Intrapericardial Teratoma in a Newborn

Abstract

Intrapericardial teratomas are very rare and most are benign in nature. Neonates can remain asymptomatic; however, they can present with respiratory distress from compression and pericardial tamponade. In a fetus, nonimmune hydrops fetalis could be a finding. The case presented here is of a neonate with intrapericardial teratoma who underwent surgical resection with excellent result. A 2-week-old baby boy underwent median thoracotomy resection of a capsulated intrapericardial multicystic tumor. This was adherent to the pericardium superiorly and to the adventitia of the aorta and main pulmonary artery posteriorly (Figs. 1, 2). This was confirmed as a teratoma by histopathology. On the prenatal echocardiogram, an anterior mediastinal cystic mass was seen. The infant was delivered following a full-term twin pregnancy by caesarian section with a birth weight of 2.3 kg and Apgar score of 7 and 9 at 1 and 5 min, respectively. At birth, the infant remained asymptomatic with normal vital signs and normal physical examination. Prior to surgery, a two-dimensional (2D) echocardiogram (Fig. 3) showed a multicystic capsulated tumor within the pericardium superior to the ascending aorta and to the left of the superior vena cava. A computed tomography (CT) scan of the mediastinum (Fig. 4) revealed an intrapericardial capsulated cystic tumor surrounded by thymic tissue. Eight percent of all mediastenal tumors are benign teratomas [3]. Intrapericardial teratomas accounts for 0.003% [2]. The patient can be asymptomatic or can present with cardiorespiratory distress and pericardial temponade. Fetal presentation can be that of nonimmune hydrops fetalis [5]. Teratoma originates form totipotent cells from Hansen’s node or from primitive germ cells during their migration from the yolk sac [6]. It consists of complex multiple tissues. The presence of all three layers of cells (i.e., endoderm, mesoderm, and ectoderm) is not necessary to make a diagnosis [4]. Gonzalez-Crussi [1] has graded teratomas as follows: 0 = mature (benign), 1 = immature (probably