Teratomas of the neck and mediastinum in children

Abstract

This retrospective study reviews a series of teratomas of the neck and mediastinum aiming at defining the features of these particular locations. We recorded prenatal diagnosis, perinatal management, clinical and radiologic features, pathology, surgical strategies and results in cervical and mediastinal teratomas treated over the last 10 years. During this period we treated 66 children with teratoma of which 11 (6 male and 5 female) had cervicomediastinal locations. Five babies had cervical teratomas extended into the anterior mediastinum in two cases. Prenatal diagnosis was made in three (two with polyhydramnios). Four babies were born by C-section and only one had a successful EXIT procedure. The diagnosis was confirmed by imaging and increased AFP. Surgical treatment involved total tumor removal and in one case subsequent removal of lymph node metastases. All children survived except one in whom airway could not be cleared at birth. Two children bear mild hypothyroidism. During the same period six patients aged 0-17 years were treated for mediastinal teratoma. Only one was prenatally diagnosed and only two had some dyspnea. Removal was performed either by median sternotomy, thoracotomy, or thoracoscopy. They all survive and are free of disease. Teratomas of the neck may cause fetal disease and unmanageable neonatal airway obstruction. Prenatal diagnosis and planned multidisciplinary management are mandatory at birth. In contrast, only some mediastinal tumors cause respiratory embarrassment. Although benign, these tumors are sometimes immature and may metastasize to regional lymph nodes. Total surgical removal is curative. Thyroid insufficiency may be present at birth in cervical teratomas and may be aggravated by surgery.

A newborn with respiratory distress and hydrocephalus caused by a giant mature teratoma

“…Accurate diagnosis and early resection can decrease mortality and morbidity [3-5, 12, 13]. The intrauterine or neonatal mortality rate due to airway obstruction is about 80% [4,5]. Ex utero intrapartum treatment (EXIT) is the procedure of choice for treating fetuses with huge masses and suspected airway obstruction [4,12].…”

Giant teratoma of anterior mediastinum in a 14-year-old girl as an example of potential diagnostic problems and errors

“…In case of mediastinal location, teratoma may exert symptoms of respiratory inefficiency in neonates or infants, directly threatening the child's life [3,[6][7][8]. According to American authors, 42% of tumors are diagnosed prenatally [3].…”

“…According to American authors, 42% of tumors are diagnosed prenatally [3]. Mediastinal teratomas are operated on mainly immediately after birth or during the first months of life [3,[6][7][8][9]. However, late diagnosis of thoracic teratomas may occur.…”

“…In patients under follow-up observation after completion of treatment, it may be the first indicator of cancer relapse. In most cases, teratomas are diagnosed immediately after birth or in infancy [3,[6][7][8].…”

Accumulation of gallium-67 within mature and immature teratoma in pediatric patients: investigation for the uptake mechanism

“…Their histological features are therefore heterogeneous, and they may include cystic or solid areas with organoid patterns as well as mature or immature components. Teratomas in children commonly occur in the ovary and sacrococcygeal region, but they are also found in many other anatomic regions [30]. Occult malignancy (teratoma with yolk sac elements) is common in neonatal sacrococcygeal teratomas, and detection of such yolk sac foci is particularly important [31].…”