Diagnosis, management, and outcome of cervicofacial teratomas in neonates: A Childrens Cancer Group study

Richard G. Azizkhan, Gerald M. Haase, Harry Applebaum, Peter W. Dillon, Arnold G. Coran, Phillip A. King, Denis R. King, David S. Hodge

Research output: Contribution to journalArticle

117 Citations (Scopus)

Abstract

The management of cervicofacial teratomas in neonates is often complicated and may result in significant morbidity and death. A Childrens Cancer Group (CCG) retrospective study was conducted to evaluate a multiinstitutional experience with the treatment of these extremely rare neoplasms. Twenty neonates with cervicofacial teratomas, presenting from 1971 to 1994, were identified from nine CCG institutions. Fourteen neonates had cervical teratomas, and six had orofacial teratomas. There were 12 males and eight females. A diagnostic prenatal ultrasound examination was performed in six cases. Life-threatening airway obstruction occurred in seven infants (35%) in the early postnatal period. Two neonates died in the delivery room without ever having their airway secured. Two other infants with a prenatal diagnosis survived only because tracheostomies were performed by pediatric surgeons who were in the delivery room. Three other patients were orally intubated, one after sustaining hypoxic cardiac arrest. Eighteen infants had their primary tumor excised. Three patients required tracheostomy. After resection, two patients had evidence of unilateral recurrent laryngeal nerve injury, and two required prolonged thyroid hormone replacement. Histological examination showed eight mature and seven immature teratomas. Four infants (20%) clearly had malignant lesions. Pulmonary metastases occurred in two patients and contributed to one late death at 6 months of age. The overall survival rate was 85%, and the mean follow-up period was 5 years (range, 2 months to 16 years). Twelve of 17 surviving patients (70%) have had an excellent functional and cosmetic outcome. Four children have varying degrees of developmental delay and mental retardation. Hypoxia at birth was believed to have contributed to these problems in two cases. One patient had severe hemifacial hypoplasia after resection and intraoperative radiation for invasive teratocarcinoma. Life-threatening airway obstruction at birth is common in infants who have cervicofacial teratomas. Prenatal diagnosis is a reliable and essential method for detecting these neoplasms in utero. Pediatric surgical expertise should be available in the delivery room to offer these infants the best chance for survival. Early resection has reduced the mortality rate among operative cases to a minimum. Malignant transformation occurs with sufficient frequency to warrant early surgical intervention and long-term surveillance.

Original languageEnglish (US)
Pages (from-to)312-316
Number of pages5
JournalJournal of Pediatric Surgery
Volume30
Issue number2
DOIs
StatePublished - Jan 1 1995

Fingerprint

Teratoma
Newborn Infant
Delivery Rooms
Neoplasms
Tracheostomy
Airway Obstruction
Prenatal Diagnosis
Recurrent Laryngeal Nerve Injuries
Parturition
Pediatrics
Teratocarcinoma
Heart Arrest
Thyroid Hormones
Cosmetics
Intellectual Disability
Ultrasonography
Survival Rate
Retrospective Studies
Radiation
Neoplasm Metastasis

All Science Journal Classification (ASJC) codes

  • Surgery
  • Pediatrics, Perinatology, and Child Health

Cite this

Azizkhan, Richard G. ; Haase, Gerald M. ; Applebaum, Harry ; Dillon, Peter W. ; Coran, Arnold G. ; King, Phillip A. ; King, Denis R. ; Hodge, David S. / Diagnosis, management, and outcome of cervicofacial teratomas in neonates : A Childrens Cancer Group study. In: Journal of Pediatric Surgery. 1995 ; Vol. 30, No. 2. pp. 312-316.
@article{b1e659b1f2af4b51a1a48a0c7a5797d6,
title = "Diagnosis, management, and outcome of cervicofacial teratomas in neonates: A Childrens Cancer Group study",
abstract = "The management of cervicofacial teratomas in neonates is often complicated and may result in significant morbidity and death. A Childrens Cancer Group (CCG) retrospective study was conducted to evaluate a multiinstitutional experience with the treatment of these extremely rare neoplasms. Twenty neonates with cervicofacial teratomas, presenting from 1971 to 1994, were identified from nine CCG institutions. Fourteen neonates had cervical teratomas, and six had orofacial teratomas. There were 12 males and eight females. A diagnostic prenatal ultrasound examination was performed in six cases. Life-threatening airway obstruction occurred in seven infants (35{\%}) in the early postnatal period. Two neonates died in the delivery room without ever having their airway secured. Two other infants with a prenatal diagnosis survived only because tracheostomies were performed by pediatric surgeons who were in the delivery room. Three other patients were orally intubated, one after sustaining hypoxic cardiac arrest. Eighteen infants had their primary tumor excised. Three patients required tracheostomy. After resection, two patients had evidence of unilateral recurrent laryngeal nerve injury, and two required prolonged thyroid hormone replacement. Histological examination showed eight mature and seven immature teratomas. Four infants (20{\%}) clearly had malignant lesions. Pulmonary metastases occurred in two patients and contributed to one late death at 6 months of age. The overall survival rate was 85{\%}, and the mean follow-up period was 5 years (range, 2 months to 16 years). Twelve of 17 surviving patients (70{\%}) have had an excellent functional and cosmetic outcome. Four children have varying degrees of developmental delay and mental retardation. Hypoxia at birth was believed to have contributed to these problems in two cases. One patient had severe hemifacial hypoplasia after resection and intraoperative radiation for invasive teratocarcinoma. Life-threatening airway obstruction at birth is common in infants who have cervicofacial teratomas. Prenatal diagnosis is a reliable and essential method for detecting these neoplasms in utero. Pediatric surgical expertise should be available in the delivery room to offer these infants the best chance for survival. Early resection has reduced the mortality rate among operative cases to a minimum. Malignant transformation occurs with sufficient frequency to warrant early surgical intervention and long-term surveillance.",
author = "Azizkhan, {Richard G.} and Haase, {Gerald M.} and Harry Applebaum and Dillon, {Peter W.} and Coran, {Arnold G.} and King, {Phillip A.} and King, {Denis R.} and Hodge, {David S.}",
year = "1995",
month = "1",
day = "1",
doi = "10.1016/0022-3468(95)90580-4",
language = "English (US)",
volume = "30",
pages = "312--316",
journal = "Journal of Pediatric Surgery",
issn = "0022-3468",
publisher = "W.B. Saunders Ltd",
number = "2",

}

Diagnosis, management, and outcome of cervicofacial teratomas in neonates : A Childrens Cancer Group study. / Azizkhan, Richard G.; Haase, Gerald M.; Applebaum, Harry; Dillon, Peter W.; Coran, Arnold G.; King, Phillip A.; King, Denis R.; Hodge, David S.

In: Journal of Pediatric Surgery, Vol. 30, No. 2, 01.01.1995, p. 312-316.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Diagnosis, management, and outcome of cervicofacial teratomas in neonates

T2 - A Childrens Cancer Group study

AU - Azizkhan, Richard G.

AU - Haase, Gerald M.

AU - Applebaum, Harry

AU - Dillon, Peter W.

AU - Coran, Arnold G.

AU - King, Phillip A.

AU - King, Denis R.

AU - Hodge, David S.

PY - 1995/1/1

Y1 - 1995/1/1

N2 - The management of cervicofacial teratomas in neonates is often complicated and may result in significant morbidity and death. A Childrens Cancer Group (CCG) retrospective study was conducted to evaluate a multiinstitutional experience with the treatment of these extremely rare neoplasms. Twenty neonates with cervicofacial teratomas, presenting from 1971 to 1994, were identified from nine CCG institutions. Fourteen neonates had cervical teratomas, and six had orofacial teratomas. There were 12 males and eight females. A diagnostic prenatal ultrasound examination was performed in six cases. Life-threatening airway obstruction occurred in seven infants (35%) in the early postnatal period. Two neonates died in the delivery room without ever having their airway secured. Two other infants with a prenatal diagnosis survived only because tracheostomies were performed by pediatric surgeons who were in the delivery room. Three other patients were orally intubated, one after sustaining hypoxic cardiac arrest. Eighteen infants had their primary tumor excised. Three patients required tracheostomy. After resection, two patients had evidence of unilateral recurrent laryngeal nerve injury, and two required prolonged thyroid hormone replacement. Histological examination showed eight mature and seven immature teratomas. Four infants (20%) clearly had malignant lesions. Pulmonary metastases occurred in two patients and contributed to one late death at 6 months of age. The overall survival rate was 85%, and the mean follow-up period was 5 years (range, 2 months to 16 years). Twelve of 17 surviving patients (70%) have had an excellent functional and cosmetic outcome. Four children have varying degrees of developmental delay and mental retardation. Hypoxia at birth was believed to have contributed to these problems in two cases. One patient had severe hemifacial hypoplasia after resection and intraoperative radiation for invasive teratocarcinoma. Life-threatening airway obstruction at birth is common in infants who have cervicofacial teratomas. Prenatal diagnosis is a reliable and essential method for detecting these neoplasms in utero. Pediatric surgical expertise should be available in the delivery room to offer these infants the best chance for survival. Early resection has reduced the mortality rate among operative cases to a minimum. Malignant transformation occurs with sufficient frequency to warrant early surgical intervention and long-term surveillance.

AB - The management of cervicofacial teratomas in neonates is often complicated and may result in significant morbidity and death. A Childrens Cancer Group (CCG) retrospective study was conducted to evaluate a multiinstitutional experience with the treatment of these extremely rare neoplasms. Twenty neonates with cervicofacial teratomas, presenting from 1971 to 1994, were identified from nine CCG institutions. Fourteen neonates had cervical teratomas, and six had orofacial teratomas. There were 12 males and eight females. A diagnostic prenatal ultrasound examination was performed in six cases. Life-threatening airway obstruction occurred in seven infants (35%) in the early postnatal period. Two neonates died in the delivery room without ever having their airway secured. Two other infants with a prenatal diagnosis survived only because tracheostomies were performed by pediatric surgeons who were in the delivery room. Three other patients were orally intubated, one after sustaining hypoxic cardiac arrest. Eighteen infants had their primary tumor excised. Three patients required tracheostomy. After resection, two patients had evidence of unilateral recurrent laryngeal nerve injury, and two required prolonged thyroid hormone replacement. Histological examination showed eight mature and seven immature teratomas. Four infants (20%) clearly had malignant lesions. Pulmonary metastases occurred in two patients and contributed to one late death at 6 months of age. The overall survival rate was 85%, and the mean follow-up period was 5 years (range, 2 months to 16 years). Twelve of 17 surviving patients (70%) have had an excellent functional and cosmetic outcome. Four children have varying degrees of developmental delay and mental retardation. Hypoxia at birth was believed to have contributed to these problems in two cases. One patient had severe hemifacial hypoplasia after resection and intraoperative radiation for invasive teratocarcinoma. Life-threatening airway obstruction at birth is common in infants who have cervicofacial teratomas. Prenatal diagnosis is a reliable and essential method for detecting these neoplasms in utero. Pediatric surgical expertise should be available in the delivery room to offer these infants the best chance for survival. Early resection has reduced the mortality rate among operative cases to a minimum. Malignant transformation occurs with sufficient frequency to warrant early surgical intervention and long-term surveillance.

UR - http://www.scopus.com/inward/record.url?scp=0028871117&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=0028871117&partnerID=8YFLogxK

U2 - 10.1016/0022-3468(95)90580-4

DO - 10.1016/0022-3468(95)90580-4

M3 - Article

C2 - 7537809

AN - SCOPUS:0028871117

VL - 30

SP - 312

EP - 316

JO - Journal of Pediatric Surgery

JF - Journal of Pediatric Surgery

SN - 0022-3468

IS - 2

ER -