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Jain A, Rai AK, Pujani M, Kaur J. Dysphagia in an Infant. Dysphagia 2024; 39:310-312. [PMID: 37851135 DOI: 10.1007/s00455-023-10624-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Accepted: 09/20/2023] [Indexed: 10/19/2023]
Affiliation(s)
- Avani Jain
- Department of ENT, ESIC Medical College and Hospital, Faridabad, Haryana, India.
| | - Anil Kumar Rai
- Department of ENT, ESIC Medical College and Hospital, Faridabad, Haryana, India
| | - Mukta Pujani
- Department of Pathology, ESIC Medical College and Hospital, Faridabad, India
| | - Jasleen Kaur
- Department of ENT, ESIC Medical College and Hospital, Faridabad, Haryana, India
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2
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Liaqat N, Ud Din I, Ali Z, Rashid M, Liaqat A. Congenital Immature Grade ΙΙΙ Teratoma of the Neck: A Case Report. Cureus 2023; 15:e44373. [PMID: 37779741 PMCID: PMC10540656 DOI: 10.7759/cureus.44373] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/30/2023] [Indexed: 10/03/2023] Open
Abstract
Teratoma is a rare type of germ cell tumor that consists of structures derived from all three germ layers of the embryo with varying proportions. While most of these are benign, some can turn malignant. The most common location of teratomas is the sacrococcygeal region, while their occurrence in the neck region is very rare. Broadly classified, immature teratomas contain poorly differentiated tissues, while mature ones have well-differentiated tissues. Here, the authors present a case of a 12-month-old child who presented with a huge neck mass. Radiological imaging studies were performed. Under a multidisciplinary team approach, the child was treated successfully with surgical excision. Histopathology revealed the mass to be an immature teratoma of grade III. Postoperatively, no recurrence has been noted.
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Affiliation(s)
- Nazneen Liaqat
- Department of Otorhinolaryngology, Head and Neck Surgery, Khyber Teaching Hospital (KTH), Peshawar, PAK
| | - Israr Ud Din
- Department of Otorhinolaryngology, Head and Neck Surgery, Khyber Teaching Hospital (KTH), Peshawar, PAK
| | - Zeeshan Ali
- Department of Medicine, Khyber Medical University, Peshawar, PAK
| | - Majid Rashid
- Department of Internal Medicine, Khyber Teaching Hospital (KTH), Peshawar, PAK
| | - Afsheen Liaqat
- Department of Hematology, Armed Forces Bone Marrow Transplant Center, Rawalpindi, PAK
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3
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Malhotra S, Negi P, Sagar P. A Case of Cervical Teratoma in an Infant. Indian J Otolaryngol Head Neck Surg 2022; 74:6519-6523. [PMID: 36742920 PMCID: PMC9895199 DOI: 10.1007/s12070-021-02942-w] [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: 09/23/2021] [Accepted: 10/14/2021] [Indexed: 02/07/2023] Open
Abstract
Cervical teratoma is a rare form of teratoma in neonates and is an unusual cause of cervical masses in them. Teratomas are unusual tumors derived from all 3 germs cell layers: endoderm, mesoderm, and ectoderm, with varying proportions. The cervical teratoma is a rare entity. Its prognosis mostly depends on the risk of neonatal respiratory distress, its extension and potential malignancy. Surgical management must be as complete as possible to avoid recurrences and malignant transformation. We report a case of a cervical immature teratoma in an infant with total excision and cure. No recurrence has been reported. The aim of our study is to review the diagnosis, management and outcomes of congenital cervical teratomas. Cervical teratoma although uncommon should be considered in the differential diagnosis of neck masses in neonates. Teratomas are rare tumors derived from all three germ cell layers affecting the neck in 3% of all cases. An early complete surgical approach to congenital cervical teratomas allows good results with low rates of complication and recurrence.
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Affiliation(s)
- Sonali Malhotra
- Department of Otorhinolaryngology-Head & Neck Surgery, Lady Hardinge Medical College & Associated Hospitals, Shaheed Bhagat Singh Marg, New Delhi, 110001 India
| | - Prerna Negi
- Department of Otorhinolaryngology-Head & Neck Surgery, Lady Hardinge Medical College & Associated Hospitals, Shaheed Bhagat Singh Marg, New Delhi, 110001 India
| | - Poonam Sagar
- Department of Otorhinolaryngology-Head & Neck Surgery, Lady Hardinge Medical College & Associated Hospitals, Shaheed Bhagat Singh Marg, New Delhi, 110001 India
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4
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Azam H, Hanif MA, Khan MI, Masood A, Hashmi MU. Cervical Cystic Teratoma: An Unusual Cause of Airway Obstruction in the Pediatric Population. Cureus 2021; 13:e19166. [PMID: 34873509 PMCID: PMC8631485 DOI: 10.7759/cureus.19166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/30/2021] [Indexed: 11/05/2022] Open
Abstract
Cystic teratoma is a germ cell tumor, which usually involves the gonads. However, it can be located occasionally in other organs. The most common extragonadal sites for germ cell tumors include midline structures such as the retroperitoneum, mediastinum, pineal body, and supra-sellar space. Here, we describe a case of a patient who presented with a cystic teratoma involving the anterior aspect of the neck. The chief complaints of the patient consisted of a large swelling in front of the neck, difficulty in breathing, and frequent regurgitation of milk during feeding. Initially, a diagnosis of cystic hygroma was instituted for which the patient underwent sclerotherapy utilizing bleomycin. However, no improvement was observed in the patient's condition. A detailed evaluation was planned, starting with a CT scan of the head and neck that suggested cystic teratoma as the likely etiology. Surgical excision of the mass was performed, and an excisional biopsy for histopathological examination was taken. A final diagnosis of cervical cystic teratoma was established based on the histopathological findings. The purpose of reporting this case is to raise awareness among fellow healthcare professionals that cystic teratoma can also present with a large swelling in the anterior neck with obstructive features.
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Affiliation(s)
- Huzaifa Azam
- Anesthesiology, The Children's Hospital and The Institute of Child Health, Multan, PAK
| | - Muhammad Amir Hanif
- Pediatric Surgery, The Children's Hospital and The Institute of Child Health, Multan, PAK
| | - Muhammad Imran Khan
- Anaesthesiology, Chaudhry Pervaiz Elahi Institute of Cardiology, Multan, PAK
| | - Ayousha Masood
- Internal Medicine, Faisalabad Medical University Hospital, Faisalabad, PAK
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Nastos C, Paspala A, Stamelos M, Mavroeidi I, Proikas K, Thomopoulou G, Psyrri A, Pikoulis E. Primary thyroid teratoma in adults: A case report and systematic review of the literature. Mol Clin Oncol 2021; 15:169. [PMID: 34295469 DOI: 10.3892/mco.2021.2331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Accepted: 04/08/2021] [Indexed: 11/05/2022] Open
Abstract
Extragonadal germ cell tumors are uncommon in adults and only 2-5% of teratomas develop in extragonadal sites. Primary thyroid teratomas represent <0.1% of all primary thyroid gland neoplasms. In the present report, a case of primary thyroid teratoma in a 65-year-old female is described. Furthermore, the current literature regarding patients who were diagnosed with primary thyroid teratoma and underwent surgical resection was systematically reviewed. A total of 15 studies of 27 patients (age range, 17-65 years). Growing mass or neck swelling were the primary symptoms in 14 patients (51.8%). Only one (5.5%) patient was preoperatively diagnosed with malignant thyroid teratoma. All patients underwent thyroidectomy, but 6 cases had more advanced surgery, including lymph node dissection. A total of 12 patients received a combination of adjuvant chemoradiation postoperatively, 10 (45.4%) patients reported recurrence of disease and 8 (29.6%) were postoperatively diagnosed with distant metastases. A total of 9 (39.1%) patients died due to progression of the disease. In conclusion, primary thyroid teratomas are rare and difficult to diagnose preoperatively. In particular, malignant cases are very aggressive tumors with a considerably poor prognosis, even after surgical resection combined with adjuvant chemoradiation.
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Affiliation(s)
- Constantinos Nastos
- Third Department of Surgery, Attikon University Hospital, National and Kapodistrian University of Athens, 12462 Athens, Greece
| | - Anna Paspala
- Third Department of Surgery, Attikon University Hospital, National and Kapodistrian University of Athens, 12462 Athens, Greece
| | - Mathew Stamelos
- Third Department of Surgery, Attikon University Hospital, National and Kapodistrian University of Athens, 12462 Athens, Greece
| | - Ioanna Mavroeidi
- Endocrine Unit, 2nd Propaedeutic Department of Internal Medicine and Research Institute, Attikon University Hospital, National and Kapodistrian University of Athens, 12462 Athens, Greece
| | - Konstantinos Proikas
- ENT Department, Attikon University Hospital, National and Kapodistrian University of Athens, 12462 Athens, Greece
| | - Georgia Thomopoulou
- Department of Cytopathology, Attikon University Hospital, National and Kapodistrian University of Athens, 12462 Athens, Greece
| | - Amanda Psyrri
- Department of Internal Medicine, Section of Medical Oncology, School of Medicine, Attikon University Hospital, National and Kapodistrian University of Athens, 12462 Athens, Greece
| | - Emmanuil Pikoulis
- Third Department of Surgery, Attikon University Hospital, National and Kapodistrian University of Athens, 12462 Athens, Greece
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Large Neck Teratoma in a Newborn with Respiratory Distress Syndrome. ACTA ACUST UNITED AC 2021; 42:105-108. [PMID: 33894120 DOI: 10.2478/prilozi-2021-0009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Neonatal tumours in the neck region are a rare finding. Teratomas typically comprise all three germ cell layers with tissues usually foreign to the anatomic site of origin. Head and neck teratomas account a smaller part of congenital teratomas. They can cause major airway obstruction due to the external compression that oropharyngeal or neck masses produce. In addition, there can be an intrinsic lesion in the larynx or trachea. We describe a premature, 30-gestational week-old newborn with large subcutaneous neck mass. Pre-delivery ultrasound showed heterogeneous tumor structure and displaced larynx. The intubation was successful. The newborn developed respiratory distress syndrome immediately after birth which rendered the surgical removal of the neck tumor impossible. An autopsy was done, and the histopathology revealed mature teratoma comprising muscle, brain, salivary and pulmonary tissues, as well as well-developed hyaline membranes in the alveoli. The combination of the respiratory distress syndrome and the neck tumor compression proved fatal. Prenatal diagnosis, therapeutic options and ex utero intrapartum treatment (EXIT) procedures are discussed for the diagnosis and management of this very rare tumor.
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7
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Hassan HM, Omar AS, Mohammed AA. Mature cystic teratoma of the neck misdiagnosed at cystic hygroma; Case report. Int J Surg Case Rep 2020; 78:321-325. [PMID: 33388510 PMCID: PMC7787949 DOI: 10.1016/j.ijscr.2020.12.062] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Revised: 12/20/2020] [Accepted: 12/20/2020] [Indexed: 10/26/2022] Open
Abstract
BACKGROUND Teratomas arise from primordial germ cells which arrest during its migration from the hindgut allantois the gonads during the first weeks of gestational life, they may occur in both gonadal and extra-gonadal locations. They occur in 1/40,000 live births. The most common anatomical locations are the sacro-coccygeal region and the ovary, neck teratomas constituted about 1.5%. Malignant transformation has been reported. CASE PRESENTATION A 2-year-old boy presented with a gradually enlarging mass in the left side of the neck causing stridor and difficulties in respiration especially during sleep, the parents noticed difficulties during swallowing. The mass was misdiagnosed as cystic hygroma and the patient underwent 2 sessions of sclerotherapy with no improvement. Clinical examination showed a large mass in the left side of the neck which was multilobulated causing tracheal shift to the opposite side. There were no signs of inflammations over the mass. CT-scan showed evidence of enhancing multi-cystic lesion with multiple flecks of calcification. Complete surgical resection was done successfully and the histopathological study of the mass showed mature elements of ectodermal, mesodermal, and ectodermal germinal layers which was consistent with mature cystic teratoma. The follow up showed no postoperative complications. CONCLUSION Mature cystic teratoma of the neck is very rare and may be difficult to be differentiated both clinically and radiologically from other neck masses. The accurate diagnosis must be made before any kind of treatment is started. Complete surgical resection is the main management option and required to decrease the recurrence.
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Affiliation(s)
- Hassan Muhsen Hassan
- Department of Surgery, College of Medicine, University of Duhok, Kurdistan Region, Iraq
| | - Asaad Shareef Omar
- Department of Surgery, College of Medicine, University of Duhok, Kurdistan Region, Iraq
| | - Ayad Ahmad Mohammed
- Department of Surgery, College of Medicine, University of Duhok, Kurdistan Region, Iraq.
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Ex utero intrapartum treatment to extracorporeal membrane oxygenation: lifesaving management of a giant cervical teratoma. The Journal of Laryngology & Otology 2020; 134:650-653. [PMID: 32605677 DOI: 10.1017/s0022215120001206] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Ex utero intrapartum treatment ('EXIT' procedure) is a well described method for maintaining maternal-fetal circulation in the setting of airway obstruction from compressive neck masses. When ex utero intrapartum treatment to airway is not feasible, ex utero intrapartum treatment to extracorporeal membrane oxygenation ('ECMO') has been described in fetal cardiopulmonary abnormalities. OBJECTIVE This paper presents the case of a massively compressive midline neck teratoma managed with ex utero intrapartum treatment to extracorporeal membrane oxygenation, allowing for neonatal survival, with controlled airway management and subsequent resection. CASE REPORT A 34-year-old-female presented with a fetal magnetic resonance imaging scan demonstrating a 15 cm compressive midline neck teratoma. Concern for failure of ex utero intrapartum treatment to airway was high. The addition of the ex utero intrapartum treatment to extracorporeal membrane oxygenation procedure provided time for the planned subsequent resection of the mass and tracheostomy. CONCLUSION Ex utero intrapartum treatment procedures allow for securement of the difficult neonatal airway, while maintaining a supply of oxygenated blood to the newborn. Ex utero intrapartum treatment circulation lasts on average less than 30 minutes. The arrival of extracorporeal membrane oxygenation has enabled the survival of neonates with disease processes previously incompatible with life.
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Goldstein NP, Zhang X, Sollinger C, Chaturvedi A, Turri R, Mehta R, Metlay LA, Katzman PJ. Superior Vena Cava Syndrome and Hypoxic Ischemic Encephalopathy Secondary to a Massive, Right-Sided Immature Cervical Teratoma. Pediatr Dev Pathol 2020; 23:152-157. [PMID: 31335287 DOI: 10.1177/1093526619865422] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Cervical teratomas are a rare form of fetal teratoma that can grow to massive size. Generally, these masses can be surgically excised after birth with excellent physical and functional prognosis because the benign variants respect anatomical borders. The primary complications of these masses are associated with compromise of the trachea and esophagus: upper airway obstruction and polyhydramnios. We report the first documented occurrence of superior vena cava syndrome and hypoxic ischemic encephalopathy associated with a massive, right-sided cervical teratoma. This case highlights that when cervical teratomas are right-sided and sufficiently large, they can extend inferiorly and compromise central venous return to the heart. This unique presentation would likely have required fetal surgical excision to avoid catastrophic cerebral injury.
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Affiliation(s)
- Nicolas Pn Goldstein
- School of Medicine & Dentistry, University of Rochester Medical Center, Rochester, New York
| | - Xin Zhang
- Department of Pathology and Laboratory Medicine, Indiana University School of Medicine, Indianapolis, Indiana
| | - Christina Sollinger
- Division of Neonatology, Department of Pediatrics, University of Rochester Medical Center, Rochester, New York
| | - Apeksha Chaturvedi
- Department of Imaging Sciences, University of Rochester Medical Center, Rochester, New York
| | - Riki Turri
- Department of Pathology and Laboratory Medicine, University of Rochester Medical Center, Rochester, New York
| | - Rupal Mehta
- Department of Pathology and Laboratory Medicine, University of Rochester Medical Center, Rochester, New York
| | - Leon A Metlay
- Department of Pathology and Laboratory Medicine, University of Rochester Medical Center, Rochester, New York
| | - Philip J Katzman
- Department of Pathology and Laboratory Medicine, University of Rochester Medical Center, Rochester, New York
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Maruguchi H, Nomura T, Sasaki S, Hashikawa K, Terashi H. Mature teratoma treated as lymphatic malformation for 5 years: a case report and literature review. CASE REPORTS IN PLASTIC SURGERY AND HAND SURGERY 2019; 6:63-68. [PMID: 31231672 PMCID: PMC6566496 DOI: 10.1080/23320885.2019.1619458] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/08/2018] [Accepted: 05/13/2019] [Indexed: 11/29/2022]
Abstract
Teratomas and lymphatic malformations are included in the differential diagnosis of congenital neck masses. They can exhibit similar clinical findings. The authors present a case of mature teratoma that had been managed as a lymphatic malformation for years. Clinicians should be careful not to dismiss clues for the correct diagnosis.
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Affiliation(s)
- Hayato Maruguchi
- Department of Plastic Surgery, Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan
| | - Tadashi Nomura
- Department of Plastic Surgery, Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan
| | - Satoru Sasaki
- Center for Vascular Anomalies, Tonan Hospital, Sapporo, Hokkaido, Japan
| | - Kazunobu Hashikawa
- Department of Plastic Surgery, Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan
| | - Hiroto Terashi
- Department of Plastic Surgery, Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan
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Dionisio RG, Harb JL, Scott AR. Newborn With a Sublingual Mass. JAMA Otolaryngol Head Neck Surg 2019; 145:278-279. [DOI: 10.1001/jamaoto.2018.2568] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Affiliation(s)
- Robert G. Dionisio
- Medical student, Chicago Medical School, Rosalind Franklin University, North Chicago, Illinois
| | - Jennifer L. Harb
- Department of Otolaryngology–Head & Neck Surgery, Tufts Medical Center, Boston, Massachusetts
| | - Andrew R. Scott
- Department of Otolaryngology–Head & Neck Surgery, Tufts Medical Center, Boston, Massachusetts
- Division of Pediatric Otolaryngology, Floating Hospital for Children at Tufts Medical Center, Boston, Massachusetts
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Abstract
RATIONALE Teratomas are extremely rare in the thyroid gland. A cervical teratoma presenting as a cystic or mixed thyroid lesion can be easily confused with a thyroglossal duct cyst. It is difficult for pediatricians to differentiate between these 2 types of lesions. PATIENTS CONCERNS A 2-year-old girl who presented a growing thyroid mass for 14 months showed a mass in her left thyroid lobe under contrast-enhanced computed tomography (CT). DIAGNOSIS AND INTERVENTIONS Ultrasonography found a mass of 5 × 3.5 cm within the left lobe of the thyroid gland, and the sonogram revealed areas with echo-free and mixed-echo patterns. There was no accumulation of technetium-99m pertechnetate on the thyroid scintigraphy (cold thyroid nodule). CT scan showed a mass (5.0 × 3.0 × 2.5 cm in size) that extended from the left thyroid lobe to the anterior mediastinum with no evident enhancement and clear margins that contained calcifications. Complete excision without intraoperative capsule disruption was achieved. Histologically, the thyroid mass was diagnosed as a mature teratoma. OUTCOMES The postoperative course was uneventful after follow-ups for 2 years, and the patient had no inflammatory signs or evidence of recurrence. LESSONS Thyroid teratoma is rare in infants and is usually benign; however, some thyroid teratomas are malignant and inclined to relapse. The authors emphasize that thyroid teratomas in children should be included in the differential diagnosis of cystic lesions located in the head and neck area. Complete resection is essential for good outcomes. In addition, long-term follow-ups are warranted to follow the complications of the malignant or recurrent disease.
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Olivares E, Castellow J, Khan J, Grasso S, Fong V. Massive fetal cervical teratoma managed with the ex utero intrapartum treatment (EXIT) procedure. Radiol Case Rep 2018; 13:389-391. [PMID: 29904479 PMCID: PMC5999839 DOI: 10.1016/j.radcr.2017.12.011] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2017] [Accepted: 12/09/2017] [Indexed: 12/18/2022] Open
Abstract
Teratomas are rare congenital tumors typically comprising all 3 germ cell layers. Cervical teratomas arise in the neck and represent a minority of all teratomas. These are associated with high morbidity and mortality because of their propensity to cause airway obstruction. Demonstration on prenatal magnetic resonance imaging is uncommon, especially for a tumor of this size. Fetuses diagnosed with large neck masses are managed through cesarean section with the ex utero intrapartum treatment procedure to secure the airway, such as in our case of a large cervical teratoma in the female fetus of a 30-year-old mother who went into preterm labor.
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Affiliation(s)
- Emily Olivares
- School of Medicine, Eastern Virginia Medical School, Norfolk, VA, USA
| | - Justin Castellow
- Department of Pediatrics, Children's Hospital of the King's Daughters, Norfolk, VA 23507, USA
| | - Jamil Khan
- Department of Pediatrics, Children's Hospital of the King's Daughters, Norfolk, VA 23507, USA
| | - Susanne Grasso
- Department of Radiology, Eastern Virginia Medical School, PO Box 1980, Norfolk, VA 23501, USA
| | - Victor Fong
- Department of Radiology, Eastern Virginia Medical School, PO Box 1980, Norfolk, VA 23501, USA
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