Accessible Unlicensed Requires Authentication Published by De Gruyter June 1, 2005

Strategy for management of newborns with cervical teratoma

Antoine De Backer, Gerard C. Madern, Cees P. van De Ven, Dick Tibboel and Frans W.J. Hazebroek
From the journal

Abstract

Background: Cervical teratomas are extremely rare tumors with high perinatal mortality and morbidity rates.

Objective: To compare our experience and outcome in newborns with cervical teratoma with similar reports from the literature, in order to propose a structured approach.

Methods: A retrospective review of seven patients treated between 1986 and 2000 was performed. The results of these seven patients were compared with and added to a series of 44 well-documented patients retrieved from the literature.

Results: In four of the seven patients, the diagnosis was not suspected antenatally. Three of the patients survived, one died. In the other three, the diagnosis was made antenatally. Two were born using the ex-utero intrapartum treatment (EXIT) procedure, one by planned cesarean section. Only one of these three survived. Mortality in the total series of 51 patients was 33% overall, and 46% in the group in which the diagnosis had been made antenatally. Peri- and post-operative complications were reported in 27%. Although larger tumors caused polyhydramnios more frequently than smaller tumors, and were associated with more severe respiratory distress, the relationship between tumor volume at birth and final outcome could not be established. This makes difficult the identification of fetuses with a disastrous prognosis.

Conclusion: Although mostly benign, cervical teratomas are still associated with high mortality rates. Timely antenatal diagnosis is indispensable in reducing morbidity and mortality caused by upper airway obstruction. A structured approach to the management of cervical teratoma is proposed.

:

Corresponding author: Antoine De Backer, M.D., Department of Pediatric Surgery, Academic Hospital, Free University of Brussels, Laarbeeklaan 101, B-1090 Brussels/Belgium. Tel.: +32-2-477-6061, Fax: +32-2-477-5783, E-mail:

References

1 April MM, RF Ward, JM Garelick: Diagnosis, management, and follow-up of congenital head and neck teratomas. Laryngoscope108 (1998) 1398Search in Google Scholar

2 Axt-Fliedner R, HJ Hendrik, K Ertan, et al.: Course and outcome of a pregnancy with a giant fetal cervical teratoma diagnosed prenatally. Ultrasound Obstet Gynecol18 (2001) 543Search in Google Scholar

3 Azizkhan RG, GM Haase, H Applebaum, et al.: Diagnosis, management, and outcome of cervicofacial teratomas in neonates: a children’s cancer group study. J Pediatr Surg30 (1995) 312Search in Google Scholar

4 Bouchard S, MP Johnson, AW Flake, et al.: The EXIT procedure: experience and outcome in 31 cases. J Pediatr Surg37 (2002) 418Search in Google Scholar

5 Byard RW, CL Jimenez, L Moore: Mechanisms of sudden death in patients with congenital teratoma. Pediatr Surg Int7 (1992) 464Search in Google Scholar

6 Carr MM, P Thorner, JH Phillips: Congenital teratomas of the head and neck. J Otolaryngol26 (1997) 246Search in Google Scholar

7 Chervenak FA, MA Farley, LR Walters, et al.: When is termination of pregnancy during the third trimester morally justifiable? N Engl J Med310 (1984) 501Search in Google Scholar

8 Chervenak FA, MA Farley, LR Walters, et al.: Termination of pregnancy during the third trimester (Letter) N Engl J Med311 (1984) 265Search in Google Scholar

9 Elmasalme F, M Giacomantonio, KD Clarke, et al.: Congenital cervical teratoma in neonates: case report and review. Eur J Pediatr Surg10 (2000) 252Search in Google Scholar

10 Green JS, FL Dickinson, A Rickett, et al.: MRI in the assessment of a newborn with cervical teratoma. Pediatr Radiol28 (1998) 709Search in Google Scholar

11 Gundry SR, JR Wesley, MD Klein, et al.: Cervical teratoma in the newborn. J Pediatr Surg18 (1983) 382Search in Google Scholar

12 Hany Hassab M, SM Shadi, YF Al-Olayet, et al.: Ten years’ experience in the management of cervical teratomas. Pediatr Surg Int11 (1996) 536Search in Google Scholar

13 Hirose S, RM Sydorak, K Tsao, et al.: Spectrum of intrapartum management strategies for giant fetal cervical teratoma. J Pediatr Surg38 (2003) 446Search in Google Scholar

14 Holinger LD, JC Birnholz: Management of infants with prenatal ultrasound diagnosis of airway obstruction by teratoma. Ann Otol Rhinol Laryngol96 (1987) 61Search in Google Scholar

15 Jordan RB, MWL Gauderer: Cervical teratomas: an analysis. Literature review and proposed classification. J Pediatr Surg23 (1988) 583Search in Google Scholar

16 Kagan AR, RJ Steckel: Cervical mass in a fetus associated with maternal hydramnios. Am J Roentgenol140 (1983) 507Search in Google Scholar

17 Kathary N, DI Bulas, KD Newman, et al.: MRI imaging of fetal neck masses with airway compromise: utility in delivery planning. Pediatr Radiol31 (2001) 727Search in Google Scholar

18 Kelly MF, L Berenholz, KA Rizzo, et al.: Approach for oxygenation of the newborn with airway obstruction due to a cervical mass. Ann Otol Rhinol Laryngol99 (1990) 179Search in Google Scholar

19 Kerner B, E Flaum, H Mathews, et al.: Cervical teratoma: prenatal diagnosis and long-term follow-up. Prenat Diagn18 (1998) 51Search in Google Scholar

20 Kountakis SE, AM Minotti, A Maillard, et al.: Teratomas of the head and neck. Am J Otolaryngol15 (1994) 292Search in Google Scholar

21 Lack EE: Extragonadal germ cell tumors of the head and neck region. Hum Pathol16 (1985) 56Search in Google Scholar

22 MacPherson LK, AM Fink: Giant cervical teratoma with airway obstruction: the role of fetal and neonatal MRI in perinatal management. Clin Radiol Extra57 (2002) 21Search in Google Scholar

23 Mychaliska GB, JF Bealer, JL Graf, et al.: Operating on placental support: the ex-utero intrapartum treatment procedure. J Pediatr Surg32 (1997) 227Search in Google Scholar

24 Murphy DJ, PM Kyle, P Cairns, et al.: Ex-utero intrapartum treatment for cervical teratoma. Br J Obstet Gynaecol108 (2001) 429Search in Google Scholar

25 O’Callaghan SP, P Walker, C Wake, et al.: Perinatal care of a woman with the prenatal diagnosis of a massive fetal neck tumor (cervical teratoma). Br J Obstet Gynaecol104 (1997) 261Search in Google Scholar

26 Patel RB, JY Gibson, CA D’Cruz, et al.: Sonographic diagnosis of cervical teratoma in utero. Am J Roentgenol139 (1982) 1220Search in Google Scholar

27 Rothschild MA, P Catalano, M Urken, et al.: Evaluation and management of congenital cervical teratoma. Arch Otolaryngol Head Neck Surg120 (1994) 444Search in Google Scholar

28 Sbragia L, BW Paek, VA Feldstein, et al.: Outcome of prenatally diagnosed solid fetal tumors. J Pediatr Surg36 (2001) 1244Search in Google Scholar

29 Shah SI, A Holterman, GR Licameli: Congenital cervical teratoma: airway management and complications. Otolaryngol Head Neck Surg124 (2001) 53Search in Google Scholar

30 Sichel JY, R Eliashar, I Yatsiv, et al.: A multidisciplinary team approach for management of a giant congenital cervical teratoma. Int J Ped Otorhinolaryngol65 (2002) 241Search in Google Scholar

31 Stevens GH, BC Schoot, MJW Smets, et al.: The ex-utero intrapartum treatment (EXIT) procedure in fetal neck masses: a case report and review of the literature. Eur J Obstet Gynecol Reprod Biol100 (2002) 246Search in Google Scholar

32 Wakhlu A, AK Wakhlu: Head and neck teratomas in children. Pediatr Surg Int16 (2000) 333Search in Google Scholar

33 Zerella JT, FJ Finberg: Obstruction of the neonatal airway from teratomas. Surg Gynecol Obstet170 (1990) 126Search in Google Scholar

Published Online: 2005-06-01
Published in Print: 2004-11-04

© Walter de Gruyter