Congenital Teratoma: About Three Cases

Presenter: A. Layouni (e-mail: [e-mail])

Introduction: Teratomas are complex malformations tumors. They are most often located in the sacrum coccyx area. The cervical spine, rare, commits the aesthetics and life-threatening by the obstructive nature of the upper airway. Antenatal diagnosis is possible by ultrasound and magnetic resonance imaging (MRI). The diagnostic confirmation is based on imaging (CT or MRI) and histological examination. The treatment is surgical. The excision should be radical and early to avoid degeneration or tumor recurrence. We report three cases of teratomas collected in our department between 2010 and 2015.

Case Reports: Case 1: Newborn male, from a well followed pregnancy, was born at 30 weeks’ gestation. The diagnosis of sacrum coccyx teratoma is evoked by fetal MRI. He was hospitalized at birth for respiratory failure and was noted on examination a fleshy mass sacrum coccyx 20 × 20 cm, purplish, vascularized and bleeding in places with loss of substance. Imaging concluded a mass of teratoma. The rate of α fetal protein (AFP) was high. Surgical excision is practiced at 14 days of age. Histology confirmed the diagnosis of immature teratoma. At 3 months of follow-up, the patient was doing well with normal serum AFP. A CT control is satisfactory (no recurrence). Case 2: Newborn girl, from a good pregnancy followed, sonographic prenatal diagnosis of a cervical mass at 31 week of amenorrhea. She was born at 37 weeks’ gestation by cesarean, it was noted on examination a neck mass, 15 × 15 cm, vascularized and obstructive. Immediately intubated in the delivery room. Imaging concluded a mass of teratoma. The rate of α fetal protein (AFP) was high. Subtotal resection is performed at 14 days of age. Histology confirmed the diagnosis of immature teratoma. The patient died at 36 days of age after septic shock. Case 3: Newborn male, was born at 37 weeks’ gestation by cesarean, it was noted on examination an immediate and severe respiratory distress with cervical mass 30 × 30 cm obstructive. Intubation was difficult because of the bulging mass in the pharynx with the presence of cleft palate. Imaging concluded a compressive mass of teratoma. The rate of α fetal protein was high. Subtotal resection is performed at 11 days of age, complicated by tracheal breach. Histology confirmed the diagnosis of immature teratoma. Extubation was impossible and the newborn has died at the age of two months. The autopsy showed a pulmonary tumor metastasis and constrictive pericarditis.

Conclusion: Teratomas are rare congenital tumors, whose most frequent location is sacrum coccyx and exceptionally cervical engaging the vital and functional prognosis. There are possibilities of malignant transformation, hence the importance of early excision and extended follow.