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Cervical teratomas in the newborn
Insights
Cervical teratomas in newborns are rare neck masses that can cause severe respiratory distress. Prompt surgical intervention significantly reduces mortality rates for these congenital tumors.
Area of Science:
- Pediatric Surgery
- Neonatal Oncology
- Endocrinology
Background:
- Cervical teratomas are rare neoplasms.
- Infrequently reported in medical literature.
Observation:
- Six newborns presented with large, semicystic neck masses.
- Four neonates required intubation due to respiratory distress.
- Thyroid-stimulating hormone (TSH) levels were elevated in two infants.
Findings:
- Surgical removal via total thyroid lobectomy was successful in four neonates operated within 24 hours.
- Tumors were well-encapsulated, associated with the thyroid gland.
- Prompt surgery reduced mortality from 80% to 15%.
Implications:
- Cervical teratomas can cause significant neonatal respiratory distress.
- Emergency surgery is crucial for improving outcomes in affected newborns.
- Early diagnosis and surgical management are key to survival.
Abstract:
Cervical teratomas are rare neoplasms which have been infrequently reported. During the period of July 1974 to April 1982, six newborns with this lesion were seen at the Mott Children's Hospital. There were three males and three females, all of whom presented at birth with large semicystic neck masses. In four infants, calcifications were seen on x-ray. Four patients required intubation within the first hours of life for respiratory distress. One child of 33 weeks gestation expired prior to operation because of a hypoplastic left ventricle and bilateral hypoplastic lungs. Cord blood T3 and T4 values were normal in three patients; the TSH was elevated 1.5 and 2 times normal in two of these infants. Four neonates were operated upon within 24 hours of birth and suffered no postoperative complications. One baby presented on the third day of life and expired three hours postoperatively from persistent respiratory distress. The tumors were well encapsulated and arose from or were surrounded by a lobe of the thyroid gland. In each case, the tumor was removed by performing a total thyroid lobectomy. The presence of normal thyroid tissue at the resection margin (in the isthmus) was verified by frozen section. One patient presented with cervical node metastases but is currently free of disease one year postoperatively. These six cases bring the total reported cases in the literature to 136. The 80% mortality in cases not operated upon has been reduced to 15% by prompt operation. This series substantiates the significant respiratory distress that can occur in newborns with cervical teratomas and confirms the need for emergency surgery in this group of patients.