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Teratoma in Infants and Children - Abstract

Ahmed H. Al-Salem*, Mustafa Hamchou, Akhter Nawaz, Hilal Matta


Background: Teratomas are a unique group of tumors with variable behavior depending on the site, size, histology and age at diagnosis. This paper aims to highlight the clinical features, investigations and treatment of teratomas at different parts of the body, in our settings.

Patients and Methods: The medical records of all infants and children with the diagnosis of teratoma treated between 1989 and 2007 were retrospectively reviewed for: age at diagnosis, sex, presenting symptoms, site of tumor, treatment, histology and outcome.

Results: Over a period of 18 years, we treated 29 infants and children with teratomas at various sites of the body. These included sacrococcygeal (14), ovarian (4), cervical (5), retroperitoneal (4), gastric (1) and buttock (1). There were 14 sacroccocygeal teratomas, all were females except two. The age at presentation ranged from birth to 18 months, but the majority (78.6%) presented within the first week of life. According to Altman's classification, 10 were type 1, 2 type 2, and 1 type 3. In one patient, it was difficult to classify. The majority (77%) were benign. Two of the three with malignant sacrococcygeal teratoma presented late. Five had cervical teratoma. All were left sided. In all, the swelling was large to the extent that 3 presented with acute respiratory distress necessitating emergency intubation and one developed brain hypoxia. All were benign except one who had immature grade I teratoma. Four had ovarian teratoma, one of them presented as an emergency. Two were malignant. Four had retroperitoneal teratoma, one of them was malignant. A 4-days old male with a very large abdominal mass and calcifications was found to have a large gastric teratoma which was immature grade I. A 6-months old female was found to have a benign teratoma of the buttock.

Discussions: Teratomas are an interesting group of tumors with similar histological picture but variable behavior. Sacrococcygeal teratoma is the commonest and the majorities are benign but the risk of malignant transformation increases with age. The majority of cervical teratomas are benign, but they can cause significant morbidity and mortality as a result of respiratory compromise. Surgical excision of these large tumors needs to be planned. We found staged excision in some of these patients is beneficial. Retroperitoneal teratomas are rare and the majority present with an abdominal mass which can attain a large size. Careful attention to adjacent major blood vessels in the vicinity of the tumor at the time of resection is very important as these tumors tend to distort major blood vessels including the renal vessels. Ovarian teratomas are the second most common teratoma in infants and children. The majorities are easily resectable but they can attain a large size and present as an emergency because of a twist. Gastric teratoma is very rare and resection is curative.

Key words: teratoma, sacrococcygeal, cervical, ovarian, retroperitoneal, gastric, buttock teratoma, staged excision, benign tumors, significant morbidity


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