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 Table of Contents  
CASE REPORT
Year : 2019  |  Volume : 8  |  Issue : 14  |  Page : 115-117

Cervical cystic teratoma of the neck in a neonate: A case report and literature review


Department of Pediatric Surgery, SMS Medical College, Jaipur, Rajasthan, India

Date of Submission01-Mar-2017
Date of Acceptance01-Jun-2019
Date of Web Publication04-Oct-2019

Correspondence Address:
Dr. Aditya Pratap Singh
Near the Mali Hostel, Main Bali Road, Falna, Pali, Rajasthan
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/nnjcr.nnjcr_45_16

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  Abstract 


Cervical teratoma is very rare. We are presenting here a case of cervical immature teratoma in a neonate with review of literature. A 17-day-old male baby with huge cervical teratoma and oral extension presented to us with feeding difficulties. We completely excised the tumor. The infant was discharged after 7 days with mild facial palsy. Uneventful recovery followed without recurrence. Histopathology suggested immature cystic teratoma. There was huge cervical teratoma with oral extension in the neonate. It was located at the cervical region which is very rare, and it was present in the male baby. We completely excised the tumor with mild facial palsy without recurrence. It should be kept in mind in case of neck swelling in a neonate. Cervical teratoma is a rare variety.

Keywords: Cervical, excision, neonate, teratoma


How to cite this article:
Singh AP, Tanger R, Mathur V, Gupta AK. Cervical cystic teratoma of the neck in a neonate: A case report and literature review. N Niger J Clin Res 2019;8:115-7

How to cite this URL:
Singh AP, Tanger R, Mathur V, Gupta AK. Cervical cystic teratoma of the neck in a neonate: A case report and literature review. N Niger J Clin Res [serial online] 2019 [cited 2019 Dec 5];8:115-7. Available from: http://www.mdcan-uath.org/text.asp?2019/8/14/115/268537




  Introduction Top


Classically, teratoma is composed of tissues from the three embryonic germ layers: ectoderm, mesoderm, and endoderm. Most commonly found in the sacrococcygeal region, these tumors are rare in the neck region. The cervical area is exceptionally affected.[1] The symptoms are mostly attributed to the mass effect of these lesions, making the cervical tumors potentially lethal.[2] Here, in the case report, we are presenting a rare case of huge cervical cystic teratoma with oral extension in a neonate.


  Case Report Top


A 17-day-old male baby was referred to us with a huge cervical mass detected at birth. Baby was asymptomatic except the neck swelling with some feeding difficulty. On local examination, there was a huge solitary left neck mass extending in the oral cavity, which was irregular, with a size of about 8 cm and having cystic-to-firm consistency with moderate mobility and no skin changes [Figure 1]. Blood investigations were within normal limits. Tumor markers (AFP and bHCG) were in normal range. X-ray neck lateral view suggested calcification in the soft-tissue shadow [Figure 2]. Computed tomography (CT) scan revealed tumoral calcifications and suggested mature cystic teratoma [Figure 3]. The infant underwent surgical excision. Through a left cervical incision, the tumor was completely excised [Figure 4]. The infant was discharged after 7 days with mild facial palsy. Uneventful recovery followed without recurrence. Histopathology suggested immature cystic teratoma.
Figure 1: Preoperative view of the tumor

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Figure 2: X-ray neck showed calcification

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Figure 3: Contrast-enhanced computed tomography neck image

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Figure 4: Postoperative view

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  Discussion Top


Teratomas originate from aberrant germ cells at the 4th or 5th week of gestation. These ectopic germ cells undergo proliferation and differentiate in mature (mature teratoma) or fetal (immature teratoma) tissue, depending on the amount of immature elements, most often neuroepithelium.[3]

Teratomas are known to occur anywhere in the body, the most common location being the sacral region. Cervical presentation constitutes 1.6%–9.3% of all pediatric teratomas, roughly equating to 1/40,000 births. They predominate in females (3/4 of the cases).[4] In our case, it was present in the male baby.

Mature teratomas consist of well- differentiated tissues and may be pure or have a histologic component of a mixed germ cell neoplasm. Immaturity does not equate to malignancy, as was previously thought, and <5% of congenital cervical teratomas are malignant.[5],[6]

Immature teratomas may be a component of a malignant germ cell tumor of mixed histology. The malignant component of mixed histology tumors that contain teratoma is usually of germ cell origin (yolk sac tumor, germinoma, embryonal carcinoma, or choriocarcinoma) and only rarely of somatic origin.[3]

Clinically, a cervical teratoma appears as a large single mass, although multiple lesions may occur. Airway obstruction is the main complication and is related to the size and site of the lesion, occurring in 80% to 100% of cases.[7] Peripartum mortality is often related to difficulty in establishing an airway after delivery.

The diagnosis can be made in utero on ultrasonography in pregnancy (15–16 weeks). The antenatal diagnosis of large congenital cervical teratomas allows for planned intervention by experienced personnel.[8] Ultrasonography three-dimensional and magnetic resonance imaging (MRI) may enhance the accuracy of the antenatal diagnosis and may help in the selection of newborns requiring early treatment.[9]

if the mass present after birth then ultrasonography, CT, and MRI are of primary importance for determining the extension, involvement of adjacent structures, and helps in planning surgery.[10] Complete excision should be done in all cases. The procedure must not be delayed because these lesions, although benign, may grow quickly.

If prenatal diagnosis is made, two procedures may be used: intrapartum treatment (EXIT) procedures and operation on placental support (OOPS). In the EXIT procedure, after a low transverse uterine incision, the head and at least one hand of the fetus are delivered. The rest of the body along with the umbilical cord and the placenta remain in utero. This allows examination of the airway.[1] In the OOPS procedure, the baby is completely delivered, and the umbilical cord is clamped only after securing the airway with endotracheal intubation, using a laryngoscope or rigid bronchoscope or tracheostomy.[8]

Regarding the treatment of immature teratomas, Marina et al.[11] found in a retrospective study of 73 children with extracranial immature teratomas that >85% of patients can be effectively treated with surgical resection alone and close observation.[11]

With good preoperative planning and complete surgical excision, there is no recurrence and few complications.[7] A regular and long-term follow-up is necessary to detect early recurrences.[12] Follow-up is based on clinical examination and MRI, especially in case of incomplete excision.[2] A trimestrial alpha-fetoprotein quantification is recommended by some authors.[2],[5] The recurrence can occur in <10% of operated patients and can be treated with further surgery or chemotherapy.[8],[11]


  Conclusion Top


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.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Acknowledgment

The authors would like to thank Dr. Annu Bhandari, senior professor, radiologist, Department of Radiology, SMS Medical College, Jaipur, Rajasthan, India.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Bergé SJ, von Lindern JJ, Appel T, Braumann B, Niederhagen B. Diagnosis and management of cervical teratomas. Br J Oral Maxillofac Surg 2004;42:41-5.  Back to cited text no. 1
    
2.
Mohanty MK, Sahu P, Jaiswal AA, Singal R, Gupta S, Kohli G, et al. Ahuge immature cervical teratoma; antenatal diagnosis, and its management – An unusual entity. J Clin Neonatol 2013;2:42-5.  Back to cited text no. 2
[PUBMED]  [Full text]  
3.
Silberman R, Mendelson IR. Teratoma of the neck: Report of two cases and review of the literature. Arch Dis Child 1960;35:159-70.  Back to cited text no. 3
    
4.
Uchiyama M, Iwafuchi M, Naitoh S, Matsuda Y, Naitoh M, Yagi M, et al. Ahuge immature cervical teratoma in a newborn: Report of a case. Surg Today 1995;25:737-40.  Back to cited text no. 4
    
5.
Batsakis JG, el-Naggar AK, Luna MA. Teratomas of the head and neck with emphasis on malignancy. Ann Otol Rhinol Laryngol 1995;104:496-500.  Back to cited text no. 5
    
6.
Byard RW, Jimenez CL, Carpenter BF, Smith CR. Congenital teratomas of the neck and nasopharynx: A clinical and pathological study of 18 cases. J Paediatr Child Health 1990;26:12-6.  Back to cited text no. 6
    
7.
Bianchi B, Ferri A, Silini EM, Magnani C, Sesenna E. Congenital cervical teratoma: A case report. J Oral Maxillofac Surg 2010;68:667-70.  Back to cited text no. 7
    
8.
Shine NP, Sader C, Gollow I, Lannigan FJ. Congenital cervical teratomas: Diagnostic, management and postoperative variability. Auris Nasus Larynx 2006;33:107-11.  Back to cited text no. 8
    
9.
Lloyd C, McHugh K. The role of radiology in head and neck tumours in children. Cancer Imaging 2010;10:49-61.  Back to cited text no. 9
    
10.
Agarwal G, Kar DK. Teratoma of the anterior mediastinum presenting as a cystic neck mass: A case report. J Med Case Rep 2008;2:23.  Back to cited text no. 10
    
11.
Marina NM, Cushing B, Giller R, Cohen L, Lauer SJ, Ablin A, et al. Complete surgical excision is effective treatment for children with immature teratomas with or without malignant elements: A Pediatric Oncology Group/Children's Cancer Group Intergroup Study. J Clin Oncol 1999;17:2137-43.  Back to cited text no. 11
    
12.
Benouaiche L, Couly G, Michel B, Devauchelle B. Diagnosis and management of cervicofacial congenital teratomas: About 4 cases, literature review and restatement. Ann Chir Plast Esthet 2007;52:114-23.  Back to cited text no. 12
    


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4]



 

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