Excision of an intrapericardial immature teratoma in a 26-week premature neonate

Abstract

We present a case of a 26 week premature newborn with an immature intrapericardial teratoma. The patient was transferred from an outside hospital for management of a large mediastinal mass causing respiratory insufficiency. The newborn was supported with the help of a large interdisciplinary team until day of life 22 when he underwent surgical excision. On follow up the infant is doing very well and is one of the youngest survivors to date.

Fetal Intrapericardial Teratomas: An Update

“…Tumor compression was observed in 33 (60 %) cases, and the most commonly compressed structures were the right heart chambers (▶ table 2). Three (5.5 %) fetuses had associated congenital heart defects: a patent ductus defect in 2 cases [13,22] and transposition of the great arteries with a secundum atrial septal defect in 1 case [36].…”

“…In 11 (61.1 %) of the 18 fetuses, reaccumulation occurred one to three times [11, 14, 16, 22-24, 26, 27, 34, 44, 50], and in 1 (5.6 %) fetus, pericardial effusions persisted [21]. Further management was required in these 12 fetuses, including repeated pericardiocentesis in 8 (66.7 %) fetuses [14,23,24,26,27,34,44,50], a pericardio-amniotic shunt in 3 (25 %) fetuses [11,16,34], and pericardial drain placement in 1 (8.3 %) fetus [22]. The antenatal management applied in the other 6 (25 %) fetuses was: an ex utero intrapartum treatment (EXIT) procedure in 3 (50 %) cases [9,43,49], a pericardio-amniotic shunt in 2 (33.3 %) cases [48,51], and laser ablation of the feeding vessels of the tumor, which resolved the pericardial effusions but failed to inhibit the growth of tumor in 1 (16.7 %) case [30].…”

“…The gross pathology of the teratomas was reported for 33 (60 %) cases: 18 (54.5 %) were cystic [9-13, 16-22, 25, 27, 32-38, 40, 42, 43, 45-47, 50, 51]; 2 (6.1 %) were cystic with solid areas [23,41]; 1 (3.0 %) was solid [28]; and 12 (36.4 %) were solid with cystic components [14, 15, 24, 26, 29-31, 38, 39, 48, 49]. The histology of the tumors was reported for 47 (85.5 %) cases: 12 (25.5 %) were mature [10,14,15,21,25,31,32,[34][35][36]46]; 14 (29.8 %) were immature [9,11,12,16,22,24,28,33,38,39,41,[49][50][51]; 10 (21.3 %) were mixed mature and immature with a predominance of mature cells [13, 18, 23, 26, 29, 30, 38, 41, 42, ]; 4 (8.5 %) were mixed mature and immature with a predominance of immature components; and 3 (6.4 %) were unspecified teratomas [17,20,27].…”

“…▶Fig. 1 The decreasing trend of the α-fetoprotein level from birth to 6 months after tumor resection in newborns in whom an intrapericardial teratoma was detected during fetal life [9,13,19,22,24,32,33,35,42]. m, month.…”