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Li YL, Zhen L, Li DZ. Prenatal Diagnosis of Oral Teratoma by Ultrasound. J Med Ultrasound 2024; 32:76-78. [PMID: 38665348 PMCID: PMC11040491 DOI: 10.4103/jmu.jmu_47_22] [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: 05/17/2022] [Revised: 07/03/2022] [Accepted: 08/30/2022] [Indexed: 11/05/2022] Open
Abstract
A pregnant woman had a normal second-trimester anatomic survey at 22 weeks gestation. She was revealed to have a fetal oral mass with polyhydramnios and invisible stomach bubble by ultrasound at 28 weeks. A 50 mm × 36 mm × 42 mm, solid mass was found in the fetal mouth, filling the entire oral cavity. Fetal magnetic resonance imaging showed a homogeneous solid mass in the oral cavity compressing the hypopharynx. At 33 weeks, preterm labor occurred because of the continuation of increased amniotic fluid volume, and a female infant was vaginally delivered. The infant died shortly after tracheal intubation attempt failed. Autopsy confirmed the prenatal sonographic finding. The final pathologic diagnosis was oral immature teratoma. Our study indicates that although oral teratomas are rare, they are readily apparent at prenatal sonographic examinations. Respiratory compromise is the frequent complication of oral teratomas, which is associated with high perinatal mortality.
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Affiliation(s)
- Yan-Lin Li
- Prenatal Diagnostic Center, Guangzhou Women and Children’s Medical Center, Guangzhou, Guangdong, China
| | - Li Zhen
- Prenatal Diagnostic Center, Guangzhou Women and Children’s Medical Center, Guangzhou, Guangdong, China
| | - Dong-Zhi Li
- Prenatal Diagnostic Center, Guangzhou Women and Children’s Medical Center, Guangzhou, Guangdong, China
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Meneses-Parra AL, Tarazona-Bueno RE, Aragón-Mendoza RL, Altman-Restrepo M. Teratoma nasofaríngeo inmaduro con diagnóstico prenatal: reporte de un caso y revisión de la literatura. REVISTA COLOMBIANA DE OBSTETRICIA Y GINECOLOGÍA 2023; 74:68-86. [PMID: 37093940 PMCID: PMC10174717 DOI: 10.18597/rcog.3906] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Accepted: 01/16/2023] [Indexed: 03/30/2023]
Abstract
Objetivos: reportar el caso de una gestante con diagnóstico de feto con teratoma nasofaríngeo inmaduro y realizar una revisión describiendo el pronóstico de esta patología.
Materiales y métodos: se reporta el caso de una gestante de 27 años, atendida en la Unidad de Ginecología y Obstétrica de un centro de referencia en Bogotá (Colombia), por hallazgo durante el control prenatal de un feto con evidencia de polihidramnios secundario a teratoma nasofaríngeo. Se realizó una búsqueda bibliográfica en las bases de datos Medline vía PubMed, Scopus, SciELO y ScienceDirect, restringiendo tipo de idioma (inglés y español) y por fecha de publicación (enero de 2001 a enero de 2021). Se incluyeron reportes de caso y series de casos que abarcaran el pronóstico de esta patología.
Resultados: la búsqueda recuperó 168 títulos, de los cuales 55 cumplieron con los criterios de inclusión. En total se reportó el resultado perinatal de 58 fetos con diagnóstico de teratoma nasofaríngeo inmaduro detectado en etapa prenatal. En los casos identificados, la mortalidad perinatal fue del 25,4 % y el porcentaje de óbito fue cercano al 3,6 %.
Conclusiones: el teratoma nasofaríngeo inmaduro es una patología poco frecuente. La literatura disponible sugiere que el pronóstico fetal depende del grado de compromiso de las estructuras intracraneales y de la posibilidad de resección de la lesión. Se requieren más estudios que evalúen el pronóstico de los fetos con teratoma nasofaríngeo inmaduro.
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Pellegrini V, Colasurdo F, Guerriero M. Epignathus with oropharynx destruction. AUTOPSY AND CASE REPORTS 2021; 11:e2021293. [PMID: 34249796 PMCID: PMC8232380 DOI: 10.4322/acr.2021.293] [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] [Received: 04/27/2021] [Accepted: 05/17/2021] [Indexed: 11/23/2022] Open
Abstract
Epignathus, is a rare oropharyngeal teratoma arising from the head and neck region. Sporadic cases have been described with associated intracerebral teratoma. Even more infrequent and extraordinary is the circumstance of a teratoma with oropharynx destruction. We describe the case of a fetus with pharyngeal mass that completely destroyed the oral cavity. The histological examination revealed an immature teratoma (G3); only one other G3 case has been described.
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Affiliation(s)
- Valerio Pellegrini
- Ospedale Antonio Cardarelli, Regional Health Authority of Molise, Medical Department, Campobasso, Italy
| | - Francesco Colasurdo
- Ospedale Antonio Cardarelli, Regional Health Authority of Molise, Analysis Department of Transmural Services, Campobasso, Italy
| | - Massimiliano Guerriero
- Ospedale Antonio Cardarelli, Regional Health Authority of Molise, Pathology Laboratory Department of Transmural Services, Campobasso, Italy
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Mardy AH, Chetty SP, Norton ME, Sparks TN. A system-based approach to the genetic etiologies of non-immune hydrops fetalis. Prenat Diagn 2019; 39:732-750. [PMID: 31087399 DOI: 10.1002/pd.5479] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2019] [Revised: 04/11/2019] [Accepted: 05/09/2019] [Indexed: 12/11/2022]
Abstract
A wide spectrum of genetic causes may lead to nonimmune hydrops fetalis (NIHF), and a thorough phenotypic and genetic evaluation are essential to determine the underlying etiology, optimally manage these pregnancies, and inform discussions about anticipated prognosis. In this review, we outline the known genetic etiologies of NIHF by fetal organ system affected, and provide a systematic approach to the evaluation of NIHF. Some of the underlying genetic disorders are associated with characteristic phenotypic features that may be seen on prenatal ultrasound, such as hepatomegaly with lysosomal storage disorders, hyperechoic kidneys with congenital nephrosis, or pulmonary valve stenosis with RASopathies. However, this is not always the case, and the approach to evaluation must include prenatal ultrasound findings as well as genetic testing and many other factors. Genetic testing that has been utilized for NIHF ranges from standard chromosomal microarray or karyotype to gene panels and broad approaches such as whole exome sequencing. Family and obstetric history, as well as pathology examination, can yield additional clues that are helpful in establishing a diagnosis. A systematic approach to evaluation can guide a more targeted approach to genetic evaluation, diagnosis, and management of NIHF.
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Affiliation(s)
- Anne H Mardy
- Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco, San Francisco, CA, US
| | - Shilpa P Chetty
- Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco, San Francisco, CA, US
| | - Mary E Norton
- Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco, San Francisco, CA, US
| | - Teresa N Sparks
- Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco, San Francisco, CA, US
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Sun H, Ding H, Wang J, Zhang E, Fang Y, Li Z, Yu X, Wang C, Zhao Y, Chen K, Wen S, Li L, Shan S, Hong L, Chen F, Su P. The differences between gonadal and extra-gonadal malignant teratomas in both genders and the effects of chemotherapy. BMC Cancer 2019; 19:408. [PMID: 31039746 PMCID: PMC6492338 DOI: 10.1186/s12885-019-5598-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2018] [Accepted: 04/11/2019] [Indexed: 11/21/2022] Open
Abstract
Background A tumor comprising of different types of tissues (such as hair, muscle, bone, etc.) is known as a teratoma. It is a type of germ cell (cells that make sperm or eggs) tumor. When these germ cells have rapid cancerous growth, then such a teratoma is called a malignant teratoma. We have studied the differences between gonadal and extra-gonadal malignant teratomas and the effects of chemotherapy in both genders. Methods The samples of 3799 male and 1832 female patients with malignant teratoma samples, between the ages of 1 and 85+ years, were selected from the years 1973 to 2014. Trends in incidence, estimated prevalence, incidence rates, and frequency were calculated in gonadal and extra-gonadal tumors with age adjustment. The five-year observed, expected, and relative survival rates were analyzed to study the prognosis. Results The gonadal took over a majority percentage of malignant teratomas compared with the extra-gonadal (90% vs. 10% in male; 83% vs. 17% in female). For the male, the total of the gonadal and the extra-gonadal were all significantly decreased from 1973 to 2014 (p < 0.05). For the female, there were no significant trends. As for prevalence, incidence, and frequency, there were two separate peaks of malignant teratomas. One peak was at under 1 year old, which was composed of the extra-gonadal tumor; the other peak was at 20–24 for male and 10–34 for female, which was composed of the gonadal tumor. This separation of the gonadal and extra-gonadal showed a significant difference (p < 0.05). As for the prognosis, the extra-gonadal tumor showed significantly lower survival rates than the gonadal (p < 0.05). In the short term, the survival rate of the chemotherapy group was higher than the supportive care group. However, in the long term, the survival rate of the chemotherapy group was lower than the supportive care group. Conclusion The gonadal and extra-gonadal malignant teratomas show lots of differences. Chemotherapy might not help improve survival rates. Electronic supplementary material The online version of this article (10.1186/s12885-019-5598-0) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Hang Sun
- Department of Endocrinology, Shanghai Tenth Peoples' Hospital, Tongji University, No.301 Middle Yanchang Road, Shanghai, 200072, China.
| | - Hongxin Ding
- Hospital of Yantai University, Yantai University, Yantai, China
| | - Jianjun Wang
- Tongji Hospital, Tongji University, Shanghai, China
| | - Emma Zhang
- Mannjo Informatics Studio, Shanghai, China
| | - Yihua Fang
- The First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Zhenhua Li
- Yantai Yuhuangding Hospital, Qingdao University School of Medicine, Yantai, China
| | - Xiao Yu
- Huangshan First Peoples' Hospital, Huangshan, China
| | - Chongren Wang
- Shanghai General Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Yifan Zhao
- Department of Endocrinology, Shanghai Tenth Peoples' Hospital, Tongji University, No.301 Middle Yanchang Road, Shanghai, 200072, China
| | - Kan Chen
- Department of Endocrinology, Shanghai Tenth Peoples' Hospital, Tongji University, No.301 Middle Yanchang Road, Shanghai, 200072, China
| | - Siwan Wen
- Tongji Hospital, Tongji University, Shanghai, China
| | - Liang Li
- Tongji Hospital, Tongji University, Shanghai, China
| | - Shan Shan
- Shanghai Sixth Peoples' Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Liu Hong
- Sam M. Walton College of Business, University of Arkansas, Fayetteville, AR, USA
| | - Face Chen
- Department of Informatics, Discovery & Analytical Solutions, PerkinElmer, Shanghai, No.1670, Zhang Heng Road, Zhangjiang Hi-Tech Park, Shanghai, 201203, China
| | - Pu Su
- Department of Informatics, Discovery & Analytical Solutions, PerkinElmer, Shanghai, No.1670, Zhang Heng Road, Zhangjiang Hi-Tech Park, Shanghai, 201203, China.
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Kirishima M, Yamada S, Shinya M, Onishi S, Goto Y, Kitazono I, Hiraki T, Higashi M, Hida AI, Tanimoto A. An autopsy case of epignathus (immature teratoma of the soft palate) with intracranial extension but without brain invasion: case report and literature review. Diagn Pathol 2018; 13:99. [PMID: 30579363 PMCID: PMC6303979 DOI: 10.1186/s13000-018-0776-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2018] [Accepted: 12/10/2018] [Indexed: 12/17/2022] Open
Abstract
Background Epignathus is a rare congenital orofacial teratoma infrequently associated with intracranial extension. Intracranial extension of an epignathus indicates a poor prognosis; however, only a small number of such cases have been reported. While there have been some studies reporting cases of epignathus expanding directly into the cranium, others have reported no communication between an epignathus and an intracranial tumor. Case presentation A fetus at gestational week 27 was suspected of having an epignathus with intracranial tumor as shown by ultrasonographic and magnetic resonance imaging. The fetus was stillborn and an autopsy was performed. An epignathus measuring 12 × 6 × 6 cm and weighing 270 g protruded from the mouth, with its base on the soft palate. An intracranial tumor weighing 14 g was located at the middle intracranial fossa and connected to the epignathus through the right side of the sella turcica. The intracranial tumor was encapsulated, and there was no invasion into the brain. Histologically, both the epignathus and intracranial tumor were immature teratomas, with neural and pulmonary components that were especially immature as compared to those of the internal organs and brain tissues of the fetus. Conclusion There have been several reports of epignathus and intracranial tumors that did not communicate; therefore, careful evaluation is needed when a fetus is suspected of having an epignathus extending into an intracranial lesion. Our case supports the findings that an epignathus can directly expand into the cranium. Moreover, this is a rare case of an epignathus in which the intracranial lesion was encapsulated and did not invade the brain. These rare but important findings will provide additional, potential therapeutic strategies for gynecologists, neurosurgeons, and pathologists.
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Affiliation(s)
- Mari Kirishima
- Department of Pathology, Field of Oncology, Graduate School of Medical and Dental Sciences, Kagoshima University, 8-35-1 Sakuragaoka, Kagoshima, 890-8544, Japan. .,Department of Pathology, Kagoshima University Hospital, 8-35-1 Sakuragaoka, Kagoshima, 890-8544, Japan.
| | - Sohsuke Yamada
- Department of Pathology and Laboratory Medicine, Kanazawa Medical University, 1-1 Daigaku, Uchinada, Kahoku, Ishikawa, 920-0293, Japan
| | - Mitsuhisa Shinya
- Department of Obstetrics and Gynecology, Kagoshima University Hospital, 8-35-1 Sakuragaoka, Kagoshima, 890-8544, Japan
| | - Shun Onishi
- Department of Pediatric Surgery, Research Field in Medical and Health Sciences, Medical and Dental Area, Research and Education Assembly, Kagoshima University, 8-35-1 Sakuragaoka, Kagoshima, 890-8544, Japan
| | - Yuko Goto
- Department of Pathology, Field of Oncology, Graduate School of Medical and Dental Sciences, Kagoshima University, 8-35-1 Sakuragaoka, Kagoshima, 890-8544, Japan
| | - Ikumi Kitazono
- Department of Pathology, Field of Oncology, Graduate School of Medical and Dental Sciences, Kagoshima University, 8-35-1 Sakuragaoka, Kagoshima, 890-8544, Japan
| | - Tsubasa Hiraki
- Department of Pathology, Kagoshima University Hospital, 8-35-1 Sakuragaoka, Kagoshima, 890-8544, Japan
| | - Michiyo Higashi
- Department of Pathology, Kagoshima University Hospital, 8-35-1 Sakuragaoka, Kagoshima, 890-8544, Japan
| | - Akira I Hida
- Department of Pathology, Field of Oncology, Graduate School of Medical and Dental Sciences, Kagoshima University, 8-35-1 Sakuragaoka, Kagoshima, 890-8544, Japan
| | - Akihide Tanimoto
- Department of Pathology, Field of Oncology, Graduate School of Medical and Dental Sciences, Kagoshima University, 8-35-1 Sakuragaoka, Kagoshima, 890-8544, Japan
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Carvalho CHPD, Nonaka CFW, Elias CTV, Matheus RDCS, Dias RMB, Souza LBD, Pinto LP. Giant Epignathus Teratoma Discovered at Birth: A Case Report and 7-Year Follow-Up. Braz Dent J 2018; 28:256-261. [PMID: 28492758 DOI: 10.1590/0103-6440201701368] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2016] [Accepted: 06/20/2017] [Indexed: 05/13/2023] Open
Abstract
Teratomas are tumors composed by tissues derived from the three germ cell layers, and they are relatively uncommon in head and neck. The term epignathus has been applied to teratomas from the oropharynx. This paper reports the case of a giant epignathus teratoma discovered at birth, which was successfully managed and followed up for 7 years. A newborn boy presented a polypoid tumor mass exteriorizing through the mouth over a length of 9 cm, with some surface areas resembling skin and others exhibiting hair. Computed tomography showed that the mass arose deep from the left hemiface. Alpha-fetoprotein (AFP) levels were high (316,000 ng/mL). Surgery was performed and microscopic analysis confirmed the diagnosis of mature teratoma. Because of residual tumor and high AFP levels, the patient was submitted to chemotherapy, resulting in complete regression of the lesion and normalization of AFP levels. Surgical repair of a cleft palate was performed at 5 years of age. At 7 years of age, the patient was in good general health and showed no clinical signs of recurrence. Although epignathus is a rare condition, it should be diagnosed in the fetus as early as possible. Prenatal care provides unquestionable benefits, providing the early diagnosis of anomalies that can jeopardize the life of the fetus and contributing to the indication of cases that require treatment before birth.
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Affiliation(s)
| | | | | | | | | | - Lélia Batista de Souza
- Department of Oral Pathology, Dental School, UFRN - Universidade Federal do Rio Grande do Norte, Natal, RN, Brazil
| | - Leão Pereira Pinto
- Department of Oral Pathology, Dental School, UFRN - Universidade Federal do Rio Grande do Norte, Natal, RN, Brazil
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Prenatal diagnosis of epignathus with multiple malformations in one fetus of a twin pregnancy using three-dimensional ultrasonography and magnetic resonance imaging. Obstet Gynecol Sci 2015; 58:65-8. [PMID: 25629021 PMCID: PMC4303755 DOI: 10.5468/ogs.2015.58.1.65] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2014] [Revised: 07/25/2014] [Accepted: 07/31/2014] [Indexed: 11/16/2022] Open
Abstract
Epignathus is an extremely rare type of congenital teratoma arising in the oral cavity. Although it is a benign tumor, it is associated with high mortality and morbidity rates because of severe airway obstruction and other malformations. We present a case of epignathus affecting one fetus in a twin pregnancy. The tumor was associated with multiple congenital malformations including cleft palate, bifid tongue, bifid uvula, congenital heart defect, and bilateral inguinal hernias. The diagnostic value of three-dimensional ultrasonography and magnetic resonance imaging was explored with respect to antenatal counseling and peripartum management.
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Clinical Presentation of Epignathus Teratoma With Cleft Palate; and Duplication of Cranial Base, Tongue, Mandible, and Pituitary Gland. J Craniofac Surg 2013; 24:1486-91. [DOI: 10.1097/scs.0b013e3182953b1f] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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10
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Nagy GR, Neducsin BP, Lázár L, Stenczer B, Csapó Z, Rigó J. Early prenatal detection of a fast-growing fetal epignathus. J Obstet Gynaecol Res 2012; 38:1328-30. [PMID: 22564030 DOI: 10.1111/j.1447-0756.2012.01865.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Epignathus is a rare congenital orofacial teratoma. We present a case of a fast-growing tumor, where early prenatal diagnosis was made and where fetopathological examination revealed the reason of the remarkable ultrasonographic signs and underlined the expected poor prognosis. Ultrasonographic examination at 18 weeks' gestation showed that there was a growing tumor protruding from the fetus's mouth. The fetal stomach could not be seen and extreme polyhydramnios was also detected. After counseling, the couple opted for a termination of pregnancy. Fetopathological examination showed that the tumorosus mass was not only protruding from the mouth, but also inexplicably grew downwards, was connected to the hard palate and the periosteum of the vertebral corpus, making an airway and esophageal obstruction, causing the ultrasonographic findings. Postnatal treatment and surgical removal of this tumor seemed to be impossible. In case of an early detection of a fast-growing fetal epignathus, pregnancy termination should be considered.
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Affiliation(s)
- Gyula R Nagy
- 1st Department of Obstetrics and Gynecology, Faculty of Medicine, Semmelweis University, Budapest, Hungary.
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11
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Calda P, Novotná M, Cutka D, Břešt'ák M, Hašlík L, Goldová B, Vítková I, Vaněčková M, Seidl Z. A case of an epignathus with intracranial extension appearing as a persistently open mouth at 16 weeks and subsequently diagnosed at 20 weeks of gestation. JOURNAL OF CLINICAL ULTRASOUND : JCU 2011; 39:164-168. [PMID: 21387329 DOI: 10.1002/jcu.20762] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/29/2010] [Accepted: 09/20/2010] [Indexed: 05/30/2023]
Abstract
We report a rare case of oral mass (epignathus) with intracranial extension originally suspected antenatally at 16 weeks' gestation because of a persistent open mouth. Postmortem MRI and pathologic examination of the fetus confirmed an oral teratoma with bilateral ventricular dilatation, corpus callosum agenesis, and a neuroepithelial intracranial cyst. The relevant literature regarding this anomaly is reviewed.
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Affiliation(s)
- Pavel Calda
- Charles University in Prague, First Faculty of Medicine, Department of Obstetrics and Gynecology of the First Faculty of Medicine and General University Hospital, Apolinářská 18, 128 51, Prague 2, Czech Republic
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12
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Tonni G, Centini G, Inaudi P, Rosignoli L, Ginanneschi C, De Felice C. Prenatal Diagnosis of Severe Epignathus in a Twin: Case Report and Review of the Literature. Cleft Palate Craniofac J 2010; 47:421-5. [DOI: 10.1597/08-224.1] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
A prenatal ultrasound diagnosis of epignathus in a dichorionic-diamniotic twin pregnancy is reported. A complex mass protruding from the fetal face was seen at week 19. Amniocentesis resulted in a 46,XX fetus with elevated alpha-fetoprotein (α-FP). An increase in tumor size and severe polyhydramnios ensued. Selective feticide performed at 22 weeks led to untreatable uterine contractions with iatrogenic abortion and early neonatal mortality of the healthy cotwin. Without development of polyhydramnios and tumor growth, weekly scan and transvaginal cervical assessment would have been carried out and cesarean section planned at around 32 weeks. Necroscopy and histology aided the ultrasound-based prenatal diagnosis.
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Affiliation(s)
- Gabriele Tonni
- Prenatal Diagnostic Service, Division of Obstetrics and Gynecology, Guastalla Civil Hospital, AUSL Reggio, Emilia, Italy
| | - Giovanni Centini
- Prenatal Diagnostic Service, Department of Obstetrics and Gynecology, Policlinic Hospital “Le Scotte,” University of Siena, Italy
| | - Pieraldo Inaudi
- Department of Pediatric, Obstetric, and Reproductive Medicine, University of Siena, Italy
| | - Lucia Rosignoli
- Prenatal Diagnostic Service, Department of Obstetrics and Gynecology, Policlinic Hospital “Le Scotte,” University of Siena, Italy
| | - Chiara Ginanneschi
- Service of Human Pathology and Oncology, Pathologic Anatomy Unit, Policlinic Hospital “Le Scotte,” University of Siena, Italy
| | - Claudio De Felice
- Neonatal Intensive Care Unit, Policlinic Hospital “Le Scotte,” University of Siena, Italy
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13
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Tonni G, De Felice C, Centini G, Ginanneschi C. Cervical and oral teratoma in the fetus: a systematic review of etiology, pathology, diagnosis, treatment and prognosis. Arch Gynecol Obstet 2010; 282:355-61. [PMID: 20473617 DOI: 10.1007/s00404-010-1500-7] [Citation(s) in RCA: 66] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2010] [Accepted: 04/26/2010] [Indexed: 10/19/2022]
Abstract
INTRODUCTION The aim of the study was to produce a systematic review about etiology, pathology, diagnosis, prognosis and clinical management regarding oral and cervical teratomas. MATERIALS AND METHODS A systematic review of Pubmed/Medline using the following keywords was made: epignathus, cervical teratoma, fetus, oral teratoma, prenatal diagnosis, prognosis, treatment, ultrasound. CONCLUSION The following clinical conclusions can be reached: (1) teratomas are rare, usually benign congenital tumors which recognized multifactorial etiology; (2) prenatal ultrasound diagnosis can be made early in pregnancy (15-16 weeks); (3) 3D ultrasound and MRI may enhance the accuracy of the antenatal diagnosis (location, extension and intracranial spread) and may aid in the selection of patients requiring treatment; (4) prenatal karyotype and search for associated abnormalities is mandatory in all teratomas; (5) delivery should involve elective Cesarean section with ex utero intrapartum treatment procedure or resection of the tumor mass, which may be performed on placental support operation on placental support procedure to increase the chances of postnatal survival.
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Affiliation(s)
- Gabriele Tonni
- Division of Obstetrics and Gynecology, Guastalla Civil Hospital, AUSL Reggio Emilia, Guastalla, Italy.
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Dar P, Rosenthal J, Factor S, Dubiosso R, Murthy AS. First-trimester diagnosis of fetal epignathus with 2- and 3-dimensional sonography. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2009; 28:1743-1746. [PMID: 19933492 DOI: 10.7863/jum.2009.28.12.1743] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Affiliation(s)
- Pe'er Dar
- Department of Obstetrics and Gynecology, Montefiore Medical Center, 1695 Eastchester Rd, Suite 14, Bronx, NY 10461, USA.
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Ruano R, Benachi A, Aubry MC, Parat S, Dommergues M, Manach Y. The impact of 3-dimensional ultrasonography on perinatal management of a large epignathus teratoma without ex utero intrapartum treatment. J Pediatr Surg 2005; 40:e31-4. [PMID: 16291137 DOI: 10.1016/j.jpedsurg.2005.07.059] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
We report a case of epignathus teratoma diagnosed at 22 weeks of gestation in which 3-dimensional ultrasound (3DUS) was useful to plan perinatal management. A significant enlargement of the tumor, associated with polyhydramnios and preterm labor, was observed at 35 weeks of gestation. After amniotic fluid evacuation, 3DUS was performed in the presence of pediatricians, obstetricians, and otolaryngologists. Three-dimensional ultrasound revealed that great part of the tumor was located outside the fetal mouth and anterior to fetal mandible, suggesting that the newborn could breathe spontaneously by nasal via. A cesarean section with longitudinal hysterotomy was performed at 36 weeks followed by an immediate extirpation of the tumor and the intubation of the newborn. The management of this rare case illustrates that the ex utero intrapartum treatment (EXIT) procedure is not always necessary in this situation. Besides, the actual prenatal goal consists on carefully selecting fetuses with epignathus teratoma that will need the EXIT procedure from those that will not. Three-dimensional ultrasound and magnetic resonance imaging in association with 2DUS can be helpful in this prenatal selection.
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Affiliation(s)
- Rodrigo Ruano
- Maternité, Hôpital Necker-Enfants Malades AP-HP, Université de Paris V, France, 75743 Paris Cedex 15, France.
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Chen CP, Shih JC, Huang JK, Chin DTH, Tzen CY, Lin YH, Wang W. Two- and three-dimensional ultrasound demonstration of a giant epignathus. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2003; 21:407-409. [PMID: 12704754 DOI: 10.1002/uog.70] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
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Pino Rivero V, Mogollón Cano-Cortés T, Pando Pinto JM, Rejas Ugena E, Blasco Huelva A. [Epignathus. A case report and review of the literature]. ACTA OTORRINOLARINGOLOGICA ESPANOLA 2003; 54:305-8. [PMID: 12825247 DOI: 10.1016/s0001-6519(03)78418-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Epignathus is an uncommon form of oropharyngeal teratoma that is associated with a high mortality during the neonatal period. We report the clinical case of a neonate born through cesarean in week 35, Apgar 2-4, neurologic breakdown and widespread hypotonia. The prenatal diagnosis was performed by ultrasonography; the diameter of the solid mass was 5 cm with inner calcium density. An urgent tracheostomy was carried out as it was not possible to get orotracheal intubation (IOT) and, later, we proceeded to remove the mass which was embedded in the hard palate. Our patient died three weeks later due to respiratory and heart failure. We carry out a review of the literature for this pathology.
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Affiliation(s)
- V Pino Rivero
- Servicio de O.R.L. Hospital Infanta Cristina, Badajoz
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