What is a cervical teratoma?
A cervical teratoma is a tumor located in the neck comprised of several different types of embryonic tissue. There are usually solid and cystic components and some portions maybe calcified. A teratoma can occur in any part of the body, most often the sacral region. A cervical teratoma is very rare and accounts for about 5% of all teratomas. It affects both sexes and all ethnicities, equally. The cause is unknown.
What testing is recommended during the pregnancy?
Serial ultrasounds will monitor the size and vascularity of the tumor, the baby's growth, and the amount of amniotic fluid present. Polyhydramnios, an increased amount of amniotic fluid, often develops when a large tumor is identified. A fetal MRI is recommended to better define the airway anatomy and the extent of the mass. If the tumor is highly vascular, a fetal echocardiogram is recommended.
Are there special considerations for the delivery?
Airway management at birth is critical with giant neck masses. It is recommended that the delivery be planned at a fetal therapy center prepared for high-risk deliveries as well as pediatric and fetal surgery. Airway obstruction is life-threatening and is associated with high mortality.
Preterm labor is common due to an increased amount of amniotic fluid which is caused by compression at the esophagus causing the baby's to swallow much less amniotic fluid than expected.
Is there fetal treatment for a cervical teratoma?
A procedure was developed to address the immediate need to secure an airway at birth and prevent asphyxiation. This procedure is called ex utero intrapartum treatment, or EXIT procedure. This is a type of modified C-section delivery in which the mother requires general anesthesia. The use of general anesthesia ensures a relaxed uterus which permits the placenta to continue supplying oxygenated blood to the baby while the airway is being secured with either a breathing tube or a surgical tracheostomy. Patients undergo extensive evaluation to assess the need for an EXIT procedure.
What is the treatment for a cervical teratoma?
Surgical removal of the tumor is performed often after the baby is stabilized. Cranial nerve monitoring is utilized to reduce the risk of nerve damage during surgery. All tumors are sent to the laboratory to be carefully examined.
Are there other health problems that are more common among babies with a cervical teratoma?
A cervical teratoma may involve the thyroid and parathyroid glands. Therefore, these infants are at risk for hypoparathyroidism, and hypothyroidism. A pediatric endocrinologist (a specialist in glands and hormones) is often consulted to assess blood tests and provide supplementation as needed to help the baby grow.
In general, a cervical teratoma is a benign tumor, although there is a small possibility of malignancy. If there is complete surgical excision, chemotherapy is not indicated. However, in rare cases of recurrence in immature or malignant tumors, chemotherapy is very effective.
Alpha-fetoprotein (AFP) is a protein produced by immature cells of the fetus and is elevated in patients with cervical teratomas. These levels should fall after tumor removal. Subsequent AFP levels are used as a screening tool for recurrence. Serial physical examination and imaging of the neck area is recommended until 3 years of age.
Some babies will need a temporary tracheostomy, an airway created in the neck with a small tube through the skin and into the windpipe. This may be in for weeks to months post-operatively. Transient swallowing problems may also occur.
Can this happen again with another pregnancy?
This is a very rare occurrence. The risk of cervical teratoma in a future pregnancy is extremely low. Your doctor and a genetic counselor will review your risk.