Teratomas of the head and neck

Neonatal Nasal Obstruction: A Comprehensive Analysis of Our 20 Years' Experience

Neonates are obligatory nasal breathers hence nasal obstruction is a very important symptom to be evaluated. Although causes can be trivial most of the time, they can be life-threatening in some. Respiratory distress immediately after birth, feeding difficulties, paradoxical cyanosis, and failure to thrive are the most evident symptoms, and determination of unilateral or bilateral involvement guides the rationale for elective or emergency intervention. This study aimed to evaluate the causes, presentation, and management of neonates with nasal obstruction. We collected the data of all the neonates evaluated for nasal obstruction at our hospital over the past 20 years from June 2003 to May 2023 and assessed the strategy of approach for diagnosis and management of those cases. In our study, the commonest cause for neonatal nasal obstruction was found to be choanal atresia and the rarest was iatrogenic. A variety of other causes were also reported. As neonatal nasal obstruction has a multitude of rare causes each carries a unique assessment and treatment plan. History taking and clinical examination are the most important parts of evaluation including endoscopic evaluation in an office-based setup. Imaging studies add to the evaluation of cases of anatomical obstructions and associated anomalies (syndromes). Early diagnosis and swift intervention can be life-saving. The need for follow-up visits and second-stage corrections should be emphasized in getting the best long-term results.

An Unusual Lesion of Epignathus with Duplicate Tongue and Ranula in a Neonate

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.

Prenatal Diagnosis of a Facial Teratoma. A Proposed Approach to Diagnose Prenatal Facial Anomalies

We report on a rare case of a prenatally diagnosed isolated facial teratoma, presenting as an avascular elongated ossified lesion arising from the inferior lateral rim of the orbit. There was no evidence of fetal compromise throughout the course of the pregnancy, which resulted in term delivery of a healthy neonate by elective Caesarean section. We summarize the key features, differential diagnoses, prognosis and management of fetal facial lesions.

A SEER database study of malignant teratomas in the head and neck region

OBJECTIVE

To review tumor and patient characteristics as well as survival of pediatric head and neck malignant teratomas (HNMT) in comparison to the adult population.

DESIGN

This investigation was a retrospective cohort study. The Surveillance, Epidemiology, and End Results (SEER) database (SEER-18 Regs Custom registry, November 2018) was reviewed for all cases of head and neck malignant teratomas from 1975 to 2016. A log rank test was used to compare survival between infant, pediatric, and adult HNMT, and between head and neck and non-head and neck malignant teratomas. Infant, pediatric, and adult patients were defined as younger than one year old, younger than 18 years old, and older than 18 years old, respectively.

RESULTS

Sixty-three malignant teratoma cases (1.96%) occurred in the head and neck region from 1975 to 2016, including 11 adult (17.46%) and 52 (82.54%) pediatric patients. 79.37% (50 patients) were diagnosed during infancy. The most common location was the soft tissue of the head and neck in pediatric patients (65.38%) and the thyroid gland in adults (54.54%). The 5-year survival was 45.83% (±7.19%) in infants and 46.00% (±7.05%) in pediatric patients. There were differences in 1-year and 5-year survival between pediatric HNMT and non-head and neck malignant teratomas, (76.01% versus 86.20%) (p = 0.022) and (46.00% versus 67.10%) (p < 0.001), respectively. There was no difference in 1-year and 5-year survival between pediatric patients and adults with HNMT, (76.01% versus 81.81%) (p = 0.618) and (46.00% versus 54.54%) (p = 0.560), respectively.

CONCLUSION

HNMT occurred most frequently in patients under the age of 1. Prognosis of pediatric HNMT is poor in comparison to pediatric non-head and neck malignant teratomas. Repeat studies after accumulating more patients in the database would be beneficial to confirm our findings.

Mature Nasopharyngeal Teratoma in a Neonate: Case Report and a Review of Literature

Teratomas are true neoplasms that contain tissues foreign to the site in which they arise. They are derived from germ cells with components of the three embryonic layers (ectoderm, mesoderm and endoderm). The present report is about a 10 day old neonate with teratoma arising from the nasopharyngeal surface of the soft palate, which was successfully removed.

Fetal Evaluation and Airway Management

Congenital causes of airway obstruction once noted at birth are now diagnosed prenatally. The adoption of ex utero intrapartum treatment has allowed for planned airway stabilization on placental support, dramatically decreasing the incidence of hypoxic injury or peripartum demise related to neonatal airway obstruction. Airway access is gained either through laryngoscopy, bronchoscopy, or a surgical airway. In complete airway obstruction, primary resection of the obstructing lesion may be performed before completion of delivery. This article reviews the current and emerging methods of fetal evaluation, indications for ex utero intrapartum treatment, and provides a detailed description of the procedure and necessary personnel.

Management of nasopharyngeal teratomas associated with cleft palate

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.

Diagnosis and Surgical Management of Congenital Intranasal Teratoma in a Newborn: A Rare Case Report

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.

Teratoma of the neonatal head and neck: A 41-year experience

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.

Huge nasopharyngeal teratoma with a cleft palate and bifid tongue in a patient with pierre robin syndrome

PURPOSE

Nasopharyngeal teratoma is a very rare neoplasm that develops on the oronasal cavity as an expanding and cavity-filling lesion. We present a rare case of nasopharyngeal teratoma associated with a cleft palate and bifid tongue in a patient with Pierre Robin syndrome.

METHODS

A preterm male neonate of 33 weeks and 6 days was referred to our department. A protruding solid mass with approximately 7.0 × 4.0-cm size arising from the vomer and combined cleft palate and tongue covered with pinkish skin with lanugo were observed. In addition, there was a bandlike tissue connecting vomer and sublingual area, which divided and restricted the anterior portion of the tongue.

RESULTS

An early surgical intervention was decided because of problems with airways and nutrition caused by the mass. The mass was completely removed from the vomer. The histologic examination of the mass was consistent with mature teratoma. After his first operation, he was finally diagnosed with the Pierre Robin syndrome. After 4 months, a tongue reduction was conducted for macroglossia, and after 9 months, remnant teratoma excision and a palate repair were conducted using 2-flap palatoplasty.

CONCLUSIONS

A nasopharyngeal teratoma is a rare case and induces a cleft palate and bifid tongue in a preterm infant, leading to severe airway and nutritional problems. A teratoma interferes with the fusion of embryonic tissues in the early developmental period, in particular, with the palatal fusion severely prevented if the teratoma is accompanied by a Pierre Robin syndrome such as in this case.

A rare case of oropharyngeal teratoma diagnosed antenatally with MRI

Oropharyngeal teratomas are extremely rare congenital tumors and have an incidence rate of one in 35,000-200,000 newborn babies/neonates. Oropharyngeal teratomas may cause life threatening airway obstruction to a newborn. Early diagnosis with ultrasound and magnetic resonance imaging (MRI) is essential to plan management. Here, we present a rare case of oropharyngeal true teratoma diagnosed with MRI antenatally in a fetus at 34 weeks of gestation in a 25-year-old female who was being evaluated for polyhydraminos. We found MRI to be more helpful for antenatal diagnosis, counseling, and management than ultrasonography and computed tomography (CT).

[Cervical teratoma in a child]

Teratomas are unusual tumors derived from all 3 germs cells layers: endoderm, mesoderm, and ectoderm, with varying proportions. The cervical area is exceptionally affected. We report 4 cases of cervical teratoma. The clinically and radiologically suggested diagnosis was confirmed by histology. We describe herein the main clinical, radiological, and histological aspects and outcomes of this disease. Despite its most often benign histologic nature, cervical teratoma may threaten newborn infants' life due to airway compression. A multidisciplinary approach to the disease starting at delivery is required to improve the prognosis.

An unusual case of a mature teratoma on the left perineal region of a young cat: surgical treatment and pathological description

A 10-month-old intact male cat with a clinical history of a large mass in the left perineal region was submitted to the surgery department. The mass had reportedly been present as a small swelling after birth. Cytological evaluation using a fine-needle aspirate showed eosinophilic keratinaceous debris, and was not convincing for the definitive diagnosis. Complete surgical excision was performed. Postoperative function and aesthetics were excellent. Based on gross and histological features the definitive diagnosis of the tumor was mature teratoma with ectodermal and endodermal components. After a follow-up period of 4 months, no signs of recurrence were evident. Surgical excision of the teratoma in our case was considered curative. A perineal location has not been previously reported in the cat and should be considered a rare condition in this species.

Oropharyngeal teratoma, a rare cause of airway obstruction in neonates

Oropharyngeal teratomas are extremely rare congenital tumours, and because of their location in the upper airway they represent one of the most unusual causes of airway obstruction during the neonatal period. We report a 2-month-old girl who presented with repeated vomiting, failure to thrive and recurrent bouts of stridor and cyanosis since birth. On examination there was a mass originating from the oropharynx. The mass was excised under general anaesthesia by CO(2) laser. Histopathological examination revealed a teratoma of the oropharynx. We discuss the clinical presentation, diagnosis and treatment of this case as well as a review of the literature.

Malignant epignathus including a nephroblastoma component and successful management

A male infant was born to a 24-year-old mother (gravida 1 para 1) by cesarean delivery at 33 1/7 weeks of gestation. The physical examination revealed a large mass protruding from the baby's mouth, which appeared to be attached to the palate. Tracheostomy was performed immediately in the delivery room. A partial surgical excision was performed on the second postnatal day, removing most of the teratoma (epignathus), which was attached to the back of the pharynx and protruding from the baby's mouth measuring 13×11×9 cm and weighing 545 g. The final pathological diagnosis was "malignant epignathus with nephroblastoma component." According to our knowledge, this is the first case that have malignant epignathus including nephroblastoma component in the literature.

Malignant epignathus

Report of a neonate with a huge mass protruding from the oral cavity. The mass has originated from the base of the tongue. Successful excision and histopathological examination revealed it to be a malignant epignathus.

Infantile myofibroma or lymphatic malformation: differential diagnosis of neonatal cystic cervicofacial lesions

A 5-day-old male neonate was referred to our vascular anomalies center with a large cystic submandibular mass. History and physical examination and ultrasonographic results indicated the diagnosis to be macrocystic lymphatic malformation. Consequently, the child was treated with sclerotherapy and subtotal excision. The histopathological examination result showed that the lesion was infantile myofibroma. This diagnostic error was attributed to atypical features of infantile myofibroma in this child: unusually large cysts, rapid enlargement, and coagulopathy. This report expands the clinical spectrum of infantile myofibromatosis and suggests its consideration in the differential diagnosis of neonatal cystic cervicofacial lesions.

Neonatal airway obstruction caused by rapidly growing nasopharyngeal teratoma

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.

Congenital neck masses

Congenital neck lesions reflect abnormal embryogenesis in head and neck development. A thorough knowledge of embryology and anatomy is critical in the diagnosis and treatment of these lesions. The appropriate diagnosis of these lesions is necessary to provide appropriate treatment and long-term follow up, because some of these lesions may undergo malignant transformation or be harbingers of malignant disease.

Oropharyngeal teratoma in a neonatal sable antelope (Hippotragus niger)

A neonatal male sable antelope (Hippotragus niger) was found dead. A 5 by 12-cm lobulated mass was present in the oral cavity, attached to the caudal border of the soft palate; this mass contained hair, cartilage, bone, nervous tissue, muscle, and multiple gland-like structures. Histopathologic diagnosis was consistent with oropharyngeal teratoma. As a result of the lack of wear of the fetal hooves, the firm, collapsed appearance of the lungs, and the lack of other gross or histopathologic abnormalities, the oropharyngeal tumor is suspected to have caused an airway obstruction, resulting in the calf's early postnatal death. This is the first report of an oropharyngeal teratoma in the veterinary literature.

Congenital teratoma of the tongue: a case report and review of the literature

Teratomas of the head and neck are rare. They develop in neonates and are associated with feeding difficulty, airway obstruction, and difficulty in swallowing (which may cause polyhydramnios). Although some tumors consist of immature elements, teratomas of the head and neck are mature in nature, and excision is the most effective treatment. We present a case report of a neonate with a polypoid mass protruding from his mouth. He exhibited respiratory arrest immediately after birth and underwent intubation. The mass, which was completely excised, was histologically identified as a mature teratoma.

Congenital cervical teratomas: diagnostic, management and postoperative variability

OBJECTIVE

To review the diagnosis, management and outcomes of congenital cervical teratomas presenting to a tertiary referral centre.

METHODS

Retrospective chart review of three cases presenting within an 18-month period.

RESULTS

Of the three patients in this series, one was diagnosed antenatally. The remaining cases were diagnosed at birth. The antenatally diagnosed patient underwent an EXIT procedure whereby the airway was secured by tracheostomy. This patient subsequently died 30 min after separation from the materno-foetal circulation. Neither of the other two cases had any neonatal respiratory distress, despite having large tumours. Both patients had neonatal surgical excision of the teratomas performed. Both patients had postoperative respiratory distress, requiring intervention. Both patients made a full recovery. No recurrence has been reported.

CONCLUSION

The antenatal diagnosis of large congenital cervical teratomas allows for planned intervention by experienced personnel. A successful outcome may not be obtained. All patients that undergo surgical excision of these tumours must be closely observed for post-operative respiratory distress, even in the absence of pre-operative symptoms.

Strategy for management of newborns with cervical teratoma

BACKGROUND

Cervical teratomas are extremely rare tumors with high perinatal mortality and morbidity rates.

OBJECTIVE

To compare our experience and outcome in newborns with cervical teratoma with similar reports from the literature, in order to propose a structured approach.

METHODS

A retrospective review of seven patients treated between 1986 and 2000 was performed. The results of these seven patients were compared with and added to a series of 44 well-documented patients retrieved from the literature.

RESULTS

In four of the seven patients, the diagnosis was not suspected antenatally. Three of the patients survived, one died. In the other three, the diagnosis was made antenatally. Two were born using the ex-utero intrapartum treatment (EXIT) procedure, one by planned cesarean section. Only one of these three survived. Mortality in the total series of 51 patients was 33% overall, and 46% in the group in which the diagnosis had been made antenatally. Peri- and post-operative complications were reported in 27%. Although larger tumors caused polyhydramnios more frequently than smaller tumors, and were associated with more severe respiratory distress, the relationship between tumor volume at birth and final outcome could not be established. This makes difficult the identification of fetuses with a disastrous prognosis.

CONCLUSION

Although mostly benign, cervical teratomas are still associated with high mortality rates. Timely antenatal diagnosis is indispensable in reducing morbidity and mortality caused by upper airway obstruction. A structured approach to the management of cervical teratoma is proposed.

Novel karyotypic changes detected by comparative genomic hybridization in a case of congenital cervical immature teratoma

BACKGROUND

Cervical immature teratoma is a rare congenital tumor, and very few cases have been studied cytogenetically.

CASE

In this article, we describe a case of this tumor type and present the findings of the karyotype of the lesion, which was performed with the bacterial artificial chromosome arrays using the comparative genomic hybridization method. The chromosomal abnormalities that we found included an amplification on 1p21.1, a 9p22 deletion, and a 1-copy gain of 17q21.33.

CONCLUSIONS

None of the identified chromosomal aberrations have been previously associated with congenital extragonadal teratomas. Important genes that lie in these DNA regions may be implicated in the pathogenesis of congenital teratomas.

Reconstruction of a congenital midpalatal hairy polyp

Hairy polyps (dermoids or oronasopharyngeal teratomas) are a type of congenital tumour that contain elements of bigerminal origin (ectoderm and mesoderm). We describe a baby who presented with a hairy polyp of the hard palate protruding from the mouth. This was not causing respiratory distress but she had feeding difficulties. She was successfully operated on the age of 5 days, the defect was reconstructed with hairless skin of the mass and she was able to suck after a month.

Congenital immature teratoma of the tongue: an autopsy case

Congenital immature teratoma of the tongue is a very rare form of extragonadal teratoma. We report an infant autopsy case of a huge congenital immature teratoma protruding from the tongue of a female infant born to a woman at 28 weeks' gestation of her first pregnancy. The mass obstructed the infant's mouth and produced hydroamnios. Maternal alpha-fetoprotein serum level was elevated and the infant's tumor was identified before birth by ultrasonography. The pregnancy was terminated by cesarean section.

Emerging paradigms in mind-body medicine

The emerging paradigms in medicine can be seen through mind-body interactions. Observations in many meditative traditions suggest a series of objective indicators of health beyond absence of disease. Several of the physical signs have been confirmed by research or are consistent with modern science. Further correlation with long term health outcome is needed. Integration of meditation with conventional therapy has enriched psychotherapy with parallels drawn between the Nine Step Qigong and Freudian developmental psychology. A unified theory of the chakra system and the meridian system widely used in traditional mind-body interventions and acupuncture is presented in terms of modern science based on the morphogenetic singularity theory. Acupuncture points originate from the organizing centers in morphogenesis. Meridians and chakras are related to the underdifferentiated, interconnected cellular network that regulates growth and physiology. This theory explains the distribution and nonspecific activation of organizing centers and acupuncture points; the high electric conductance of the meridian system; the polarity effect of electroacupuncture; the side-effect profile of acupuncture; and the ontogeny, phylogeny, and physiologic function of the meridian system and chakra system. It also successfully predicted several findings in conventional biomedical science. These advances have implications in many disciplines of medicine.

Isochromosome 1q as the sole chromosomal abnormality in two fetal teratomas. Possible trisomic or tetrasomic zygote rescue in fetal teratoma with an additional isochromosome 1q

An isochromosome of the long arm of chromosome 1 leading to tetrasomy 1q was detected as the sole chromosomal aberration in two cases of fetal teratoma arising from the oral cavity. This type of teratoma is extremely rare and has seldom been investigated cytogenetically. Studies of DNA markers in the tumor, normal fetal skin, and parental cells demonstrated that in both cases the additional 1q material was of maternal origin. In one of the patients, the teratoma had maternal 1q marker alleles that were not found in the fetal body cells. This implies that the tumor was not derived in a direct way from the fetal body tissue; instead, the chromosomally-normal fetus might be the result of some trisomic or tetrasomic zygote rescue mechanism.

Epignathus: a germ-cell tumour presenting as neonatal respiratory distress

A full-term neonate developed acute upper airway obstruction immediately after birth secondary to a polypoidal mass in the oropharynx. After the child's airway had been secured, the mass was excised and found to be a nasopharyngeal teratoma, a rare congenital germ cell tumour which is frequently associated with other congenital malformations. It is sometimes possible to diagnose these tumours in utero, thereby enabling appropriate precautions to be taken during the delivery, otherwise if the diagnosis is unknown, then it is essential for any attending clinician to urgently secure the airway by means of either intubation or tracheostomy. Such a case is presented with a review of the possible management options. This case emphasises the fact that although many conditions are uncommon, the total incidence of rare conditions is surprisingly high, and that care needs to be taken at all times in the management of patients, in order not to overlook such life-threatening diagnoses.

Diagnosis, management, and follow-up of congenital head and neck teratomas

OBJECTIVE

To describe our clinical experience with congenital teratomas of the head and neck.

STUDY DESIGN

A retrospective review of the six patients as well as a review of the literature in the setting of academic referral centers.

METHODS

In six infants with teratomas, four in the cervical region and two arising from the nasopharynx, surgical excision of all tumors was performed. Outcome measures were clinical and radiographic follow-up and the use of a-fetoprotein (AFP) for postoperative monitoring.

RESULTS

There was no recurrence of teratomas.

CONCLUSIONS

Surgical excision is the treatment for congenital teratomas. Postoperative monitoring for recurrences should include AFP levels in difficult cases.

Teratoma in a newborn: an unusual cause of airway obstruction

We report the case of a newborn girl who presented with an inspiratory stridor and apneic episodes due to a mass in the oropharynx. On flexible pharyngo-laryngoscopy, it appeared that on inspiration this swelling, originating from the oropharynx, was sucked into the larynx, obstructing the airway. After intubation under flexible optic control the swelling was excised using the CO2-laser. Histopathological examination showed a teratoma of the oropharynx. The postoperative course was uneventful. Teratomas of the oropharynx are rare and are treated by surgical excision. If respiratory distress accompanies the lesion, priority must be given to securing the airway.

A nasopharyngeal dermoid causing neonatal airway obstruction

A case of neonatal respiratory distress due to a pedunculated nasopharyngeal dermoid is presented with its MRI assessment. The dermoid was removed without complications. Nasopharyngeal teratomas are uncommon, consisting of tissues from all three germ layers with varying degrees of differentiation. Symptoms arise during the neonatal period and are associated with airway obstruction. MRI can be performed for contemporary assessment. The first goal of management is to establish a safe and protected airway using complete surgical excision.

Glial choristoma in the oral cavity: histopathologic and immunohistochemical features

This report describes the morphologic and immunohistochemical features of two cases of glial choristoma arising in the palate. The bulk of the lesions consisted of mature neuroglial tissue admixed with salivary glands, adipose tissue and lymphoid aggregates in case 1 and of cartilage, bone and foci of smooth muscle cells in case 2. In addition, case 2 showed choroid plexus and melanin-containing epithelium. Neuroglial tissue was intensely positive for CD57 as well as for glial fibrillary acidic protein, S-100 protein and vimentin. Neuron-specific enolase and neurofilament were focally or weakly positive. Proliferating cell nuclear antigen was negative in case 1 but sparsely positive in case 2. These features reflect the fact that glial choristoma is a developmental malformation of heterotopic central nervous tissue with limited growth potential.

Developmental lesions of the head and neck: terminology and biologic behavior

As much confusion has been generated in the literature by the inaccurate or improper use of terms describing developmental lesions such as hamartoma, choristoma, and teratoma, a number of different benign and malignant developmental lesions are described and distinguished in the hope that these lesions can be more reliably identified and consequently also more adequately managed.