Teratomas of the Neck: Report of Two Cases

Abstract

Teratomas of the neck in the newborn present as a mass in the region of the thyroid gland. Bale (1) attempted to classify these tumors as: (a) teratoma of the thyroid gland, (b) teratoma in the region of the thyroid gland replacing all or part of the gland, and (c) teratoma probably in the region of the thyroid gland. This classification has been criticized by McGoon (4) and Thomas (5). Regardless of where the particular tumor belongs in this classification, its very presence is an indication for removal. These masses frequently produce airway or esophageal obstruction, and the symptoms and findings usually demand prompt surgical evaluation. Clinically, the examiner observes a large anterior neck mass which is usually central but possibly lateral in location. Cystic hygromas, common neck tumors presenting at birth, have a characteristic location about the lateral aspect of the neck and ordinarily can be fairly well distinguished by their fluctuant and lobular nature. Congenital goiters are typically symmetrical. They are enlarged thyroid masses which retain the basic bilateral lobes and isthmus configuration of the normal thyroid gland. The absence of cretinism is not helpful. It is seldom evident at birth because the congenital signs such as pallor, constipation, and skin dryness are not sufficiently characteristic to permit this diagnosis. A history of intake of goitrogenic substances by the mother during pregnancy may be helpful. Teratomas may simulate either congenital goiters or thyroglossal duct cysts, particularly when they arise from within the central thyroid areas. Calcification in soft-tissue x-ray studies suggests teratoma, although it may exist in congenital goiter as well. One fact the surgeon would wish to establish is whether or not any neck mass represents thyroid tissue or is connected in any way with the thyroid gland. Aberrant thyroid tissue may be removed with a thyroglossal duct cyst and congenital absence of the thyroid tissue unfortunately proved by the development of a severe state of myxedema. This may be avoided by the radioisotopic location of functioning thyroid tissue below or apart from the mass. The presence of actual functioning thyroid tissue within the mass would suggest a congenital goiter or functioning thyroid tissue within a thyroglossal duct cyst. In addition, a radioactive uptake scan in conjunction with protein-bound-iodine evaluation is useful in assessing the thyroid function and could help distinguish between the types of congenital goiter that may present as an anterior neck mass. In planning his approach to tumor masses of this nature, the surgeon should have as much diagnostic information as possible. We have recently utilized radioisotopic study to indicate normal thyroidal function and to localize a neck mass as extrathyroidal.