Teratomas In Children Research Articles

Retroperitoneal Teratoma in an InfantCase Report

Common location of teratomas in children are sacrococcygeal, gonadal, mediastinal and retroperitoneal, but teratomas may also occur at very unusual locations. A one-year-old girl presented with a large swelling at her left abdomen. Clinical examination revealed a solitary, non-tender, soft to firm, irregular cystic mass, occupying her left abdominal region. Computed Tomography (CT) scan finding was consistent with retroperitoneal teratoma. Complete surgical excision of the tumour was done without any difficulties. Histology of the excised tumour was conclusive of mature cystic teratoma.

Ovarian teratoma in children: a plea for collaborative clinical study

BackgroundAlthough teratomas are the most common histologic subtype of childhood ovarian germ cell tumors, their appropriate treatment in this age group still remains unclear. Paucity of research dedicated exclusively to both mature and immature teratomas of the ovary, contribute to decision making difficulties.Therefore, we decided to review retrospectively our experience in treatment of pediatric ovarian teratomas in order to assess the epidemiology, presenting features, and diagnostic as well as surgical management of these lesions.ResultsThe study comprised 58 patients. Fifty percent of patients were between 9 and 15 years old. Mature teratoma was diagnosed in 55(94.83%) patients, while 3(5.17%) patients presented with immature teratoma. Twenty eight (50.91%) girls with mature teratoma had laparotomy and 23 (41.82%) had laparoscopy performed as an initial operative approach. Ovarian tissue sparing technique (preservation of the ovarian tissue of the affected gonad) was applied in only 11.11% of patients operated in the first study period (years 1999–2003) and increased to 40.54% in the second half of our study (years 2004–2016). The extent of gonadal resection was not related with the size of the lesion. Bilateral lesions were noted in 8 patients with mature teratoma. All girls with immature teratoma were subjected to formal laparotomy. Two patients had stage III of the disease and one had stage IV. They underwent at least resection of the affected gonad. Adjuvant chemotherapy was given to all girls with immature teratoma after the surgery.ConclusionsUnder particular conditions ovarian-sparing surgery might be successfully applied in children with mature teratoma. Laparotomy is the treatment of choice in large masses, suspicious for malignancy and if surgical staging is required. High quality prospective multi-institutional studies are required in order to get an objective insight into biology and prognostic factors of teratomas in children.

Primary adrenal teratoma: A case series and review of the literature.

Primary adrenal teratoma is a rare type of cancer. Of the 338 patients who underwent adrenalectomy during this study, only 2 (aged 69 and 29 years) were diagnosed with adrenal teratoma and underwent laparoscopic retroperitoneal adrenalectomy. For the purposes of the present study, the term 'adrenal teratoma' was searched in the PubMed database, and 237 articles published between June 1952 and March 2017 were retrieved. However, we were only able to identify 10 relevant studies. In total, these studies reported a series of 18 cases of primary adrenal teratoma in patients aged >16 years, another 8 cases of adult adrenal retroperitoneal teratoma, and 7 cases of adrenal teratoma in children aged <16 years. In the 18 cases aged >16 years, the age range was 17-61 years (mean ± standard deviation, 33.06±15.47 years), the median tumor diameter was 8.25 cm and 13 patients (72.22%) were female. Almost all patients underwent laparoscopic surgery between 2006 and 2017 (75%). Among the 7 cases of adrenal teratoma in children under the age of 16 years, 5 cases (71.43%) were male, the median tumor diameter was 10 cm, the oldest patient was aged 8 years, 5 cases (71.43%) were selected for open surgical resection of the tumor, and 5 cases (71.43%) were followed up without recurrence or death. These data indicate that primary adrenal teratomas in children are rarer compared with adults. Although the data are limited, it was observed that the clinical symptoms of primary adrenal teratoma are not typical, the preferred treatment is retroperitoneal laparoscopic surgery, and the prognosis is favorable. The aim of the present study was to elucidate the clinical characteristics associated with primary adrenal teratoma, in order to further raise awareness of this rare disease.

Cervical teratomas

Cervical teratomas

Sacrococcygeal Teratoma in Children- Experience in a Tertiary Military Hospital

Introduction: Sacrococcygeal teratoma (SCT) is the most common solid tumour found in neonates. Most SCTs are reported in neonates and children, but SCTs are found in adults also. SCTs occur more commonly in females than males. If not detected antenatally, clinical features at birth are prominent in most cases as a palpable or visible mass. Surgery is the principal mode of treatment. The standard treatment for SCT with malignant elements is surgery and chemotherapy.&#x0D; Objective: To share the experience with sacrococcygeal teratoma, the most common tumour found in newborn in a tertiary military hospital.&#x0D; Materials and Methods: This observational study was carried out in the Department of Paediatric Surgery, CMH Dhaka during the period of January 2010 to December 2015. During the study period a total of 6 neonates with SCT were admitted in this hospital that were included in the study.&#x0D; Results: The age of the patients ranged from 3 days to 1 month. Out of them 5(83.33%) were female, 1(16.67%) was male with a female to male ratio of 5:1. Four neonates (66.67%) had type-I and 2(33.33%) had type II SCT. They were not diagnosed antenatally. All presented in neonatal period and were operated as elective cases. Five neonates (83.33%) were born by normal vaginal delivery and one (16.67%) was born by Caesarean section due to cervical dystocia. All patients had elevated alpha fetoprotein (AFP). Posterior sacral approach was sufficient in all the cases and histopathology revealed benign lesion. There was no perioperative death but 1 patient (16.67%) developed malignant recurrence within 1st year and 1 patient (16.67%) developed neurogenic bladder with bilateral hydronephrosis.&#x0D; Conclusion: SCTs are rare tumours that occur most frequently in neonates. Antenatal diagnosis is possible in many cases in this modern era. Follow up of cases after surgery should not only the look out for tumour recurrence, it includes the management of possible secondary urinary and/or bowel incontinence.&#x0D; Journal of Armed Forces Medical College Bangladesh Vol.13(1) 2017: 17-21

The management of immature testicular teratomas in children

Objective To summarize the management of immature testicular teratomas in children. Methods The clinical data of 19 children (age between 16 days to 13 months) with immature testicular teratomas were retrospectively analyzed. There were 10 cases in left and 9 cases in right side. The main presentation was painless scrotal mass .The size of the tumor was 1.5 cm×1.2 cm×0.5 cm-6.0 cm×5.0 cm×4.5 cm. Abnormal alpha fetopmtein (AFP)concentrations were detected in 17 patients before surgery. Results Testis-sparing surgeries were done in 11 patients, and the other 8 patients underwent testicle resection because of tumor severely invading testis. Fifteen cases were followed up for 1-10 years. All of them were alive. Conclusions Immature testicular teratomas was rare and almost presenting in children younger than 1 year old. The biological behavior of immature testicular teratomas in children was benign. Testicular-sparing surgery was possible. Close follow-up should be done postoperatively. Key words: Immature teratomas; Testis; Children

Analysis of Recurrent Sacrococcygeal Teratoma in Children: Clinical Features, Relapse Risks, and Anorectal Functional Sequelae.

BackgroundSacrococcygeal teratoma (SCT) is a relatively uncommon tumor. Recurrence with poor survival and anorectal dysfunction are the 2 leading problems for patients. Here, we would review the clinic features of patients with SCTs in our hospital to identify risk factors of recurrent SCTs and to analyze anorectal functional sequelae.Material/MethodsA retrospective review of all patients with SCTs in our center between 2007 and 2013 was performed. We analyzed the recorded data on each patient and performed follow-up through phone calls.ResultsOur study included 105 inpatients (78 girls and 27 boys); 104 cases underwent surgical resection, and 62.5% cases had a mature histopathology. The proportion of malignant teratomas rose with increasing age. Fifteen children developed recurrent SCTs with a median of 11.5 months, and most of them had an elevation of AFP levels. Four recurrent children experienced a second tumor relapse. We observed a statistically significant difference in survival rate through Kaplan-Meier method between relapsed (66.7%) and non-relapsed (94.4%) patients. In univariate analysis, incomplete primary resection and malignant histology were proven to increase recurrence risks. Nearly half of patients had at least 1 of the parameters reflecting abnormal bowel function (e.g., involuntary bowel movements, fecal incontinence, and constipation). For those recurrent SCTs patients, difficulty defecating was a major problem.ConclusionsTumor recurrence affected the prognosis of children with SCT. In our research, incomplete resection and malignant histology were considered risk factors. Constipation was the main problem in anorectal functional sequelae for children who had recurrence.

Surgical intervention and perioperative risk factors of retroperitoneal teratomas in children: a single institution experience.

Retroperitoneal teratomas (RTs) are rare among germ cell tumors and predominantly occur in infants. RTs are often difficult to manage by perioperative management. In this study, we retrospectively reviewed our series of RTs. Seventy patients with germ cell tumors were treated from 1989 to 2015 in our institution. Fourteen patients had RTs (3 boys and 11 girls). The median age at diagnosis was 5.5months (range 0-64), and three were antenatally diagnosed. All except one patient underwent total tumor excision. They exhibited dense adhesions with major vessels, and ligation of the splenic and gastroduodenal arteries was required in two patients. Injuries of PV and renal artery occurred in two patients. IVC injury in a neonate with a giant mass caused circulatory failure and brain death occurred postoperatively. Other major complications included injury of the diaphragm and bile duct. An infant whose tumor compressed the superior mesenteric artery developed enteritis while waiting for surgery and non-occlusive mesenteric ischemia, resulting in massive intestinal necrosis. The perioperative complication rate was 50%. Surgery for RTs remains challenging, and a preoperative evaluation of the vascular anatomy is crucial due to the high complication rate. Moreover, pre- and intraoperative fluid management is important to avoid any unexpected fatalities.

RNA-binding protein LIN28 is a sensitive marker of pediatric yolk sac tumors.

RNA-binding protein LIN28 is involved in maintaining the pluripotency of embryonic stem cells. It has been detected in different types of testicular and ovarian germ cell tumors (GCTs), but its status in pediatric YSTs (yolk sac tumors) is still unknown. The aim of this study was to determine the immunohistochemical profile of LIN28 in pediatric YSTs. Immunohistochemistry detection of LIN28 was performed in 22 cases of pediatric YSTs and 10 mature teratomas. The percentage of tumor cells stained was scored as 0, 1+ (1-30% cells), 2+ (31-60%), 3+ (61-90%), and 4+ (>90%). To compare its sensitive and specificity with alpha-fetoprotein (AFP), we also stained AFP in 22 cases of pediatric YSTs and 10 mature teratomas in children. LIN28 staining was high in all 22 pediatric yolk sac tumor (2+ in 1, 3+ in 1, and 4+ in 20), and weak staining of LIN28 was seen in 1 of 10 mature teratomas (1+), 9 of 10 mature teratomas were negative expression. However, the expression of AFP in pediatric YST was lower compared with Lin28 (- in 1, 1+ in 8, 2+ in 12, and 3+ in 1), and weak expression of AFP was seen in 2 of 10 mature teratomas (1+), 8 of 10 mature teratomas were negative. LIN28 had higher intensity expression than AFP in pediatric YSTs (P<0.001). LIN28 is a sensitive marker for pediatric YSTs and it can be used to distinguish them from mature teratomas. LIN28 is likely to become a new and valuable biomarker for diagnosing of pediatric YST.

Head and neck teratomas in children—A series of 23 cases at Great Ormond Street Hospital

ObjectiveHead and neck teratomas are rare and malignant change is rarer still. This is a report detailing all of the teratomas treated by the ear, nose and throat or craniofacial teams over the last 28 years at our institution. Examining the common presenting and radiological features as well as our success rates compared to the current literature. MethodA retrospective review of all cases presenting to our institution with a head and neck teratoma were analysed. Data regarding the following characteristics were collected: antenatal history, clinical features, biological serum makers, radiological and pathological characteristics. Surgical treatment, rates of reoccurrence and the degree of post-operative follow up were also analysed. Results23 cases in total were included: 8 cervical, 6 nasopharyngeal, 5 thyroid, 2 thymus, 2 temporal. One had malignant change. The majority of children presented at birth with respiratory distress, 5 cases were picked up antenatally and one case presented at 10 years of age. All were treated surgically; with complete excision in 20 patients. No clinical recurrence occurred but further surgery was performed for radiologically suspected residual disease in one case. DiscussionThis is the largest detailed case series in literature in regard to head and neck teratomas. Illustrating that this is frequently a benign disease process disease in the head and neck region and has an excellent long term prognosis following surgery. In the situation of incomplete resection careful meticulous follow up with radiological imaging and a multidisciplinary team approach is a safe and viable alternative.

Gastric teratoma in children: Our experience

Summary Background/Introduction Gastric teratoma is an extremely rare tumor, almost exclusively benign, accounting for Purpose/Aim This work aimed to study the clinical presentation, investigation modalities, intraoperative findings, histopathological types, and surgical outcome of gastric teratoma in children. Methods A retrospective study was performed from 1993 to 2013 in two pediatric institutes. Results There were eight patients with gastric teratoma and all of them were male. Seven (87.5%) patients presented in infancy, out of which four (50%) patients were neonates, while one (12.5%) patient was a toddler. The manifestations were as follows: a palpable abdominal mass in seven (87.5%), abdominal distension in five (67.5%), anemia in four (50%), respiratory distress in three (37.5%), gastric outlet obstruction with recurrent vomiting in three (37.5%), and abdominal pain, anorexia, and melena in one (12.5%) each. Ultrasonography showed a solid cystic mass with mixed echogenicity in all the patients, while calcification was seen in seven (87.5%) cases. Computed tomography, which was performed in four (50%) patients, clinched the preoperative diagnosis. A growth was present on the posteroinferior wall near the greater curvature in seven (87.5%) cases, while in one (12.5%) patient, it was arising from the lesser curvature. Excision of the tumor was performed in all patients. Histopathology was mature type in six (75%) cases, and immature Grade 1 and 2 in one (12.5%) each. Complications were seen in five (62.5%) cases, and one (12.5%) mortality was observed in our series. All other patients were doing well in the postoperative period. Conclusion Gastric teratoma is almost always benign and has predilection for male sex. It commonly presents as a palpable abdominal mass. Complete surgical excision is curative. Close observation is recommended for Grade 2 and 3 immature teratomas. The prognosis is excellent.

Sacrococcygeal Teratoma in Children

Introduction Germ cell tumors originate in the primary stem cell located either inside or outside the gonadal system. Teratomas are the major group, with the sacrococcygeal location being the most common extragonadal site, independent of their being benign or malignant. We describe five cases of sacrococcygeal teratoma and emphasize aspects of diagnosis, surgical techniques, and complementary approaches. Patients and Methods A total of five cases of sacrococcygeal teratoma were reported and a literature review was performed using an online database, Pubmed.gov. The authors emphasize aspects of diagnosis, classification, prognosis, and the therapeutic options. Results The five cases were females and the age range from 38 weeks intrauterine (ultrasonography diagnosis) to 1.5 years. The clinical presentation usually was a sacral mass or fecal constipation. The Altman classification was type 1 in three cases and type 4 in two cases. The serum levels of α-fetoprotein was normal in three cases. Preoperative high serum α-fetoprotein levels returned to normal levels 10 days after surgery. The radical surgical resection of the tumor and the coccyx was done in all cases through a posterior sacral approach and midline incision. The surgery did not compromise the neurological function. No tumor recurrence was seen in by radiologic and α-fetoprotein examinations after a medium follow-up of 15.3 years. Conclusion The sacrococcygeal region is the most frequent site of teratomas in children. Complete tumor resection and removal of the coccyx are the main objective in curative treatment of the teratoma. Diagnosis and treatment as early as possible is essential to prevent it from becoming malignant.

Evaluation and Management of Ovarian Teratomas in Children and Adolescents at a Single Institution- The Influence of Pediatric Gynecology

Evaluation and Management of Ovarian Teratomas in Children and Adolescents at a Single Institution- The Influence of Pediatric Gynecology

Anterior Chest Wall Mass in an Asymptomatic Child

We describe a pediatric case of mediastinal benign teratoma presenting as recurrent chest wall mass. Most common differential diagnosis for chest wall mass in children is cavernous hemangioma, PNET/ Ewing’s sarcoma, rhabdomyosarcoma, osteosarcoma and chondrosarcoma.These tumors arise from chest wall and may have both intra and extra-thoracic components.The treatment of choice for benign mediastinal teratomas in children <15 years is total surgical excision and there is no role of radiotherapy. Recurrence of these tumors has not been reported after complete resection; therefore, long term prognosis is excellent.

Analysis of recurrence risks for sacrococcygeal teratoma in children

Background/PurposeThe purpose of this study was to investigate effects of risk factors on recurrence of sacrococcygeal teratoma (SCT). MethodsA retrospective review was conducted of 107 SCTs treated between January 2003 and December 2012 in our center. Risk factors were identified by univariate and multivariate analysis. ResultsSixteen children had recurrence of SCT a median interval of 16.25months after primary surgery. 15.6% tumors recurrence were Altman type I, 10.5% type II, 10.0% type III, and 31.3% type IV. The recurrence of mature teratoma was observed in 8 patients, immature in 2, malignant in 5. More than half of the recurrences showed a shift towards histological immaturity or malignancy, compared with the primary tumor pathology. Risk factors for recurrence were spillage of tumor parenchyma during operation (P=0.028), incomplete resection (p=0.000), and primary immature (P=0.029) and malignant histology (P=0.026). Size, Altman classification, and age were not risk factors for recurrence. There was a statistically significant difference in OS between patients who developed relapse (64.8%) and those who did not (95.0%) (P=0.0002). ConclusionsTumor recurrence affected the outcome of children with SCT. Risk factors were tumor spillage, immature and malignant histology, or incomplete resection. Regular follow-up after surgery is mandatory to find tumor relapse earlier and to improve the outcome.

Editorial Comment

Testis tumors in children are rare, with an incidence of 0.5-2.0 per 100, 000.1Ross J.H. Prepubertal testicular tumors.Urology. 2009; 74: 94-99Abstract Full Text Full Text PDF PubMed Scopus (38) Google Scholar Treatment of testis tumors in children has evolved from radical orchiectomy, as is done in adults and adolescents, to testis sparing surgeries in most children with benign testis lesions found before puberty. Although the Prepubertal Testis Tumor Registry found that yolk sac tumors are the most frequently reported pediatric testis tumor,2Ross J.H. Rybicki L. Kay R. Clinical behavior and a contemporary management algorithm for prepubertal testis tumors: a summary of the Prepubertal Testis Tumor Registry.J Urol. 2002; 168: 1675-1679Abstract Full Text Full Text PDF PubMed Google Scholar other investigators have found that teratoma tumors are actually more common in their facilities pediatric tumor occurrence.3Pohl H.G. Shukla A.R. Metcalf P.D. et al.Prepubertal testis tumors: actual prevalence rate of histological types.J Urol. 2004; 172: 2370-2372Abstract Full Text Full Text PDF PubMed Scopus (160) Google Scholar, 4Taskinen S. Fagerholm R. Aronniemi J. et al.Testicular tumors in children and adolescents.J Ped Urol. 2008; 4: 134-137Abstract Full Text Full Text PDF PubMed Scopus (75) Google Scholar, 5Metcalf P.D. Farivar-Mohseni H. Farhat W. et al.Pediatric testicular tumors: contemporary incidence and efficacy of testicular preserving surgery.J Urol. 2003; 170: 2412-2416Abstract Full Text Full Text PDF PubMed Scopus (128) Google Scholar, 6Valla J. Testis-sparing surgery for benign testicular tumors in children.J Urol. 2001; 165: 2280-2283Abstract Full Text Full Text PDF PubMed Google Scholar The incidence of teratoma, generally mature teratoma, is 39%-48% in these series. Evaluation of children before surgical treatment will give the urologic surgeon a better idea on whether the testis might be salvaged with tumor enucleation or excision. Preoperative examination of the testes with ultrasound imaging was discussed in some of the other series but no particular descriptions were given on typical ultrasound findings in testes with teratoma.4Taskinen S. Fagerholm R. Aronniemi J. et al.Testicular tumors in children and adolescents.J Ped Urol. 2008; 4: 134-137Abstract Full Text Full Text PDF PubMed Scopus (75) Google Scholar, 5Metcalf P.D. Farivar-Mohseni H. Farhat W. et al.Pediatric testicular tumors: contemporary incidence and efficacy of testicular preserving surgery.J Urol. 2003; 170: 2412-2416Abstract Full Text Full Text PDF PubMed Scopus (128) Google Scholar, 6Valla J. Testis-sparing surgery for benign testicular tumors in children.J Urol. 2001; 165: 2280-2283Abstract Full Text Full Text PDF PubMed Google Scholar The authors describe ultrasound findings in children with mature teratoma testis tumors as commonly having varying degrees of cystic elements, calcifications, and rare vascularity in the mass. All children were also evaluated with alpha-fetoprotein (AFP) serum tumor marker assessment as is recommended to assure that the testis tumor is not malignant with yolk sac elements. Although this series was small with only 7 cases, all the cases were found to have mature teratoma on final pathology. It is reasonable to deduce that mature teratoma with endodermal mesodermal and ectodermal tissue derivatives would have cystic and calcified elements found on ultrasound according to its composition. It is worthwhile noting that although mature teratoma can be treated by testis sparing surgery in most instances, immature teratoma should not be considered or treated the same as mature teratoma. Although there have not been any reported cases of metastasis or recurrence in children younger than 12 years with mature teratoma, that has been a reported case of metastatic immature teratoma with neuroectodermal elements.7Kato K. Ijiri R. Tanaka Y. et al.Testicular immature teratoma with primitive neuroectodermal tumor in early childhood.J Urol. 2000; 164: 2068-2069Abstract Full Text Full Text PDF PubMed Scopus (13) Google Scholar This tumor represents <10% of tumors reported to the Pediatric Oncology Group/Children's Cancer Group. It was recommended to completely remove this tumor and not to perform testis sparing surgery. All testis tumors, regardless of ultrasound findings, should at a minimum have an AFP serum marker test and surgical excision with an inguinal approach, vascular control with a tourniquet, and excisional biopsy with frozen section pathologic assessment of the mass performed with a nonmalignant assessment of the testis tissue done before consideration for testis sparing surgery. If there is an abnormal elevation of the AFP or any tissue components suspicious for malignancy, the entire testis should be removed. The authors have given us some reassuring ultrasound element assessments found in mature teratoma which help in planning a testis surgical procedure for the patient, barring elevated AFP or tissue findings not consistent with a benign testis tumor in childhood. Mature Testicular Teratoma in Children: Multifaceted Tumors on UltrasoundUrologyVol. 83Issue 1PreviewTo describe the different ultrasound (US) findings of mature testicular hamartomas in children. Full-Text PDF

Mature Testicular Teratoma in Children: Multifaceted Tumors on Ultrasound

To describe the different ultrasound (US) findings of mature testicular hamartomas in children. This is a retrospective study from January 2000 to July 2012 that reviewed the clinical, laboratory, and US findings of 7 children with a pathologic diagnosis of mature teratoma of the testis. All patients in the study received surgery (tumorectomy or orchiectomy), and the material was examined by the institution's Pathology Department. The US findings were varied and distinct. As to the lesions' consistency, they were cystic (n: 1), multicystic (n: 2), solid-cystic (n: 1), solid containing larger or smaller calcifications (n: 2), and focal calcification (n: 1). With regard to total circulation, all the solid lesions had few vessels in the interior of the lesions. Testicular teratoma has a very variable US appearance and can simulate that of other lesions. It can be single, multiseptated, small, or large. It can contain diffuse or localized calcifications. The testicle can have an increased or a normal volume.

Mature Teratoma of the Petrous Bone with Extension into the Cerebellopontine Angle: Case Report

Purpose Intracranial teratomas in children involving lateral structures such as the petrous portion of the temporal bone are very uncommon. The authors report a case of a petrous teratoma with significant extension into the cerebellopontine angle with brainstem compression. Case Report An 11-year-old girl presented left-sided facial weakness. Computed tomography (CT) demonstrated a multiloculated lesion expanding the labyrinthine structures in the left petrous temporal bone including the vestibule, semicircular canals, and cochlea, with extension to the left cerebellopontine angle via the expanded left internal auditory canal. The tumor was resected via a transtemporal approach with no evidence of recurrence at nearly 2 years. Conclusion Complete resection should be the primary treatment for these tumors to minimize the risk of recurrence. To the authors' knowledge, this is the first case report of a mature teratoma originating in the petrous bone with extension into the cerebellopontine angle.

An unusual cause of neonatal apnoea (Discussion and Diagnosis)

The Case Presentation can be found on page 772. DISCUSSION While apnoea is a common problem in preterm infants, in term neonates, apnoea should always raise concern for a pathologic cause. This differential diagnosis of apnoea in the term neonate is broad. As episodes are usually brief, it can be difficult to classify occurrences as central, obstructive or mixed. Initial work-up should focus on identifying potentially treatable, life-threatening conditions such as sepsis, metabolic disturbances, accidental or intentional poisoning, abusive head injury, seizures and cardiovascular causes. To my knowledge, neonatal apnoea has not been previously described in the literature as presentation of gastric teratoma. Although the overall prevalence of neonatal teratomas is unknown, themost common form, sacrococcygeal teratoma, occurs once in every 14,900 live births (1). While rare, neonatal teratomas represent the most common congenital tumours and comprise 35% of neonatal tumours (2). The majority of teratomas in children and adults arise from gonadal sites; however, teratomas in neonates most commonly arise from extra-gonadal sites such as the sacrococcygeal area and mediastinum. Gastric teratomas account for less than one percentage of neonatal teratomas (3). To date, there are nine reported cases of neonatal gastric teratomas in the literature. Clinical presentations described by previous authors include severe anaemia, gastrointestinal bleeding, abdominal distension and respiratory distress (4–6). Neonatal teratomas are usually benign; therefore, complications are related to mass effect rather than malignant potential. Surgical resection is curative, but complete resection is often challenging due to the location of these tumours. Alpha-fetoprotein (AFP) should be followed as a marker of incomplete resection or recurrence (7). Interpretation of serum AFP in the neonatal period is challenging as levels are normally elevated at birth and decline over the first year of life. In this patient, serum AFP was 3225 ng/mL prior to resection, 40.5 ng/mL at 2 months and 1.5 ng/mL at 1 year of age. Yearly MRI has not shown evidence of recurrence. The patient is now 5-year old. He is growing appropriately and performing well in school.

Ovary-sparing surgery for teratomas in children

To share our experience in ovary-sparing surgery for teratomas in children. The medical records of nine patients (mean age of 11.2 years, r 6-15 years) who had undergone ovary-sparing surgery for teratoma were analyzed retrospectively. Mean duration for follow-up was 29.5 months (r 15-75 months). Five patients suffered from chronic abdominal pain; two had acute colicky abdominal pain. In two patients, there was no presenting clinical symptom. Two patients were operated on emergency basis due to symptoms related with acute abdomen. On the other hand, seven were operated electively. Ultrasonography was performed in all patients. Additionally, MRI and tumor markers were performed in all but two. Main radiologic findings consisted of heterogenous cystic and solid ovarian masses predictive of teratoma. The definitive diagnosis in emergency cases were as follows: perforated appendicitis plus teratoma [1]; torsion of the ovarian mass with teratoma [1]. The final diagnosis in electively treated seven patients were: unilateral ovarian teratoma [4], bilateral ovarian teratoma [1], bilateral teratoma plus appendiceal inflammatory mass [1], unilateral teratoma and contralateral corpus hemorrhagicum cyst [1]. The operations were performed by open conventional surgery in six and laparoscopy in three patients. The procedures were ovary-sparing surgery in 12 ovaries, appendectomy in 2 patients and detorsion of ovary in 1 patient. The main indication for ovary-sparing surgery was the "existence of a perfect dissection plane between the tumor margins and healthy ovarian tissue". The remaining ovarian tissue was evaluated macroscopically for residual lesions. Frozen section was performed in three suspected patients and the ovarian margins were free of any tumor cell. The pathologic diagnosis was: mature cystic teratoma in 10, immature teratoma in 1 and corpus hemorrhagicum cyst in 1. The postoperative outcome and follow-up was uneventful. Heterogenous ovary mass containing solid and cystic portions with echogenic areas on ultrasound imaging is highly suggestive of ovarian teratomas. Emergent surgical intervention is indicated if there is any suspicion of ovarian torsion. Otherwise, MRI is performed for further radiological evaluation. Based on radiologic findings, ovary-sparing surgery can be safely performed if the preoperative diagnosis is teratoma and there is always a plane of dissection between the normal ovary and cyst wall.