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

Hamartomas, choristomas, and teratomas of the oral cavity: A 49-years cross-sectional study in an oral diagnostic service

BACKGROUND

To investigate the incidence and demographic profile of hamartomatous, choristomatous, and teratoid lesions in a Brazilian population over a 49 years-period.

METHODS

A retrospective cross-sectional study was performed, and data regarding demographic and clinical aspects were obtained from the medical records of a [removed for blind peer review] referral center (1970-2019). The collected data were submitted to descriptive analysis and Pearson's chi-square, Fisher's exact, and Kruskal-Wallis tests (p ≤ 0.05).

RESULTS

In a total of 16,412 medical records analyzed, 300 (1.83 %) were hamartomatous, 2 (0.01 %) choristomatous, and 1 (0.01 %) teratoid lesions. Hamartomas were most diagnosed in females and adults. Statistical significance was observed between hamartoma and age group (p < 0.001). Odontoma was the most frequent hamartomatous lesion. In choristomatous and teratoid lesions, there was no occurrence in males. The jaws were the most affected anatomical site by hamartoma. Choristomas were observed on the mandible and tongue, while a teratoid lesion was seen on the floor of the mouth.

CONCLUSIONS

Low occurrence of choristomatous and teratoid lesions over hamartomatous lesions and a heterogeneous occurrence profile regarding sex, age group, and anatomic site were observed. Hamartomas are relatively common and benign conditions that may cause damage and require special care during dental treatment. Thus, the dentist needs to be able to identify and treat them appropriately. Likewise, although choristomas and teratomas present no risk to patients and have a lower occurrence than hamartomas, they also require treatment.

Surgical Management and Outcomes of Pediatric Congenital Head and Neck Teratomas: A Scoping Review

Objective

To perform a scoping review to characterize postoperative outcomes of pediatric patients (ages 0-18) with a history of congenital head and neck teratomas.

Data Sources

PubMed, EMBASE, Web of Science, Cochrane, Clinicaltrails.gov.

Review Methods

A search of multiple databases was performed. Studies were included if they detailed the surgical management and outcomes of pediatric patients with a history of congenital head and neck teratomas.

Results

One hundred and eight studies totaling 137 patients were identified. The median gestational age at birth was 37 weeks. Respiratory distress, prompting emergent endotracheal intubation or tracheostomy, was present in most patients (58%). The ex utero intrapartum treatment (EXIT) procedure was utilized for 21 (15%) patients. The teratomas were resected after a median duration of 4 days from birth. The most common postsurgical complications were vocal cord paralysis (3%), hemorrhage (2%), and tracheomalacia (2%). Death occurred perioperatively in 2 patients (2%). Twenty-six patients (19%) required additional surgery, and 5 patients (4%) needed adjuvant chemotherapy. Patients were monitored for a median duration of 24 months with a recurrence rate of 6%. Four recurrent cases (50%) had intracranial extension, and 88% of the recurrent cases were mature teratomas at initial histopathological diagnosis.

Conclusion

Most patients with congenital head and neck teratomas require emergent airway management perinatally. Excisional and surgical complications are rare, and most patients are cured of their disease with a single operation. Recurrent teratomas tend to have an intracranial extension and are likely to be of mature pathology at the time of initial diagnosis.

Teratoma of the Tongue in a Fetus: A Case Report and Review of the Literature

Teratomas are tumors composed of multiple embryonic germ layers of tissue, and those occurring in the tongue of the fetus are extremely rare. This paper reports the case of a 20-week-old fetus diagnosed with oral masses combined with a cleft lip and palate using prenatal ultrasonography. The patient decided to terminate the pregnancy due to economic factors after prenatal genetic consultation. The mother underwent induction termination and delivered a stillborn male fetus. The mass originated from the tongue and was pathologically confirmed as a mature teratoma by histology. Teratoma of the tongue is a rare congenital tumor that is usually benign. Its etiology is multifactorial, and prenatal karyotyping is necessary. Ultrasound is the main method of prenatal diagnosis, and magnetic resonance imaging is an effective complement to ultrasonography. Tumors can cause other malformations and abnormalities, and their location and size have an essential impact on prognosis. The imaging approach should focus on the associated abnormalities in order to assess the impact of the mass on the fetal airway and swallowing. Appropriate follow-up imaging can be helpful in the dynamic assessment of management.

Management of oropharyngeal teratoma: Two case reports and a literature review

Pharyngeal teratomas are very rare congenital tumours derived from pluripotent stem cells. Surgical resection is the main treatment to avoid breathing and feeding difficulties. This current case report describes two newborn infants with congenital oropharyngeal teratomas. In one of the infants, the tumour presented along with a cleft tongue and cleft palate. Prenatal diagnosis by ultrasonography did not identify the tumours because the masses were small and there was no polyhydramnios. Both cases were treated surgically and histological examination of the masses in both cases confirmed the diagnosis of a congenital epignathus. There were no complications such as infection, bleeding or residual recurrence following surgery. After 1-year follow-up, there was no recurrence of the epignathus in either case. Oropharyngeal teratoma is a very rare congenital tumour that may cause upper airway obstruction and feeding difficulties in the newborn, so it should be treated surgically in a timely manner.

Unusual exophytic gingival lesion in a newborn treated with diode laser

Gingival lesions rarely occur in newborns. However, when present, they commonly worry the parents and impair the infant's feeding, thus affecting growth. Such lesions are usually nonneoplastic in nature, although malignancies may develop; therefore, specimens must be submitted for histopathologic examination. A 2-month-old girl presented with a 10-mm nodule on the anterior lower alveolar ridge in association with natal tooth extraction and neonatal tooth eruption. The lesion was excised with high-power laser under local anesthesia, and a histopathologic diagnosis of a peripheral ossifying fibroma was made. In addition to peripheral ossifying fibromas being rare in newborns, the use of high-power lasers for surgical procedures in newborns have been proven to be safe, comfortable, and efficient.

Oral teratoma in a neonate: A case report of anesthetic challenge

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.

Unusual Fungal Lesion Presenting as a Neoplastic Pediatric Tongue Mass

Tongue lesions in the pediatric population are rare. The differential diagnosis of these lesions is broad, and rapid growth of the lesion is concerning for a neoplastic process. We present a rare case of a fungal lesion mimicking a neoplastic growth in a 22-month-old girl. She underwent complete excision successfully. Full evaluation for benign and malignant neoplasms was negative. Tissue culture demonstrated growth of a rare Candida species to be the cause of the lesion. Postoperatively, she continues to do well, without regrowth 6 months later. This case reinforces the role of tissue culture when histology fails to demonstrate a diagnosis and emphasizes the need for efficient communication between the pediatrician, otolaryngologist, and pathologist for timely excision.

Management of fetal teratomas

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.

Congenital huge submandibular and neck teratoid cyst in newborn

Head and neck teratoid cysts are the least common congenital cysts in the head and neck region, accounting for approximately 1.8% of all dermoid cysts. Teratoid cysts exhibiting mesodermal elements may be lined by gastric, intestinal, respiratory, squamous, or cilitated epithelium. We present a case of huge submandibular and neck teratoid cyst in newborn with airway obstruction and feeding difficulty. Surgical extirpation is the treatment of choice. However, before operation, some other cystic diseases in the head and neck region needs to be excluded. Fine-needle aspiration biopsy was necessary in differential diagnosis of lesions before treatment, especially that the principle of treatment of those diseases is different.

Choristoma involving the floor of the mouth and the anterior tongue: a case of teratoid cyst with gastric and respiratory epithelia

Oral dysontogenic cysts result from defective embryonic development. Among them teratoid cysts are the most unusual presentation and may be lined by gastric, intestinal, respiratory, squamous, ciliated epithelium or even pancreatic structures. Teratoid cysts containing respiratory and gastrointestinal epithelium have typically been called choristomas. This article describes a 15-year-old boy presenting a choristoma involving both the floor of the mouth and the anterior tongue and characterized by the presence of squamous epithelium with skin adnexa, gastric and respiratory epithelium.

Oral teratomas: a report of 5 cases

PURPOSE

To present a case series of 5 patients with oral teratomas, discussing the treatment and follow-up.

REPORT OF CASES

Five patients (4 girls and 1 boy) with oral teratomas presented at the Maxillofacial Surgery Department of a University Hospital with a reference population of 1,000,000 between 1980 and 2002. The associated lesions, clinical examination, histopathology, treatment and follow-up were registered and described. The newborns presented associated congenital malformations such as cleft palate, bifid tongue, dorso-nasal fistula and nasal dermoid cyst. In all 5 cases the tumor mass was excised at its base with surrounding normal tissue under general anesthesia combining conventional and electric scalpels. Histological analysis resulted in different compositions of multiple tissues typical of teratomas. After a mean follow-up of 8 years no sign of tumor recurrence had been detected.

CONCLUSION

Teratomas were a rare finding within a large population of newborn patients. Five tumors were excised and histologically diagnosed as teratomas. No recurrence occurred after 8 years of follow-up.

Giant craniofacial immature teratoma with primary intracranial lesions

Teratomas can occur in almost any region of the body and are the most common extragonadal germ cell childhood tumors. Immature teratomas in the head and neck region cause severe deformity and threat life because of several reasons. Imaging investigation (ultrasonography, computed tomography, magnetic resonance imaging) is of outmost importance for the diagnosis and preoperative planning, considering that the total surgical resection of the teratoma constitutes the treatment of choice. Untreated teratomas have mortality rates of 80% to 100%. In this study, a giant craniofacial immature teratoma having both intracranial and extracranial primary lesions is reported. As a conclusion, intracranial primary lesions should be kept in mind in extracranial head and neck immature teratoma cases.

Early resection and reconstruction of head and neck masses in infants with upper airway obstruction

OBJECTIVE

Congenital airway obstruction can be caused by tumors or lesions arising from the neck, tongue and oral cavity. Neonates may require prolonged intubation or tracheostomy before curative resection and reconstruction. The aim of the study was to carry out surgical resection and reconstruction with locoregional flap and free bone graft in the neonatal and early infantile period for definitive management of head and neck masses and treatment of potential airway obstruction.

METHODS

Newborns with obstructive head and neck masses in Queen Mary Hospital, University of Hong Kong Medical Centre between 2006 and 2009 were operated on in the neonatal period.

RESULTS

There were one obstructive neck teratoma, two intraoral teratomas and one neuroglial heterotopia. All tumors were resected within the first 3 months of life without major complication. A local cervical cutaneous flap was first used to reconstruct the lateral pharyngeal wall defect in a neonate with a huge neck teratoma, followed by another infant with a neuroglial heterotopia. A piece of cranial bone was used for reconstruction of the skull base defect. None of them required tracheostomy or prolonged intubation. Oral feeding was resumed in the early postoperative period.

CONCLUSION

Surgical resection and reconstruction with locoregional flap and bone graft can be performed safely in neonatal and early infantile period as management of head and neck masses and treatment of upper airway obstruction.

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.