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[Mediastinal teratomas in children]
1Subkatedrá dĕtské chirurgie IPVZ, Klinika dĕtské chirurgie 2. LF UK a FN Motol, Praha. mrygl@yahoo.com
Insights
Complete surgical removal is effective for most pediatric mediastinal teratomas. Malignant types require chemotherapy and long-term monitoring of tumor markers for recurrence.
Area of Science:
- Pediatric Oncology
- Surgical Pathology
- Thoracic Surgery
Context:
- Mediastinal teratomas are rare tumors in children.
- Diagnosis often occurs with respiratory symptoms.
Purpose:
- To review clinical and histopathological features of pediatric mediastinal teratomas.
- To evaluate treatment outcomes and recurrence patterns.
Summary:
- Eight pediatric cases (neonate to 15 years) of mediastinal teratoma were analyzed.
- Tumors included mature, differentiated, and one malignant teratoma.
- Complete resection was curative for mature/differentiated types; malignant teratoma recurred despite treatment.
Impact:
- Radical surgery is sufficient for benign teratomas.
- Malignant teratomas necessitate multimodal treatment (surgery + chemotherapy).
- Long-term surveillance for tumor markers and imaging is crucial for high-risk cases.
Abstract:
The objective of the work is a clinical and histopathological retrospective study of rare mediastinal teratomas in children. The authors present their experience with the treatment of eight children within the range from neonates to the age of 15 years with a histologically confirmed diagnosis of mediastinal teratoma. In two neonates the first symptom was postnatal dypnoea, teratomas in older children were diagnosed along with symptoms of acute respiratory infection. Complete resection of the tumor was performed in all patients, in neonates emergency operations were involved. Four tumors were histologically classified as mature teratomas, three as differentiated teratomas with an immature component and one as a malignant teratoma. The malignant teratoma contained mature tissues as well as tissues of embryonic carcinoma and a yolk sac tumor. Seven children with a mature or differentiated teratoma are without signs of disease 5-15 years after surgery. During the follow-up of the 15-year-old boy with the malignant teratoma the elevated alpha-fetoprotein serum level was evidence of a relapse of the disease after termination of comprehensive treatment. From the results ensues that radical extirpation is sufficient treatment for mature and differentiated teratomas. Malignant teratomas are indicated for primary resection and postoperative chemotherapy. Long-term follow up of alpha-fetoprotein and human beta-choriogonadotropin levels, clinical controls and controls by imaging methods are indicated in children with an immature or malignant component of the tumor.