Prenatal diagnosis of a giant epignathus teratoma in the third trimester of pregnancy using three-dimensional ultrasound and magnetic resonance imaging. Case report

Abstract

A 20-year-old nulliparous woman was referred due a cervical mass in the fetus in an ultrasound examination performed in the 25th week of pregnancy. The exam revealed an irregular, solid-cystic heterogeneous mass measuring 75x54 mm that came to the exterior through the mouth of the fetus. Three-dimensional ultrasound and magnetic resonance imaging confirmed the diagnosis of epignathus teratoma and the normal finding of the central nervous system. The patient was admitted at 28 weeks, in premature labor. Tocolysis, corticosteroid and amniotic fluid drainage were programmed to be performed before conducting ex utero intrapartum treatment (EXIT). However, there was premature rupture of membranes and the EXIT procedure was brought forward. After premature placental abruption, the newborn's birth was concluded. Tracheostomy was performed, but the newborn's condition progressed to bradycardia and death in a few minutes.

Prenatal diagnosis and outcomes of fetal teratomas

“…After birth, that neonate was transported to the neonatal intensive care unit and successfully underwent surgery. Similarly to our experience, previous investigators have published case reports and results of studies showing that a prenatal diagnosis of oropharyngeal and cervical teratomas is important for planning delivery and providing adequate intrapartum and postnatal resuscitation …”

“…Facial and cervical teratomas are very rare tumors that appear on US as large lobulated facial masses with solid and cystic components. They are associated with high morbidity and mortality rates because of airway obstruction and compression of other structures, polyhydramnios, nonimmune hydrops fetalis, preterm delivery, and rupture‐related complications . In our study, one pregnancy complicated by a fetal oropharyngeal teratoma associated with bilateral ventriculomegaly was terminated.…”

Neonatal epignathus in the oral and pharyngeal regions: A case report

“…Surgical resection is the only effective way to treat teratomas . The published report of clinical findings in patients with giant epignathus is shown in Table . In the present case, although partial resection of the tumor by pediatric surgeons was made as a first step, this was unavoidable because the tumor was oppressing her face.…”

“…8 The published report of clinical findings in patients with giant epignathus is shown in Table 1. 2,3,6,11,[13][14][15][16][17][18][19][20][21][22][23][24][25][26][27][28] In the present case, although partial resection of the tumor by pediatric surgeons was made as a first step, this was unavoidable because the tumor was oppressing her face. It had been difficult to approach the tumor in the pharyngeal region before resection of the tumor protruding from the left nostril.…”

Giant Epignathus Teratoma Discovered at Birth: A Case Report and 7-Year Follow-Up

“…Prenatal care permits some measures to save the infant's life and to reduce sequelae. These procedures include ex-utero intrapartum treatment (EXIT) or resection of the tumor at the time of cesarian section and prior to cutting the umbilical cord, called operation on placental support (OOPS) (20,21). In the present case, it was not possible to perform any procedure before the birth of the patient.…”