Pediatric Teratoma and Dermoid Cysts

Congenital Neck Masses

There are many possible causes of congenital neck masses, with the most common ones being thyroglossal duct cysts, branchial cleft anomalies, and vascular malformations. Most congenital neck masses are asymptomatic in the neonatal period, but depending on the location and the size, they can cause airway obstruction and serious complications at birth. Proper diagnosis is important for optimal treatment planning, and if the airway is compromised, multidisciplinary teamwork is critical for proper airway management. This review summarizes the clinical features, etiology, diagnosis, management, and prognosis of different types of congenital neck masses.

A Pediatric Lateral Submental Mass: A Rare Presentation of Dermoid Cyst

Dermoid cysts are benign cutaneous neoplasms that contain germ cells from the ectoderm and mesoderm. Approximately 70% are diagnosed during childhood before the age of 5. Although they can present throughout the body, the prevalence is 7% for those arising from the head and neck. These lesions present primarily as midline masses and are classified as sublingual, submental, or overlapping depending on their relationship with the muscles of the floor of mouth. A 10-year-old female presented with a 2-week history of right submental swelling. She denied pain, dysphagia, odynophagia, or respiratory distress. Physical examination showed nontender fullness of the submental region without erythema or induration and no palpable cervical lymphadenopathy. Ultrasound showed an oval-shaped cystic mass measuring 4.8 × 4.0 × 2.6 cm. After a course of clindamycin, a computed tomography was obtained which showed a right 4.5 × 4.0 × 2.6 cm fluid filled lesion, within the right lateral floor of mouth. Intraoral resection was performed and the mass was freed from the geniohyoid and mylohyoid. Histopathology was consistent with a dermoid cyst. Submental masses have a broad differential, but rarely are they dermoid cysts if they arise lateral to the midline. With appropriate diagnosis and total surgical excision, patients and their families can be reassured in similar cases.

An operation on placental support in a fetus with a nasopharyngeal teratoma

Airway obstruction diagnosed antenatally in the fetus due to congenital high airway obstruction syndrome or nasopharyngeal masses are the primary indications for performing an operation on placental support. Prenatally diagnosed nasopharyngeal masses pose the risk of total airway obstruction upon delivery. Placental support utilises uteroplacental blood flow to facilitate an airway intervention on the fetus while maintaining oxygenation. These interventions must be completed in under 20 min due to amniotic fluid loss and uterine contractions. This case report describes the anaesthetic management of a fetus with a nasal teratoma. In this report, we discuss the clinical indications and anaesthetic considerations of the operation on placental support procedure for nasopharyngeal masses.

Case report and review of the literature: rare fetus-in-fetu presenting as oropharyngeal epignathus

An epignathus is caused by a continuous spectrum of masses of the oral cavity or oropharynx ranging in its entity from mature teratoma to the exceedingly rare fetus-in-fetu. Due to its location, regardless of the entity, the occurrence of an epignathus is frequently associated with life threatening airway obstruction. Here we demonstrate a case of a fetus-in-fetu presenting as an epignatus. We describe its successful management and review the available literature. Early diagnosis and knowledge of the preoperative workup are essential to enable a multidisciplinary management. Once the airway is secured, surgical excision is the treatment of choice often resulting in a good clinical outcome and prognosis.

Cervical Cystic Teratoma: An Unusual Cause of Airway Obstruction in the Pediatric Population

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.

Diagnostic Approach to Congenital Cystic Masses of the Neck from a Clinical and Pathological Perspective

BACKGROUND

neck cysts are frequently encountered in pediatric medicine and can present a diagnostic dilemma for clinicians and pathologists. Several clinical items enable to subclassify neck cyst as age at presentation, anatomical location, including compartments and fascia of the neck, and radiological presentation.

SUMMARY

this review will briefly describe the clinical, imaging, pathological and management features of (I) congenital and developmental pathologies, including thyroglossal duct cyst, branchial cleft cysts, dermoid cyst, thymic cyst, and ectopic thymus; (II) vascular malformations, including lymphangioma. Key Messages: pathologists should be familiar with the diagnostic features and clinicopathologic entities of these neck lesions in order to correctly diagnose them and to provide proper clinical management.

A Large Cervical Immature Cystic Teratoma in a New-Born-Simulating Lymphatic Malformation

Cervical 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.

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.

The congenital sternoclavicular sinus: a single-institution retrospective study of 88 patients

BACKGROUND

Sinus near the sternoclavicular joint was considered as a rare congenital neck abnormality. Though it was reported as a dermoid sinus in some literatures, the embryological origin of the sinus was unclear. This study aimed at reviewing the clinical and histological characteristics and analyzing the possible embryological origin of this malformation in children.

METHODS

The medical records of all patients with congenital sternoclavicular sinus who underwent surgical resection between March 2018 through June 2020 were reviewed retrospectively. The clinical presentations, complications, histological examination, and treatment were analyzed.

RESULTS

Of the 88 patients with congenital sternoclavicular sinus included, the mean age of surgery was 2.73 ± 1.71 years old. The sinuses occurred on the left side in 73 (83.0%) cases. Sixty-three patients experienced sinus infection and 44 patients underwent incision and drainage before excision. All patients received surgical resection with one patient who recurred after surgery. Histopathological examination showed that the sinuses were lined by squamous epithelium in most patients. However, ciliated epithelium was observed in one patient and salivary glands were detected in two patients.

CONCLUSIONS

The congenital sternoclavicular sinus should be excised promptly to prevent recurrent infection. According to the ciliated epithelium and salivary gland were found in the wall of sinus, it should be viewed as the skin side remnant of the fourth branchial cleft rather than a dermoid cyst/sinus.

A rare case of dermoid cyst arising in the upper lip

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Dermoid cysts arising from the upper lip are relatively rare.

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Dermoid cysts have been histopathologically classified as epidermoid, dermoid and teratoid cysts.

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The diagnosis and management of dermoid cysts can be improved with the combined use of ultrasonography.

Introduction

Generally, dermoid cysts commonly arise from the anus and ovaries. Oral and maxillofacial lesions are most commonly observed in the midline of the floor of the mouth, and lesions arising from the upper lip are relatively rare.

Presentation of case

A 50-year-old man was referred to our hospital due to swelling of the left upper lip. Clinical examination revealed an elevated alar base, Gerber protrusion and nasal deformity. Ultrasonography revealed a clearly defined 30-mm lesion with more hypoechoic bands. Meanwhile, magnetic resonance imaging revealed a 30-mm mass below the orbicularis oris of the left upper lip. The lesion had a homogeneous, low-signal intensity on T1-weighted imaging. Thus, based on these findings, a dermoid cyst was suspected. The lesion was then removed en bloc without the overlying skin while the patient was under general anaesthesia. Histopathological examination revealed a cystic cavity lined by an orthokeratinised stratified squamous epithelium. However, skin appendages were not found. Based on the clinical and histopathological features of the lesion, a diagnosis of epidermoid cyst was made. Swelling of the left upper lip, nasal deformity and Gerber protrusion significantly improved after surgery.

Conclusion

Although dermoid cysts arising from the upper lip are rare, the diagnostic accuracy for dermoid cyst can be improved with the combined use of ultrasonography and other imaging modalities even though these lesions are difficult to distinguish from differential diagnosis.

Meet in the middle: a technique for resecting nasocranial dermoids-technical note and review of the literature

INTRODUCTION

Nasal dermoids with intracranial extension are benign lesions that can have life-threatening consequences, as a nasal punctum may serve as a portal of entry for infection into the central nervous system. The surgical management of these lesions can be challenging, as the extracranial and intracranial cysts and sinus tract must be resected to prevent recurrence, and the surgery must be carried out with an acceptable esthetic result.

TECHNIQUE

The authors present a technique for the resection of nasocranial dermoids that eliminates the need to remove and replace the frontonasal segment. Working through a small frontal craniotomy enables the surgeon to drill out the sinus tract through the foramen cecum and inferiorly into the nose. This exposure eliminates the need to enter the frontal sinus, if it is present.

CONCLUSION

The extracranial punctum and tract are resected from below in a minimally invasive fashion that permits removal of the lesion without a disfiguring scar.

Intracranial complications of midline nasal dermoid cysts

BACKGROUND

Nasal dermoid cysts are common tumors in children. Due to anomalies in embryologic development of the nasal complex, sometimes an intracranial extension exists. When these cysts become infected they can lead to meningitis, brain abscess and death.

METHODS

We report the case of a 1.5-year-old girl admitted to the paediatric intensive care unit after infection of a nasal dermoid cyst.

RESULTS

The infant had a spiking fever and epileptic seizures. She was stabilized, intubated and a CT scan showed a subcutaneous mass with an adjacent zone of encephalitis and brain abscess formation. Neurosurgical interventions were necessary to lower intracranial pressure and control infectious spread. After a hospital stay of 69 days the child could be discharged. Due to her young age, irreversible brain damage is expected.

CONCLUSION

Nasal midline dermoid cysts are considered benign swellings. When an intracranial extension exists, infection can lead to deleterious complications. It is important for health care practitioners to be aware of this imminent risk. Suspicion of a nasal midline dermoid cyst should prompt a careful clinical work-up with an ultrasound followed by CT or MRI imaging. The treatment is complete excision to avoid disastrous complications and recurrences.

Congenital Neck Masses

Congenital neck masses can be a developmental anomaly of cystic, solid, or vascular origin. They can also constitute neoplasms, including malignancies, although this is rare in the pediatric population. The history and examination can help quickly narrow the differential diagnosis. Imaging also plays an essential role in defining the characteristics and likely cause of neck masses. The most common neck masses in young children are thyroglossal duct cysts, branchial cleft anomalies, and dermoid cysts. Also important to consider in the differential diagnosis are solid tumors, such as teratomas, or vascular lesions, such as hemangiomas.

Update from the 4th Edition of the World Health Organization Classification of Head and Neck Tumours: What Is New in the 2017 WHO Blue Book for Tumors and Tumor-Like Lesions of the Neck and Lymph Nodes

The World Health Organization (WHO) 2017 Classification of Head and Neck Tumors ("Blue Book") will now include a new chapter on tumors and tumor-like lesions of the neck and lymph nodes, which was not included in the previous edition. Tumors and tumor-like lesions, including a variety of cysts and metastases, can arise in any component in the neck, including soft tissue, lymph nodes, and developmental remnants. The pathology and clinical features of metastatic carcinoma of unknown primary in the head and neck has changed dramatically in the last several years. Many of these tumors which were previously diagnosed as unknown primary are now identified as oropharyngeal and nasopharyngeal carcinomas related to human papillomavirus (HPV), less commonly to Epstein-Barr virus (EBV) and occasionally even to Merkel cell polyomavirus. Many unusual features can arise in these metastases, such as undifferentiated morphology, extensive cystic change with central degeneration, gland formation, and even ciliated cells. Rarely, carcinoma in the neck can arise in association with a heterotopic tissue, primarily thyroid or salivary gland tissue. Tumor-like lesions include branchial cleft cysts, thyroglossal duct cyst, dermoid and teratoid cyst, and ranula. Pathologists should be familiar with the diagnostic features and clinicopathologic corrections of these neck lesions in order to correctly diagnosis them and to provide for proper clinical management. This article will briefly describe the pathologic and clinical features of these entities as they are covered in the new 2017 Blue Book.

Dermoid of the oral cavity: case report with histopathology correlation and review of literature

Dermoid cysts are rare masses of the oral cavity derived from ectodermal elements. These are benign, slow-growing tumors that are typically asymptomatic but cause complications of inflammation or dysphagia, dystonia, and airway encroachment due to mass effects. We report the case of a 17 year old female with a painless mass in the left side of the oral cavity. Ultrasound findings demonstrated non-specific findings of a cystic lesion, and definite diagnosis was made with contrast-enhanced CT and intraoperatively with pathologic confirmation. This retrospective report highlights the challenges in evaluating masses of the oral cavity with imaging and provides a comprehensive discussion on imaging of oral masses on various imaging modalities to guide diagnosis and management.

Congenital facial teratoma in a neonate: Surgical management and outcome

Teratomas are among the most common tumors of childhood, but craniofacial teratomas are rare. They can be diagnosed antenatally. Craniofacial teratomas may cause airway obstruction in the newborn. We present a case of a newborn male child who was diagnosed to have a facial tumor in the 8^th month of gestation. He was delivered normally and had no respiratory or feeding difficulties. He was also found to have a cleft palate. Serum alpha fetoprotein levels were normal. He underwent excision on day of life 9. At 11 months follow-up, he is well with no evidence of recurrence and good functional outcome.

Nasal obstruction in children

Nasal obstruction is a very frequent symptom in children, with numerous etiologies. Clinical diagnosis is straightforward, but general impact and rare etiologies should be explored for. Complementary examinations are guided by diagnostic orientation. Although not usually a severe condition, nasal obstruction may be life-threatening in neonates and infants. An exhaustive list of etiologies is impossible and would not be useful, but it is worth distinguishing infantile nasal obstruction and nasal obstruction in older children, as causes differ greatly. This is the topic of the present update.