Congenital nasopharyngeal teratoma: report of a case and review of the literature

Huge nasopharyngeal teratoma with a cleft palate and bifid tongue in a patient with pierre robin syndrome

PURPOSE

Nasopharyngeal teratoma is a very rare neoplasm that develops on the oronasal cavity as an expanding and cavity-filling lesion. We present a rare case of nasopharyngeal teratoma associated with a cleft palate and bifid tongue in a patient with Pierre Robin syndrome.

METHODS

A preterm male neonate of 33 weeks and 6 days was referred to our department. A protruding solid mass with approximately 7.0 × 4.0-cm size arising from the vomer and combined cleft palate and tongue covered with pinkish skin with lanugo were observed. In addition, there was a bandlike tissue connecting vomer and sublingual area, which divided and restricted the anterior portion of the tongue.

RESULTS

An early surgical intervention was decided because of problems with airways and nutrition caused by the mass. The mass was completely removed from the vomer. The histologic examination of the mass was consistent with mature teratoma. After his first operation, he was finally diagnosed with the Pierre Robin syndrome. After 4 months, a tongue reduction was conducted for macroglossia, and after 9 months, remnant teratoma excision and a palate repair were conducted using 2-flap palatoplasty.

CONCLUSIONS

A nasopharyngeal teratoma is a rare case and induces a cleft palate and bifid tongue in a preterm infant, leading to severe airway and nutritional problems. A teratoma interferes with the fusion of embryonic tissues in the early developmental period, in particular, with the palatal fusion severely prevented if the teratoma is accompanied by a Pierre Robin syndrome such as in this case.

Radiofrequency coblation of congenital nasopharyngeal teratoma: a novel technique

Introduction. Congenital nasopharyngeal teratomas are rare tumours that pose difficulties in diagnosis and surgical management. We report the first use of radiofrequency coblation in the management of such tumours. Case Report. A premature baby with a perinatal diagnosis of a large, obstructing nasooropharyngeal mass was referred to the ENT service for further investigations and management. The initial biopsy was suggestive of a neuroblastoma, but the tumour demonstrated rapid growth despite appropriate chemotherapy. In a novel use of radiofrequency coblation, the nasooropharyngeal mass was completely excised, with the final histopathology revealing a congenital nasopharyngeal teratoma. Conclusion. We report the first use of radiofrequency coblation to excise a congenital nasopharyngeal teratoma and discuss its advantages.

Uncommon presentation of a benign nasopharyngeal mass in an adolescent: comprehensive review of pediatric nasopharyngeal masses

Nasopharyngeal masses in the pediatric population are quite rare, and the majority of these are benign. In adolescent boys, there should be a high index of suspicion for juvenile nasopharyngeal angiofibromas. When malignant, the most common lesions encountered are rhabdomyosarcomas, carcinomas, and lymphomas. We report a single case from a tertiary care institution of an adolescent male with an unusual presentation of a benign nasopharyngeal mass and provide a comprehensive review of pediatric nasopharyngeal masses. Whenever possible, radiographic imaging should be obtained, in addition to biopsy, to assist in the diagnosis of pediatric nasopharyngeal masses.

A rare case of congenital nasopharyngeal teratoma presenting with respiratory distress

Teratomas of the head and neck are rare, benign neoplasms, usually presenting in the neonatal period and are often malignant with regard to their location. Teratomas occur with a frequency of one in 4,000 live births with head and neck teratomas accounting for <5% of the total. Extensive literature search has shown that there are only two cases congenital nasopharyngeal teratoma reported in India, and we report the third such case.

Nasal septal teratoma in a child

Background

Teratoma is a rare developmental neoplasm that arises from totipotential tumor stem cells. Head and neck teratomas constitute about 10% of all cases. Only two cases of mature teratoma of the nasal septum have previously been documented in the world literature.

Case presentation

We present a case of histologically confirmed mature teratoma arising from the nasal septum in an eighteen month old Nigerian female who presented with a history of noisy breathing associated with recurrent rhinorrhea since birth. Physical examination revealed obstruction of the right nasal cavity by a pale fleshy mass. She underwent a total surgical excision and to date, after thirty one months follow-up, she is free from recurrence.

Conclusion

The prognosis for benign teratoma of the nasal septum is good following total surgical excision.

Mature Teratoma of the Nasal Vestibule: A Case Report

Teratomas are rare congenital neoplasms that arise from pluripotent cells. They consist of tissue from all three embryonic germ layers. According to most studies, teratomas of the head and neck account for only 2 to 9% of all cases. In this article, we report the first case of a teratoma of the nasal vestibule in a newborn. We also discuss methods of diagnosis and treatment of upper airway teratomas, and we include a brief review of the literature.

Nasopharyngeal teratomas and dermoids: a review of the literature and case series

OBJECTIVES

Review the clinical differences between nasopharyngeal (NP) true teratomas and dermoids, with the addition of a case series to the literature. Additionally, review the impact of prenatal diagnosis on the management and outcome of these lesions.

STUDY DESIGN

Retrospective review of cases from the Children's Hospital Medical Center (Seattle, WA) and Madigan Army Medical Center (Tacoma, WA) with the histopathologic diagnosis of nasopharyngeal teratoma or dermoid. Review of medical literature for cases reported since 1977, when prenatal diagnosis of these lesions was first reported. Only tumors of the nasopharynx were considered.

METHODS

Charts and pertinent literature were reviewed and data presented with respect to age at diagnosis, signs and symptoms, perinatal diagnosis and management, preoperative evaluation, surgical treatment, and outcome.

RESULTS

The majority of lesions were diagnosed at birth, with the most common presenting symptom being respiratory distress. Teratomas had a higher incidence of maternal polyhydramnios, preterm birth, need for emergent airway management, and associated congenital abnormalities. Complete surgical excision remains the treatment of choice. Recurrences were rare, occurring only in the teratoma group. Prenatal diagnosis did not have a significant impact on the diagnosis and treatment of these lesions in our review.

CONCLUSIONS

Inconsistent use of a standard classification system has made differentiating between NP teratomas and dermoids difficult, although the clinical implications can be critical. NP teratomas have a higher incidence of preterm birth, neonatal airway distress, associated congenital abnormalities, need for more extensive surgical procedures, and recurrence. Prenatal diagnosis has made little impact on the overall diagnosis and treatment of these lesions.

Nasopharyngeal teratoma and mosaic tetrasomy 1q detected at amniocentesis. A case report and review of the literature

The occurrence of nasopharyngeal teratomas (NPT) is an infrequent event and prenatal detection of such tumors is even rarer. We present a case report and review of the literature (N = 78 cases), in which we describe the cytogenetic, DNA, and pathological findings of a fetus with a mature NPT which was detected prenatally by ultrasound investigation following complaints of severe polyhydramnios by the mother.

Prenatal sonographic detection of nasopharyngeal teratoma

We present the case of a 34-year-old pregnant woman who had an elevated maternal serum alpha-fetoprotein level and sonographic findings of a semisolid mass protruding from the fetus's oral cavity. The large, heterogeneous mass filled the oropharynx and nasopharynx. Abnormal Doppler waveforms were detected in the umbilical artery of the fetus, who died in utero. Postmortem examination revealed a nasopharyngeal teratoma.

A nasopharyngeal dermoid causing neonatal airway obstruction

A case of neonatal respiratory distress due to a pedunculated nasopharyngeal dermoid is presented with its MRI assessment. The dermoid was removed without complications. Nasopharyngeal teratomas are uncommon, consisting of tissues from all three germ layers with varying degrees of differentiation. Symptoms arise during the neonatal period and are associated with airway obstruction. MRI can be performed for contemporary assessment. The first goal of management is to establish a safe and protected airway using complete surgical excision.

Oronasopharyngeal teratomas

Oronasopharyngeal teratomas are rare tumours that usually present in the neonatal period with airway obstruction. Management should include prompt establishment of the airway and early excision. Complete excision is recommended, which may require more than one operation, but multilating surgery should be avoided as the malignant potential of these tumours is extremely low. We describe our experience with three patients along with a literature review.

Nasal obstruction in infancy

Images

Neonatal teratoma presenting as hygroma colli

We describe a neonate with a large tumour involving cranial, cervical and upper mediastinal regions, which presented clinically as hygroma colli. Radiological and pathological investigations showed characteristics of a mature teratoma and prominent cystic components within the tumour. These findings suggest that during early fetal development primary lymphatic sacs were obstructed by a teratoma leading to hygromatous dilatations of lymphatic vessels or that the abnormal proliferation of lymphatic vessels (hygroma) was part of the teratoma, developing from mesoderm as one of the three germinal layers from which teratomas originate. A third possibility is that the cystic part of the tumour originated from plexus chorioideus tissue, containing CSF. The last possibility is most probable in this patient.

Neonatal respiratory distress secondary to an obstructing nasopharyngeal dermoid

A case presentation of a newborn infant with intermittent, complete airway obstruction secondary to a pedunculated nasopharyngeal dermoid is presented. The differential diagnosis of obstructing nasopharyngeal lesions of the neonatal period is discussed, and an organized management strategy is proposed.

Germ cell neoplasms of head and neck soft tissues: a pathologic spectrum of teratomatous and endodermal sinus tumors

Germ-cell neoplasms, in particular teratomas with immature and mature somatic type tissues, are some of the most commonly found tumors in children. Approximately 5% of these neoplasms appear in one of several extracranial sites in the head and neck region. This study reports the clinical, pathologic and immunohistochemical findings in six germ-cell neoplasms occurring in the neck and facial areas. A mass was recognized at birth in five children, and the sixth patient was 2 1/2 years old at diagnosis. Four of the six neoplasms contained one or another element of endodermal sinus tumor; two of these had a mixed pattern of endodermal sinus tumor and teratoma. The other two cases were purely teratomas. The serum alpha-fetoprotein was known to be elevated in three children whose tumors had endodermal sinus elements; it returned to normal level in two of the children, but remained high in the one fatal case. Placental alkaline phosphatase and alpha-fetoprotein were demonstrated immunohistochemically in two of the three cases, with available tissue containing endodermal sinus tumor. Teratomatous metastases in ipsilateral cervical lymph nodes were found in one patient with a pure teratoma; that patient is disease-free one year after surgery. Only nine previous examples of endodermal sinus tumor have been reported in the head and neck region, exclusive of the central nervous system. There is one other case in the literature of a congenital cervicothyroidal teratoma with metastatic disease. These six neoplasms illustrate the clinical and pathologic spectrum in this nosologically homogeneous, but morphologically diverse, category of tumors.