, Indiana University School of Medicine, Indianapolis, Indiana, USA.
| |
Collapse
|
39
|
Massive Craniofacial Teratoma: A Case Report. J Oral Maxillofac Surg 2011; 69:e294-6. [DOI: 10.1016/j.joms.2011.02.123] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2011] [Revised: 02/18/2011] [Accepted: 02/18/2011] [Indexed: 11/19/2022]
|
40
|
Successful prenatal and perinatal management of a massive cervicofacial teratoma. J Med Ultrason (2001) 2011; 38:173-6. [DOI: 10.1007/s10396-011-0305-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2011] [Accepted: 03/20/2011] [Indexed: 10/18/2022]
|
41
|
Neidich MJ, Prager JD, Clark SL, Elluru RG. Comprehensive Airway Management of Neonatal Head and Neck Teratomas. Otolaryngol Head Neck Surg 2011; 144:257-61. [DOI: 10.1177/0194599810390012] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objectives. To determine the success of initial airway management and to characterize late airway-related complications in patients with airway obstruction due to congenital head and neck teratomas Study Design. Case series with chart review. Setting. Tertiary airway referral institution. Subjects and Methods. Review of consecutive patients with congenital head and neck teratomas from 1988 to 2010. Variables examined include initial airway stabilization at time of birth and perinatal airway management. Outcomes include short- and long-term complications. Results. Fourteen cases were reviewed. In 12 patients, initial airway management was accomplished on placental support with either intubation or tracheotomy. Two vaginal births required subsequent uncomplicated oral intubation within 24 hours. Nine patients required tracheotomy (3 within the delivery suite, 2 during mass excision on day of life 6 and 24, and the remaining 4 occurred at days 29, 32, 92, and 100). Five deaths occurred, 4 within several days of birth due to complications related to the cervical teratomas and 1 on day of life 32 due to an airway-related complication. Follow-up for surviving patients ranged from 1 month to 18 years. Long-term airway complications ranged from vocal cord paralysis to stenosis requiring laryngotracheoplasty. Conclusion. This study demonstrates that a multidisciplinary team and a standardized approach in the operating suite have led to successful initial airway stabilization. Furthermore, this study demonstrates the need for continued airway management after delivery. Reassessment of the airway after delivery and an airway management planning meeting with the multidisciplinary team may help decrease morbidity and mortality.
Collapse
Affiliation(s)
- Marci J. Neidich
- Department of Otolaryngology–Head and Neck Surgery, University of Cincinnati College of Medicine, and Division of Pediatric Otolaryngology, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
| | - Jeremy D. Prager
- Department of Otolaryngology–Head and Neck Surgery, University of Cincinnati College of Medicine, and Division of Pediatric Otolaryngology, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
| | - Stacey L. Clark
- Department of Otolaryngology–Head and Neck Surgery, University of Cincinnati College of Medicine, and Division of Pediatric Otolaryngology, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
| | - Ravindhra G. Elluru
- Department of Otolaryngology–Head and Neck Surgery, University of Cincinnati College of Medicine, and Division of Pediatric Otolaryngology, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
| |
Collapse
|
42
|
Huge maxillofacial teratomas. J Craniofac Surg 2010; 21:2014-7. [PMID: 21119489 DOI: 10.1097/scs.0b013e3181f5385c] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Teratomas arising from the head and neck are extremely rare. Sporadic reports in the literature mostly involve infant and young people. In this clinical report, we present a huge teratoma of the infratemporal fossa in an old patient. Current diagnosis and management approaches of this rare entity are described.
Collapse
|
43
|
Abstract
Teratomas belong to a class of tumors known as germ cell tumors. Cervical teratomas are rare and account for 1.5% to 5.5% of all pediatric teratomas. These types of tumors are the result of abnormal development of pluripotent cells. The following case study describes a 36-week male infant who was prenatally diagnosed with a large cervical mass. The neonate was delivered via the EXIT (ex utero intrapartum treatment) procedure, with expert teams present. After stabilization, the infant was transferred to the neonatal intensive care unit (NICU) at Children's Hospital Los Angeles. The teratoma was removed on day of life 5. The pathology report indicated a malignant germ cell tumor. A chemotherapy regimen was developed for this critically ill neonate in the NICU. An interdisciplinary treatment approach allowed safe and optimal quality of care. Baby CM was discharged on day of life 88 without complications and continues to be cancer free and at home thriving.
Collapse
|
44
|
Maartens IA, Wassenberg T, Halbertsma FJ, Marres HAM, Andriessen P. Neonatal airway obstruction caused by rapidly growing nasopharyngeal teratoma. Acta Paediatr 2009; 98:1852-4. [PMID: 19659708 DOI: 10.1111/j.1651-2227.2009.01458.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
UNLABELLED A case report is presented of a rapidly growing congenital nasopharyngeal teratoma (epignathus) in a preterm infant, leading to severe upper airway obstruction. Prenatal diagnosis by ultrasonography did not reveal the condition because the tumour masses were initially small and there was no polyhydramnios. Epignathus is a rare cause of upper airway obstruction of the newborn that can grow rapidly in the neonatal period and should be treated surgically. CONCLUSION Epignathus is a rare cause of upper airway obstruction of the newborn that can grow rapidly in the neonatal period.
Collapse
Affiliation(s)
- I A Maartens
- Neonatal Intensive Care Unit, Máxima Medical Centre, Veldhoven, The Netherlands
| | | | | | | | | |
Collapse
|
45
|
Wang L, Chen X, Liu B. Lower lip teratoma with ventral capillary malformation in an infant: case report and literature review. Int J Oral Maxillofac Surg 2009; 38:1330-3. [PMID: 19631510 DOI: 10.1016/j.ijom.2009.06.018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2008] [Revised: 03/04/2009] [Accepted: 06/24/2009] [Indexed: 10/20/2022]
Abstract
Teratomas are tumors that are derived from two or three of the primordial germ layers: ectoderm, mesoderm and endoderm. They arise most commonly in a midline or paraxial location from the brain to the sacral area and are most often located in the sacrococcygeal region. Head and neck teratomas are rare neoplasms and their incidence is 1 in 20,000-40,000 live births. 90% of head and neck teratomas present during the neonatal and infantile period, predominantly involve the neck and nasopharynx. Teratomas rarely originate from other superficial structures of the head. This paper describes an exceptionally unusual teratoma of the lip concomitant with a ventral capillary malformation.
Collapse
Affiliation(s)
- L Wang
- Key Laboratory for Oral Biomedical Engineering of Ministry of Education, School and Hospital of Stomatology, Wuhan University, Wuhan, Hubei, China
| | | | | |
Collapse
|
46
|
Ozeren S, Yüksel A, Altinok T, Yazgan A, Bilgiç R. Prenatal ultrasound diagnosis of a large epignathus. J OBSTET GYNAECOL 2009; 19:660-1. [PMID: 15512430 DOI: 10.1080/01443619964012] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
Affiliation(s)
- S Ozeren
- Department of Obstetrics and Gynaecology, Zeynep Kamil Maternity Hospital, Turkey.
| | | | | | | | | |
Collapse
|
47
|
Abstract
PURPOSE OF REVIEW Teratomas are rare neoplasms composed of tissue elements derived from the germinal layers of the embryo. Although they may originate anywhere along the midline, teratomas are most commonly found in sacrococcygeal, gonadal, mediastinal, retroperitoneal, cervicofacial and intracranial locations. Clinical behavior varies significantly by site and size. The presence of immature or premalignant elements may influence therapy and long-term outcome. This report reviews the current literature with regard to the diagnosis, management and outcome of teratomas in infants and children. RECENT FINDINGS Recently, large case series have further elucidated the biologic behavior and clinical course of these rare tumors. Emerging evidence indicates that age of diagnosis is an increasingly important prognostic feature independent of tumor location. Advances in imaging are facilitating earlier diagnosis and identification of patients at higher risk of adverse outcome. In select cases, fetal and early neonatal interventions are improving outcome and survival. SUMMARY Presenting symptoms may vary widely based on location; however, independent of primary location, definitive therapy for teratomas is complete surgical resection. Early diagnosis, timely intervention and meticulous follow-up are critical in the long-term favorable outcome.
Collapse
|
48
|
Johnson N, Shah PS, Shannon P, Campisi P, Windrim R. A Challenging Delivery by EXIT Procedure of a Fetus With a Giant Cervical Teratoma. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2009; 31:267-271. [DOI: 10.1016/s1701-2163(16)34126-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
|
49
|
Chen CP. Prenatal diagnosis, fetal surgery, recurrence risk and differential diagnosis of neural tube defects. Taiwan J Obstet Gynecol 2009; 47:283-90. [PMID: 18935990 DOI: 10.1016/s1028-4559(08)60125-4] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Prenatal screening with alpha-fetoprotein (AFP) and ultrasonography have allowed the prenatal diagnosis of neural tube defects (NTDs) in current obstetric care, and open spina bifida has been considered a potential candidate for in utero treatment in modern pediatric surgery. This article provides an overview of maternal serum AFP screening, amniotic fluid AFP assays, amniotic fluid acetylcholinesterase immunoassays and level II ultrasound for NTDs, prenatal repair of fetal myelomeningocele, recurrence risk of NTDs, and differential diagnosis of NTDs on prenatal ultrasound.
Collapse
Affiliation(s)
- Chih-Ping Chen
- Department of Obstetrics and Gynecology, Mackay Memorial Hospital, Taipei, Taiwan.
| |
Collapse
|
50
|
Al-Khateeb TH, Al Zoubi F. Congenital neck masses: a descriptive retrospective study of 252 cases. J Oral Maxillofac Surg 2007; 65:2242-7. [PMID: 17954320 DOI: 10.1016/j.joms.2006.11.039] [Citation(s) in RCA: 50] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2006] [Revised: 11/04/2006] [Accepted: 11/19/2006] [Indexed: 10/22/2022]
Abstract
PURPOSE This retrospective study was conducted to analyze congenital neck masses in Jordanians compared with international findings. PATIENTS AND METHODS The records of patients with congenital neck masses between 1991 and 2002 were retrieved from the Department of Pathology, Jordan University of Science and Technology, and analyzed for age, gender, location, clinical features, and treatment. RESULTS Within the 12-year period of the study, a total of 2,063 neck mass lesions were found; of these, 252 (12%) were congenital masses. These cases were distributed into 166 (66%) midline, 55 (22%) lateral, and 31 (12%) entire neck masses. The most frequent mass was thyroglossal duct cyst (fistulas) (53%), followed by cysts (fistulas) of the branchial apparatus (22%), dermoid cysts (11%), hemangiomas (7%), and 1ymphangiomas (6%). The majority of branchial arch anomalies (85%) were of the second arch. The mean age of patients was 16 years, with the greatest number of cases (38%) in the first decade. The male-to-female ratio was 1:1.2, with most lesions affecting females. The majority of lesions presented with painless neck swelling, and all lesions were surgically excised. CONCLUSIONS The overall frequency and age distribution of congenital neck masses in northern Jordanians are similar to international findings. However, the gender distribution and relative frequency of individual types of neck masses are somewhat different from those in other countries. These differences may be attributed to genetic and geographic differences.
Collapse
Affiliation(s)
- Taiseer Hussain Al-Khateeb
- Department of Oral Surgery and Medicine, Consultant in Oral and Maxillofacial Surgery, Jordan University of Science and Technology, Irbid, Jordan.
| | | |
Collapse
|