Massive immature teratoma in a neonate

Area of Science:

• Developmental Biology
• Pediatric Oncology
• Surgical Oncology

Background:

• Teratomas are embryonal tumors originating from three germinal layers with varying maturity.
• Epignathus teratomas are rare congenital tumors presenting in the head and neck region.
• Immature teratomas pose significant challenges due to rapid growth and potential for airway compromise.

Purpose of the Study:

• To report a case of a large immature epignathus teratoma managed with a multidisciplinary approach.
• To highlight the utility of prenatal diagnosis and ex utero intrapartum treatment (EXIT) for airway management.
• To evaluate the role of serum alpha fetoprotein as a potential biomarker for teratoma recurrence.

Main Methods:

• Prenatal diagnosis of a large epignathus teratoma.
• Planned cesarean delivery with ex utero intrapartum treatment (EXIT) for airway management.
• Multidisciplinary therapy including surgical resection and adjuvant chemotherapy.
• Monitoring of serum alpha fetoprotein levels post-operatively.

Main Results:

• Successful airway management and tumor control were achieved through a planned EXIT procedure.
• The teratoma, lacking a clear pedicle and capsule, required extensive surgical intervention.
• Adjuvant chemotherapy was administered.
• After 4 years, no tumor regrowth was observed, and the patient exhibits normal respiration and swallowing.
• Serum alpha fetoprotein levels showed potential as a post-operative monitoring indicator.

Conclusions:

• A multidisciplinary approach is crucial for managing complex cases of immature epignathus teratomas.
• Prenatal diagnosis and EXIT procedures are vital for optimizing outcomes in cases with predicted airway obstruction.
• Serum alpha fetoprotein may serve as a valuable indicator for monitoring teratoma recurrence post-surgery.