Intrapericardial teratoma in a low birth weight preterm infant: a successful multidisciplinary approach

Abstract

We report the case of an intrapericardial teratoma, a rare tumour in infants, prenatally diagnosed and successfully treated thanks to a multidisciplinary approach. An intrapericardial cystic mass (2.5 cm) with pericardial effusion was identified in a foetus at 32 weeks gestational age (GA). Intrauterine pericardiocentesis was performed immediately (40 ml) and repeated at 33 weeks (25 ml) and then at 34 weeks GA, just before birth (36 ml). Considering the rapid growth of the mass and the risk of hydrops, vaginal delivery was induced. A baby girl weighing 1.98 kg was born without cardiorespiratory compromise. Echocardiography and thoracic CT-scan located the 4.0×3.0 cm cystic mass between the left atrial appendage and the left superior pulmonary vein. At three days of life, the mass was completely removed without cardiobypass. It arose from the ascending aorta. Postoperative course was uneventful. Pathology diagnosed an immature intrapericardial teratoma. As long-term follow-up is required, alpha-fetoprotein can be a valid tool to monitor a possible recurrence. A multidisciplinary approach allows successful prenatal management and postnatal tumour surgery.

Fetal Intrapericardial Teratomas: An Update

“…In 11 (61.1 %) of the 18 fetuses, reaccumulation occurred one to three times [11, 14, 16, 22-24, 26, 27, 34, 44, 50], and in 1 (5.6 %) fetus, pericardial effusions persisted [21]. Further management was required in these 12 fetuses, including repeated pericardiocentesis in 8 (66.7 %) fetuses [14,23,24,26,27,34,44,50], a pericardio-amniotic shunt in 3 (25 %) fetuses [11,16,34], and pericardial drain placement in 1 (8.3 %) fetus [22]. The antenatal management applied in the other 6 (25 %) fetuses was: an ex utero intrapartum treatment (EXIT) procedure in 3 (50 %) cases [9,43,49], a pericardio-amniotic shunt in 2 (33.3 %) cases [48,51], and laser ablation of the feeding vessels of the tumor, which resolved the pericardial effusions but failed to inhibit the growth of tumor in 1 (16.7 %) case [30].…”

“…The timing of delivery was reported for 46 fetuses, which was 33.0 ± 5.0 (range, 19-40; median, 34) weeks of gestation (n = 46). The delivery modes were described in 43 cases: cesarean section in 34 (79.1 %) cases [9, 12-23, 25-30, 32-35, 38, 42-45, 49-51] (cesarean section for an EXIT procedure in 2 cases [9,43]); emergent cesarean section in 3 cases [18,19,21]); vaginal delivery in 5 (11.6 %) cases [11,24,31,38,39]; termination of pregnancy in 3 (7.0 %) cases [11,40,47]; and induction of labor of a stillborn in 1 (2.3 %) case [37]. Gender was known for 35 (63.6 %) neonates: 20 (57.1 %) were females and 15 (42.9 %) were males (χ 2 = 1.4, p = 0.339).…”

“…The gross pathology of the teratomas was reported for 33 (60 %) cases: 18 (54.5 %) were cystic [9-13, 16-22, 25, 27, 32-38, 40, 42, 43, 45-47, 50, 51]; 2 (6.1 %) were cystic with solid areas [23,41]; 1 (3.0 %) was solid [28]; and 12 (36.4 %) were solid with cystic components [14, 15, 24, 26, 29-31, 38, 39, 48, 49]. The histology of the tumors was reported for 47 (85.5 %) cases: 12 (25.5 %) were mature [10,14,15,21,25,31,32,[34][35][36]46]; 14 (29.8 %) were immature [9,11,12,16,22,24,28,33,38,39,41,[49][50][51]; 10 (21.3 %) were mixed mature and immature with a predominance of mature cells [13, 18, 23, 26, 29, 30, 38, 41, 42, ]; 4 (8.5 %) were mixed mature and immature with a predominance of immature components; and 3 (6.4 %) were unspecified teratomas [17,20,27].…”

“…▶Fig. 1 The decreasing trend of the α-fetoprotein level from birth to 6 months after tumor resection in newborns in whom an intrapericardial teratoma was detected during fetal life [9,13,19,22,24,32,33,35,42]. m, month.…”

Heart Tumors in 33 Fetuses - Review of Twenty-Two Years of the Single-Centre Experience

“…Yinon et al 6 recall three cases, none of them ends favourably. On the other hand, a multidisciplinary approach to this rare tumor may have superb effects 16,17 . Tollens et al 17 present a management algorithm for cases diagnosed with teratoma in antenatal period.…”