Teratoma of the Neck Causing Neonatal Death

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Abstract
According to statistical reports, teratoma of the neck is a rare entity. The following case is therefore considered to be worth recording. A 17-year-old primipara was referred to the Department of Radiology in the thirty-sixth week of pregnancy. Between the thirty-sixth and the thirty-seventh week her external uterine measurements increased from 33 to 43 cm. Only one fetal heart tone was audible. A fetogram demonstrated a fetus in utero with skeletal development compatible with the history of pregnancy. The fetal head was caudad and appeared to be in extended position. The fetal spine was also extended, and the extremities were peripherally placed in relation to the body. There was definite evidence of polyhydramnios. The radiographic impression was polyhydramnios with probable soft-tissue pathology, most likely involving the abdominal viscera, as the cause of the extended attitude of the fetus. One week later there developed constant abdominal distress, with irregular contractions of the uterus which persisted for twenty-four hours. A recheck fetogram at that time showed no change in the attitude of the fetus. The patient was taken to the delivery room and the membranes were ruptured. A measured 5 liters of amniotic fluid was obtained in fifteen minutes. Active labor ensued and complete dilatation was obtained in approximately ten hours. A right occiput posterior position was corrected without difficulty, but no further advancement of the head occurred. The fetal heart tones continued to be strong and regular. It became evident that there was a midpelvic arrest and section was considered advisable. A male infant weighing 2,850 grams was delivered but died immediately from anoxia due to laryngotracheal obstruction. A large cystic mass involved the entire anterior aspect of the neck from the mandible downward and projected over the anterior chest wall to the level of the nipples. A rather firm nodular structure could be felt in the left side of the mass. No other defects were visible. A radiograph revealed considerable calcific material in the left side of the tumor. This did not resemble any recognizable anatomical structure. There was no evidence of air in the lungs or in the gastrointestinal tract and no skeletal abnormalities were demonstrated. The pathologist's report is as follows: “The cervical mass weighs 483 grams, with dimensions of 12 × 10 × 9 cm. It is attached firmly to the anterior aspect of the larynx and trachea and does not extend into the mediastinum; it is separate from the thymus gland. There is appreciable edema of the larynx and sufficient distortion of the cervical portion of the respiratory tract to cause respiratory obstruction. Although there are embryonal tissues in this neoplastic mass, cells having the cytologic criteria of carcinoma are not recognized.

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