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Mediastinal teratomas: review of 15 pediatric cases
1Department of Paediatric Surgery, Hospital for Sick Children, London, England.
Insights
Mediastinal teratomas in children are rare and often undiagnosed preoperatively. Neonatal cases may present with respiratory distress and immature teratomas, requiring prompt surgical intervention.
Area of Science:
- Pediatric Surgery
- Oncology
- Thoracic Surgery
Background:
- Mediastinal teratomas are uncommon pediatric neoplasms.
- Diagnosis is frequently delayed until surgical exploration.
Purpose of the Study:
- To review the clinical and pathological features of pediatric mediastinal teratomas.
- To identify diagnostic and therapeutic challenges.
Main Methods:
- Retrospective review of 15 pediatric patients with mediastinal teratomas.
- Analysis of clinical presentation, radiographic findings, surgical approaches, and histopathology.
Main Results:
- 15 patients (6 neonates, 9 older children) presented with mediastinal masses.
- Respiratory distress was common, especially in neonates.
- Preoperative diagnosis was not achieved in any case.
- Histology revealed mature, immature, and malignant teratomas.
- Malignant teratomas occurred in older children and had poor outcomes.
- Immature teratomas were prevalent in neonates.
- Elevated alpha-fetoprotein aided in detecting recurrence.
Conclusions:
- Mediastinal teratomas in children are rare, often presenting late.
- Neonatal mediastinal teratomas can be immature and cause respiratory distress.
- Median sternotomy offers optimal surgical access for anterior mediastinal tumors.
Abstract:
One hundred fifty-three children with a teratoma presented to one hospital between 1970 and March 1992. The clinical and pathological features of 15 patients with mediastinal teratomas are reviewed; six were newborn and nine aged from infancy to 13 years. Thirteen patients including the six newborns presented with respiratory distress and all 15 patients had a mass on chest radiograph. A definite diagnosis of teratoma was not made preoperatively in any of these patients. At operation, a median sternotomy was used to approach seven anterior tumors and a lateral thoracotomy performed in the other eight patients. Histologically two were mature, 10 had immature elements, and three were malignant teratomas. The patients with malignant tumors were all over 12 years of age and died within 6 months of treatment. All six neonates had immature teratomas. Raised serum alpha-fetoprotein levels provided useful markers in two patients with recurrent tumors. Three conclusions can be drawn: (1) mediastinal teratomas are rare in children and frequently are not diagnosed before operation; (2) in newborns these tumors may be immature and present with respiratory distress; and (3) a median sternotomy gives excellent exposure for anterior mediastinal tumors.