Home | About Us | Current Issue | Ahead of print | Archives | Search | Instructions | Subscription | Feedback | Editorial Board | e-Alerts | Login 
Journal of Indian Association of Pediatric Surgeons
     Journal of Indian Association of Pediatric Surgeons
Official journal of the Indian Association of Pediatric Surgeons         
 Users Online:212 
  Print this page Email this page   Small font sizeDefault font sizeIncrease font size


 
Table of Contents   
CASE REPORT
Year : 2019  |  Volume : 24  |  Issue : 4  |  Page : 307-308
 

Cervical giant immature teratoma in a newborn: A challenge for survival


Department of Paediatric Surgery, Gandhi Medical College and Hospital, Secunderabad, Telangana, India

Date of Web Publication29-Aug-2019

Correspondence Address:
Dr. Nagarjuna Kumbha
4-7-12/53 Ravindra Nagar Colony, Nacharam, Hyderabad - 500 076, Telangana
India
Login to access the Email id

Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jiaps.JIAPS_136_18

Rights and Permissions

 

   Abstract 


Teratomas are a conglomerate of heterogenous cells arising from totipotent germ cells. Cervical teratomas occur 1 per 20,000 to 40,000 live births constituting 1.6-9.3% of all paediatric teratomas . They can present antenatally with cervical mass or polyhydramnios and postnatally with respiratory distress and facial disfigurement. Complete excision of the tumour prevents malignant transformation. Timing of the surgery is based on severity of airway compromise. Surgical outcome and survival depend on pre-existing pressure effects, operative injuries to the vital structures and also co-existing comorbidities. One such complicated case of giant cervical teratoma is described here.


Keywords: Cervical teratoma, germ cell tumor, pulmonary arterial hypertension


How to cite this article:
Kumbha N, Rohita A, Reddy SP, Sagar AK. Cervical giant immature teratoma in a newborn: A challenge for survival. J Indian Assoc Pediatr Surg 2019;24:307-8

How to cite this URL:
Kumbha N, Rohita A, Reddy SP, Sagar AK. Cervical giant immature teratoma in a newborn: A challenge for survival. J Indian Assoc Pediatr Surg [serial online] 2019 [cited 2019 Sep 15];24:307-8. Available from: http://www.jiaps.com/text.asp?2019/24/4/307/265689





   Introduction Top


Cervical teratomas constitute 1.6%–9.3% of all pediatric teratomas.[1],[2] They can present antenatally with cervical mass or polyhydramnios and postnatally with respiratory distress and facial disfigurement. Surgical outcome and survival depend on preexisting pressure effects, operative injuries to the vital structures, and also coexisting comorbidities. One such complicated case of giant cervical teratoma is described here.


   Case Report Top


A full-term female neonate was born with a huge lobulated cervical mass [Figure 1]. At birth, the baby was desaturating and was immediately intubated. Alpha-fetoprotein (AFP) was 65,000 ng/ml and beta human chorionic gonadotropin was 35 mIU/ml. The child was operated within 16 h of life due to tracheal compression. Complete excision of the tumor measuring 15 cm × 12 cm × 8 cm, adherent to pretracheal fascia, left carotid sheath, [Figure 1] displacing the trachea and the carotid vessels, with preservation of neurovascular structures, was successfully done. Histopathology showed fibrocartilaginous tissue and few cystic spaces [Figure 2] lined by mucin-secreting columnar epithelium along with extensive areas of glial tissue admixed with cluster of small-to-round cells having hyperchromatic nuclei in rossettoid pattern consistent with immature teratoma WHO grade 3.[3]
Figure 1: Preoperative appearance and completely excised gross specimen of the tumor

Click here to view
Figure 2: Histopathology demonstrating the features of immature teratoma. (a) Glandular epithelium – endoderm (short arrow); (b) cartilage – mesoderm (thin long arrow); (c) immature neural elements – ectoderm (arrowhead)

Click here to view


Postoperatively, the child required prolonged ventilation for 14 days due to tracheomalacia. Two-dimensional echo revealed severe pulmonary arterial hypertension (PAH) which was managed with ventilation, sildenafil, and bosentan. PAH and tracheomalacia regressed completely over the next 4 weeks. Neuropraxia of marginal mandibular, glossopharyngeal, vagus, and hypoglossal nerves presenting as transient mouth and tongue deviation, respiratory distress, regurgitation, and swallowing difficulties resolved completely by the time of discharge. The child is currently 6 months postoperative and AFP now is <16 ng/ml and she has no airway or facial abnormality.


   Discussion Top


Literature search revealed only a few surviving cases of giant cervical immature teratoma.[2] Antenatal scans at times may not identify the mass as in the cases reported by Gezer et al.[4] The reasons for morbidity and mortality of giant cervical teratomas are airway obstruction, pressure on cervical neurovascular structures and comorbid factors

In antenatally diagnosed cases, airway is secured either by ex utero intrapartum treatment procedure or by extracorporeal membrane oxygenation.[5] If airway is not secured, an aggressive surgical exploration has to be done by a team with adequate expertise.[6]

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.


   Conclusion Top


Giant cervical immature teratoma with PAH in a surviving neonate as reported here is of interest because of its rarity and survival is possible with aggressive multidisciplinary approach.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
   References Top

1.
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. 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.
Kurman RJ, Carcangiu ML, Simon Herrington C, Young RH. WHO Classification of Tumours of Female Reproductive Organs. 4th ed. Lyon, France: International Agency for Research on Cancer 2014; p. 61-2.   Back to cited text no. 3
    
4.
Gezer HÖ, Oǧuzkurt P, Temiz A, Bolat FA, Hiçsönmez A. Huge neck masses causing respiratory distress in neonates: Two cases of congenital cervical teratoma. Pediatr Neonatol 2016;57:526-30.  Back to cited text no. 4
    
5.
Michel TC, Rosenberg AL, Polley LS. EXIT to ECMO. Anesthesiology 2002;97:267-8.  Back to cited text no. 5
    
6.
Jang J, Park J. Huge congenital cervical immature teratoma mimicking lymphatic malformation in a 7 day old male neonate. J Pediatr Surg Case Rep 2016;8:16-8.  Back to cited text no. 6
    


    Figures

  [Figure 1], [Figure 2]



 

Top
Print this article  Email this article

    

 
  Search
 
  
 
    Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
 Related articles
    Article in PDF (1,002 KB)
    Citation Manager
    Access Statistics
    Reader Comments
    Email Alert *
    Add to My List *
* Registration required (free)  


    Abstract
   Introduction
   Case Report
   Discussion
   Conclusion
    References
    Article Figures

 Article Access Statistics
    Viewed86    
    Printed0    
    Emailed0    
    PDF Downloaded11    
    Comments [Add]    

Recommend this journal


Contact us | Sitemap | Advertise | What's New | Copyright and Disclaimer 

  2005 - Journal of Indian Association of Pediatric Surgeons | Published by Wolters Kluwer - Medknow 

Online since 1st May '05