Unborn child with a tumor—rare, but not impossible. How would you save mom and baby?
Key Takeaways
Industry Buzz
“The critical piece was making sure that we could stabilize his airway so that he could breathe for himself.” —Melinda Markham, MD, medical director of the fetal center and neonatologist for Riley Children’s Health
Halfway through pregnancy, Katy Preidt and Dustin Lower received the news that their baby had a tumor growing on his neck. Immediate concerns were raised, as doctors feared that, once delivered, the tumor would block the infant's airway. []
Their baby's high-risk birth required a specialized delivery called an EXIT procedure, which allowed the infant to be intubated while still receiving oxygen from the placenta. Fortunately, tests later revealed tumor, a cervical teratoma, was cancer-free.
More about cervical teratomas
Cervical teratomas are rare congenital tumors that develop in the neck region, predominantly in neonates. These tumors are of germ cell origin and can present significant challenges due to their size and potential to obstruct vital structures. []
A cervical teratoma is a mass composed of tissues from all three embryonic germ layers: ectoderm, mesoderm, and endoderm. []
These tumors are classified as extragonadal germ cell tumors, meaning they occur outside the gonads. While most cervical teratomas are benign, they can cause severe complications due to their location and size. []
Related: Rare cancer misdiagnosed as 'growing pains'Clinical presentation and diagnosis
Cervical teratomas are often detected prenatally during routine ultrasounds, typically around 18 weeks of gestation.
The tumors appear as large, asymmetric, and well-demarcated masses, often with solid and cystic components. Polyhydramnios, or excess amniotic fluid, may be present due to esophageal compression, leading to swallowing difficulties. []
Postnatal presentation includes respiratory distress, feeding difficulties, and visible neck masses. Diagnosis is confirmed through imaging studies such as ultrasound and MRI, which help delineate the extent of the tumor and its relationship to surrounding structures. []
Treatment and management
The primary treatment for cervical teratomas is surgical resection. Given the potential for airway obstruction, delivery planning is crucial.
In cases where airway management is anticipated to be challenging, an Ex Utero Intrapartum Treatment (EXIT) procedure may be performed. This approach allows for controlled airway management and immediate surgical intervention after birth. []
Postoperative care includes monitoring for complications such as hypothyroidism, hyperparathyroidism, and developmental delays. Long-term follow-up is essential to assess for recurrence or malignant transformation, particularly in cases with incomplete resection. []
Risk factors and prognosis
The exact etiology of cervical teratomas remains unknown; however, they are not considered hereditary and do not typically recur in subsequent pregnancies.
Prognosis is generally favorable with early detection and appropriate surgical intervention. However, large tumors or those with malignant potential require careful management and long-term surveillance .
Cervical teratomas, while rare, present significant challenges in neonatal care. Early detection through routine prenatal screening and a multidisciplinary approach to delivery and postoperative care are essential for optimal outcomes.
Related: Medical mystery: Why are babies in China being born with their organs in the wrong place?