Background: While teratomas account for the leading cause of germ cell tumors, the mediastinal teratomas represent one of the infrequent types of congenital germ cell tumors. Neonates with large mediastinal teratomas generally show severe respiratory distress, and the immediate surgical treatment is needed to alleviate their problems.
Objectives: Report clinical symptoms, diagnostic procedures, treatment option, and outcomes after the treatment for a neonate with a large mediastinal teratoma.
Methods: A 2-day-old female infant presented with acute respiratory failure diagnosed as mediastinal teratoma. It was followed with surgical treatment. The removed tissues were examined pathologically.
Results: The girl suffered an acute respiratory failure two days after birth. The chest radiography, echocardiography, and chest computerized tomography results showed the considerable size of the mediastinal teratoma. A median sternotomy was performed on the third day of infant life to remove the tumor without rupturing the capsule. Pathological diagnosis was germ cell tumor. Clinical follow-ups reported no complication.
Conclusion: The successful management of a neonate with large mediastinal teratomas was presented. Immediate detection and proper treatment of the large mediastinal teratoma in a neonate was most important to decrease the morbidity and mortality of the infant.
1. Horton Z, Schlatter M,Schultz S. Pediatric germ cell tumors. Surg Oncol. 2007; 16: 205-13.
2. Soor GS, Chakrabarti MO, Luk A, Abraham JR, Phillips K, Butany J. Prenatal intrapericardial teratomas: diagnosis and management. Cardiovasc Pathol. 2008; 30:1-4.
3. Chi JG, Lee YS, Chang KY. Fetus-in-fetu: report of a case. Ame J Clin Pathol. 1984; 82:115-9.
4. Sergi C, Ehemann V, Beedgen B, Linderkamp O, Otto HF. Huge fetal sacrococcygeal teratoma with a completely formed eye and intratumoral DNA ploidy heterogeneity. Pediatr Dev Pathol. 1999; 2: 50-7.
5. Kuno N, Kadomatsu K, Nakamura M, Miwa-Fukuchi T, Hirabayashi J, Ishizuka T. Mature ovarian cystic teratoma with a highly differentiated homunculus: a case report. Birth Defects Res A Clin Mol Teratol. 2004; 70:40-6.
6. Arlikar JD, Mane SB, Dhende NP, Sanghavi Y, Valand AG, Butale PR. Fetus in fetu: two case reports and review of literature. Pediatr Surg Int. 2009; 25:289-92.
7. Martino F, Avila LF, Encinas JL, Luis AL, Olivares P Lassaletta L, et al. Teratomas of neck and mediastinum in children. Pediatr Surg Int. 2006; 22: 627-34.
8. Merchant AM, Hedrick HL, Johnson MP, Wilson RD, Crombleholme TM, Howell LJ, et al. Management of fetal mediastinal teratoma. J Pediatr Surg. 2005; 40: 228-31.
9. Seo T, Ando H, Watanabe Y, Harada T, Ito F, Kaneko K, et al. Acute respiratory failure associated with intrathoracic masses in neonates. J Pediatr Surg. 1999; 34: 1633-7.
10. Wilson RD. Management of fetal tumors. Best Pract Res Clin Obstet Gynaecol. 2008; 22: 159-73.
11. Kuroiwa M, Suzuki N, Takahashi A, Ikeda H, Hatakeyama SI, Matsuyama S, Matsuyama S, et al. Life-threatening mediastinal teratoma in a neonate. Pediatr Surg. 2001; 17: 235-8.
12. De Lorimier AA, Harrison MR. Surgical treatment of tumor in the newborn. Am J Pediatr Hematol Oncol. 1981; 3: 271-7.
13. Mogilner JG, Fonseca J, Davies MR. Life-threatening respiratory distress caused by a mediastinal teratoma in a newborn. J pediatr Surg. 1992; 27:1519-20.
14. Wang KY, Yeh YC, Jean WH, Fan SZ. Cardiopulmonary resuscitation in the lateral position for an infant with an anterior mediastinal mass. Acta Anaesthesiol Taiwan. 2009; 47: 40-3.
15. Tollens T, Casselman F, Devlieger H, Gewillig MH, Vandenberghe K, Lerut TE, et al. Fetal cardiac tamponade due to an intrapericardial teratoma. Ann Thorac Surg. 1998; 66: 559-60.
16. Gobbi D, Rubino M, Chiandetti L, Zanon GF, Cecchetto G. Neonatal intrapericardial teratoma: a challenge for the pediatric surgeoun. J Pediatr Surg. 2007; 42: e3-6.
17. Isaacs H. Perinatal (fetal and neonatal) germ cell tumors. J Pediatr Surg 2004; 39(7): 1003-13.
18. Billmire DF. Germ cell tumors. Surg Clin N Am. 2006; 86: 489-503.
19. Gornall P. Paediatric Surgical oncology. Eur J Surg Oncol.1997; 23: 68-83.
20. Roy N, Blurton DJ, Azakie A, Karl TR. Immature intrapericardial teratoma in a newborn with elevated alpha-fetoprotein. Ann Thorac Surg. 2004; 78: e6-8.
21. Bell TA, Lightner DV. A Handbook of Normal Shrimp Histology. Baton Rouge:World Aquaculture Society, 1988.