Understanding Cervical Teratomas?

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A cervical teratoma is a rare tumor that develops in a baby's neck during pregnancy. While these tumors are usually benign (non-cancerous), they can become life-threatening because of their location and potential to block the baby's airway at birth. 

• A rare congenital tumor arising from embryonic germ cells in the fetal neck.
• Most are benign but may grow rapidly during pregnancy, especially in the 3rd trimester
• Large tumors can compress or displace the airway, esophagus, and surrounding structures.
• Polyhydramnios (excess amniotic fluid) may develop if the fetus has difficulty swallowing

The effects of a fetal teratoma depend largely on its size and location. While many are benign, large tumors can interfere with the normal development or function of nearby organs before or after birth

(Pic: child with a large cervical teratoma (arrow))

Multidisciplinary Evaluation: meet with MFM specialist, pediatric surgeon, neonatologist, pediatric Head and Neck surgeon, and other experts who will care for your baby

Comprehensive Imaging: detailed ultrasounds and other tests when indicated to assess your baby's condition and help plan treatment

Coordinated Delivery Planning: our team works to ensure your baby receives immediate specialized care at birth

Cervical teratomas are usually identified on routine prenatal ultrasound. Additionally testing at the Grant Scott Bonham Fetal Center will help further characterize the tumor to direct care.

• Fetal MRI provides detailed evaluation of tumor size and extent, and relationship to the fetal airway and major blood vessels, as well as the degree of airway compression or displacement

• Fetal echocardiography will help to assess cardiac function and evaluate for associated abnormalities. Teratomas that are primarily solid can cause excess stress on the heart leading to failure, which results in hydrops, or excess fluid in the fetus

• Serial ultrasounds monitor tumor growth, amniotic fluid volume, and fetal status throughout pregnancy

All of this information will help the fetal team give you the most accurate information so that you can make the best possible decision about treatment.

(pic: fetal MRI of a child with a cervical teratoma (arrow))

The effects of a cervical teratoma depend largely on its size and location. While many are benign, large tumors can interfere with the normal development or function of nearby organs before or after birth. 

A cervical teratoma may cause:

• Compression of the fetal airway: This typically doesn't become a problem until the child is born, and can often make it difficult for the child to breath. The distortion of the airway can also make it very difficult for a physician to place a tube in the child's airway to help them breathe

• Fluid can accumulate in the body (hydrops fetalis): Large solid tumors can put excess strain on the heart leading to impaired heart function  causing fluid buildup in the abdomen, chest, skin, or around the heart. Hydrops is a sign of severe disease and worsens prognosis

• Amniotic fluid abnormalities may occur: Compression of the airway and esophagus can interfere with fetal swallowing, sometimes leading to polyhydramnios (excess amniotic fluid)

(Pic: fetus with hydrops)

• Close monitoring during pregnancy

• Delivery is recommended at a tertiary fetal care center with immediate access to neonatal airway and surgical specialists

• If significant airway obstruction is anticipated, an EXIT (Ex Utero Intrapartum Treatment) procedure may be recommended, allowing the baby's airway to be secured while placental support is maintained

(Pic: Fetal team performing an EXIT procedure)

EXIT (Ex Utero Intrapartum Treatment) Delivery: for most fetuses with known complete or severe airway obstruction, delivery is performed using the EXIT procedure. This allows the baby to remain attached to the placenta while the airway is secured, providing oxygen and  prevents emergency airway compromise. 

Airway management during EXIT may include:

• Direct laryngoscopy or bronchoscopy
• Endotracheal intubation
• Tracheostomy if intubation is not possible

(Pic: infant undergoing an EXIT to intubation for a cervical teratoma)

Babies with a cervical teratoma should be delivered at our center where an EXIT procedure can be performed to enable safe delivery with an airway.  Once the airway is secured, the baby is fully delivered and transferred to the neonatal intensive care unit (NICU) for ongoing care. The neonatologist is a specially trained pediatrician that will manage your baby’s medications, feeding, and daily needs while in the NICU. 

Most of these children require a specialized breathing tube (endotracheal tube) and some may need a tracheostomy, or tube that goes through the skin of the neck into the airway.  

Either tube is connected to a machine to assist with breathing (ventilator). Some may also require medications to help maintain a normal blood pressure.

A tube placed through the mouth (oral gastric or OG) all the way to the stomach. This tube will suck out any fluid with in the stomach to prevent your baby from choking or breathing stomach contents into the lungs and to prevent the intestines from becoming too dilated with air.   

Your baby will receive fluids and antibiotics through a special IV called a PICC line, initially through the umbilical cord, then placed in one of the limbs.  Because the child will not be initially allowed to eat, they will also receive nutrition through the PICC line called TPN, or total parenteral nutrition. TPN contains protein, fat, sugar, vitamins, and minerals and will meet all your baby’s nutritional needs

(Pic: Child with a cervical teratoma cared for in the NICU)

• Definitive airway management: Initial priority is establishing a safe airway and stabilizing the newborn.  Some children require a tracheostomy to maintain a stable airway, either temporarily or long-term, depending on the anatomy

• Surgical removal of the tumor is the primary treatment. The timing and complexity of surgery depend on the tumor's size, location, and involvement of surrounding structures

• Some infants may require  feeding assistance during recovery, initially through an OG tube, but some may also require longer assistance through a gastrostomy (G) tube.

(Pic: child after resection of cervical teratoma)

• Most cervical teratomas are benign

• When complete surgical removal is possible, long-term outcomes are generally excellent

• Prognosis depends on: degree of airway compromise, tumor size and involvement of nearby structures, the presence of associated complications, and the overall neonatal condition at delivery

A mediastinal teratoma is a rare tumor that develops within the mediastinum, the central compartment of the chest above the heart and between the lungs. Although usually benign (non-cancerous), it can become life-threatening before or after birth by compressing the heart, lungs, or major blood vessels. 

• Rare congenital tumor that arises from embryonic germ cells
• Most are benign but can grow rapidly during pregnancy
• Depending on size and location, the tumor may compress the heart, lungs, or major blood vessels and interfere with normal fetal development

(Pic: child with arrow demonstrating large mediastinal teratoma)

Multidisciplinary Evaluation: meet with MFM specialist, pediatric surgeon, neonatologist, and other experts who will care for your baby

Comprehensive Imaging: detailed ultrasounds and other tests when indicated to assess your baby's condition and help plan treatment

Coordinated Delivery Planning: our team works to ensure your baby receives immediate specialized care at birth

A mediastinal teratoma is usually identified on routine prenatal ultrasound. Additionally testing at the Grant Scott Bonham Fetal Center will help further characterize the tumor to direct care.

• Fetal MRI provides detailed evaluation of tumor size and extent, relationship to the fetal airway and major blood vessels, and degree of airway compression or displacement

• Fetal echocardiography will help to assess cardiac function and evaluate for associated abnormalities. Mediastinal teratomas that are primarily solid can cause excess stress on the heart, or put pressure on the heart leading to failure, which results in hydrops, or excess fluid in the fetus

• Serial ultrasounds monitor tumor growth, amniotic fluid volume, and fetal status throughout pregnancy

All of this information will help the fetal team give you the most accurate information so that you can make the best possible decision about treatment.

(pic: MRI of a child with a mediastinal teratoma (arrow))

The effects of a mediastinal teratoma depend largely on its size and location. Large tumors can interfere with the normal development or function of nearby organs before or after birth. 

The mass may cause:

• Pressure to build within the chest: The enlarged mass compress nearby structures, including the heart, great vessels, and diaphragm
• The heart is compressed and displaced: Pressure on the heart can impair normal cardiac filling and function, reducing blood flow and leading to signs of heart failure before birth
• Fluid can accumulate in the body (hydrops fetalis): Impaired heart function and abnormal venous return causes fluid buildup in the abdomen, chest, skin, or around the heart. Hydrops is a sign of severe disease and worsens prognosis
• Amniotic fluid abnormalities may occur: Compression of the esophagus can interfere with fetal swallowing, sometimes leading to polyhydramnios (excess amniotic fluid)

(Pic: fetus with a mediastinal teratoma with hydrops)

• Close monitoring during pregnancy

• Delivery is recommended at a tertiary fetal care center with immediate access to neonatal airway and surgical specialists, such as the Grant Scott Bonham Fetal Center at Primary Children's Hospital

• Fetal resection: rarely, the mass causes significant cardiac compromise early in pregnancy (< 24 weeks gestation), requiring fetal surgery to remove the mass

• EXIT (Ex Utero Intrapartum Treatment) procedure:  used (> 24 weeks gestation) If significant airway obstruction is anticipated, allowing the baby's airway to be secured while placental support is maintained. Also used to resect the mass while on placental support, if felt the size of the mass will significantly compromise the child's ability to breathe upon delivery

• C-Section to Resection: immediate resection of the mass following Cesarean section. After delivery, the baby is rapidly resuscitated, then undergoes surgery to remove the mass. This is the most common approach we use when the child is close to term

(Pic: Fetal team performing fetal surgery)

Babies with a mediastinal teratoma should be delivered at our center where fetal surgery can be performed and with immediate access to a specialized team that has experience caring for these infants.  After delivery the baby is transferred to the neonatal intensive care unit (NICU) for ongoing care. The neonatologist is a specially trained pediatrician that will manage your baby’s medications, feeding, and daily needs while in the NICU. 

Most of these children will require breathing assistance through a tube (endotracheal) that is connected to a machine to assist with breathing (ventilator). Some may also require medications to help maintain a normal blood pressure.

A tube placed through the mouth (oral gastric or OG) all the way to the stomach. This tube will suck out any fluid with in the stomach to prevent your baby from choking or breathing stomach contents into the lungs and to prevent the intestines from becoming too dilated with air.   

Your baby will receive fluids and antibiotics through a special IV called a PICC line, initially through the umbilical cord, then placed in one of the limbs.  Because the child will not be initially allowed to eat, they will also receive nutrition through the PICC line called TPN, or total parenteral nutrition. TPN contains protein, fat, sugar, vitamins, and minerals and will meet all your baby’s nutritional needs

• Most mediastinal teratomas are benign

• Outcomes are generally favorable when the tumor can be safely removed.

• Prognosis depends on: tumor size and location, degree of heart or lung compression, development of hydrops fetalis, and the gestational age at delivery and neonatal condition

A pericardial teratoma is a rare tumor that develops from the heart, within the sac around the heart known as the pericardium. Although usually benign (non-cancerous), it can become life-threatening before or after birth by causing compression of the heart as it grows.

• Rare congenital tumor that arises from embryonic germ cells
• Pericardial teratoma arises from the heart, within the sac surrounding the heart (pericardium)
• Most are benign but can grow rapidly during pregnancy especially in the third trimester
• As the tumor grows it may cause compression of the heart. As the pericardium doesn't stretch, even a small amount of growth can result in severe compression of the heart leading to heart failure, seen as hydrops or extra fluid in the fetus
• This makes a pericardial teratoma is often lethal and difficult to treat depending on when it is found during gestation

(Pic: child with arrow demonstrating large pericardial teratoma)

Multidisciplinary Evaluation: meet with MFM specialist, pediatric surgeon, neonatologist, pediatric cardiothoracic surgeon, and other experts who will care for your baby

Comprehensive Imaging: detailed ultrasounds and other tests when indicated to assess your baby's condition and help plan treatment

Coordinated Delivery Planning: our team works to ensure your baby receives immediate specialized care at birth

A pericardial teratoma is usually identified on routine prenatal ultrasound. Additionally testing at the Grant Scott Bonham Fetal Center will help further characterize the tumor to direct care.

• Fetal MRI provides detailed evaluation of tumor size and extent, relationship to the fetal airway and major blood vessels, and degree of airway compression or displacement

• Fetal echocardiography will help to assess cardiac function and evaluate for associated abnormalities. Because the pericardial teratoma is within the sac around the heart (heart), and the sac doesn't stretch, even small growth can cause pressure on the heart leading to failure, which results in hydrops, or excess fluid in the fetus

• Serial ultrasounds monitor tumor growth, amniotic fluid volume, and fetal status throughout pregnancy

All of this information will help the fetal team give you the most accurate information so that you can make the best possible decision about treatment.

(pic: ultrasound of a fetus with a pericardial teratoma (arrow))

The effects of a pericardial teratoma depend largely on its size and location. While many are benign, because they arise from the heart, inside the pericardium, any growth of the tumor can interfere with normal development and function of the heart before or after birth. 

The mass may cause:

• Pressure to build within the chest: The enlarged mass compress nearby structures, including the heart and great vessels
• The heart is compressed and displaced: Pressure on the heart can impair normal cardiac filling and function, reducing blood flow and leading to signs of heart failure before birth
• Fluid can accumulate in the body (hydrops fetalis): Impaired heart function and abnormal venous return causes fluid buildup in the abdomen, chest, skin, or around the heart. Hydrops is a sign of severe disease and worsens prognosis
• Amniotic fluid abnormalities may occur: Compression of the esophagus can interfere with fetal swallowing, sometimes leading to polyhydramnios (excess amniotic fluid)

(Pic: fetus with hydrops)

• Close monitoring during pregnancy

• Delivery is recommended at a tertiary fetal care center with immediate access to neonatal airway and surgical specialists, such as the Grant Scott Bonham Fetal Center at Primary Children's Hospital

• Fetal resection: when the mass causes significant cardiac compromise early in pregnancy (< 24 weeks gestation), fetal surgery may be required to remove the mass

• EXIT (Ex Utero Intrapartum Treatment) procedure:  used (> 24 weeks gestation) may be used to resect the mass while on placental support, if felt the size of the mass will significantly compromise the child upon delivery

• C-Section to Resection: immediate resection of the mass following Cesarean section. After delivery, the baby is rapidly resuscitated, then undergoes surgery to remove the mass. This is the most common approach we use when the child is close to term

(Pic: Fetal team performing fetal surgery)

Babies with a pericardial teratoma should be delivered at our center where fetal surgery can be performed and with immediate access to a specialized team that has experience caring for these infants.  After delivery the baby is transferred to the neonatal intensive care unit (NICU) for ongoing care. The neonatologist is a specially trained pediatrician that will manage your baby’s medications, feeding, and daily needs while in the NICU. 

Most of these children will require breathing assistance through a tube (endotracheal) that is connected to a machine to assist with breathing (ventilator). Some may also require medications to help maintain a normal blood pressure.

A tube placed through the mouth (oral gastric or OG) all the way to the stomach. This tube will suck out any fluid with in the stomach to prevent your baby from choking or breathing stomach contents into the lungs and to prevent the intestines from becoming too dilated with air.   

Your baby will receive fluids and antibiotics through a special IV called a PICC line, initially through the umbilical cord, then placed in one of the limbs.  Because the child will not be initially allowed to eat, they will also receive nutrition through the PICC line called TPN, or total parenteral nutrition. TPN contains protein, fat, sugar, vitamins, and minerals and will meet all your baby’s nutritional needs

• Most pericardial teratomas are benign, however, because they grow within a confined space (inside the pericardium), they can cause significant cardiac dysfunction early leading to fetal demise

• Outcomes are generally favorable when the tumor can be safely removed. However, if done as fetal surgery, can lead to maternal complications, such as membrane rupture, preterm premature rupture of membranes (PPROM), preterm labor, and fetal demise

• Prognosis depends on: tumor size and location, degree of heart compression, development of hydrops fetalis, and the gestational age at intervention