Teratomas in Children

Emryonic development in the womb develops from 3 separate germ cells called endoderm, ectoderm and mesoderm. Teratoma is a tumor originating from these 3 germ cell layers. Since all structures of the human body develop from these 3 germ cell layers, Teratoma can develop in any anatomical region of our body. Clinical findings of the tumor also vary according to the anatomical region where it occurs.

Various cell groups that can transform into any type of cell are found irregularly in teratomas. Tumors are divided into three groups as benign, malignant or immature (potentially malignant) tumors.

Teratomas are generally benign tumors, meaning they consist of mature cells, but they can also consist of malignant, i.e. immature cells.

In Which Parts of the Body is Teratoma More Common?

Teratomas are germ cell tumors that occur in any part of the body. They are generally located in the midline of the body. Teratomas are most commonly seen in the sacrococcygeal region, and 2. They arise most frequently from the ovarian tissue in girls and boys (ovaries in girls, testicles in boys). They are then seen in the chest cavity, neck, retroperitoneal region and brain.

While they are more common in the sacrococcygeal region under the age of one, they are more common in the gonads and chest cavity between the ages of 1-10. In older children, i.e. during puberty, they are usually seen in the gonads.

What are the Clinical Findings of Teratomas?

Clinical findings vary depending on the region where the tumor is located.

Sacrococcygeal Teratoma Clinic: It is usually detected during ultrasound in the womb. If it is not detected, it is seen when the baby is born. It is seen approximately 2-3 times more in girls, and its frequency is seen in 1 in 30,000-40,000 living beings. Teratomas are divided into 4 types depending on whether they are visible from the outside or not. The first 3 types are visible from the outside, which constitute approximately 90% of sacrococcygeal teratomas, and in 10% of them, the mass that protrudes is not detected, and the mass is located completely in front of the sacrum bone in the pelvis. In this group that is not visible from the outside, diagnosis is more difficult, but diagnosis is made at later ages. The mass is detected during physical examination or ultrasonography or other imaging methods during an investigation performed for constipation, hydronephrosis or any other reason.

Teratomas in the Rib Cage: Tumors that are usually located in the anterior part of the chest cavity cause respiratory distress and protrusion of the chest wall forward.

 

Gonadal Teratomas: In males, testicular teratomas usually appear as a painless mass during puberty, while in females, they are detected during investigations for abdominal pain or ovarian torsion. They can also cause constipation and hydronephrosis due to pressure.

 

How Are Teratomas Detected During Pregnancy Monitored?

If the baby does not have life-threatening symptoms, the birth will occur at or near the normal time. A normal birth or a cesarean section can be performed. This depends on the decision of the obstetrician and the mother and the baby's condition. A pediatric surgeon should be present during the birth and evaluate the patient at the first moment. The size of the mass, whether there is any damage on it, and whether there is bleeding are important.

How Are Teratomas Diagnosed in Children?

The diagnosis is made with detailed history and physical examination findings, and the diagnosis is confirmed with a number of blood tests and imaging methods. The findings vary according to the location of the tumor.

Among the laboratory tests, complete blood count, biochemistry tests and teratoma-specific tumor markers (the parameter we call alpha Feto protein is used in diagnosis and follow-up. However, it should not be forgotten that this parameter is already high in newborns) help in diagnosis. Imaging methods and, if necessary, a biopsy by taking a tissue sample are required for definitive diagnosis.

Direct radiographs (especially ectopic calcifications should be taken into consideration), ultrasonography and computerized tomography are sufficient for diagnosis and determining the characteristics of the tumor and its relationship with neighboring organs.

How are teratomas treated?

After taking the baby's general condition and breathing under control as soon as possible, the mass is dressed with wet sterile gauze. Since it is a very large area, heat loss from here is high. A vein is opened for serum to be administered and the baby is warmed.

When it is suitable for surgery, the baby is prepared under general anesthesia in the operating room. The mass is wiped with sterile solutions in the prone position and the surgical field is left open.

The aim is to remove the mass completely without damaging the mass, to remove the bone in the coccyx with the mass, to protect the muscles around the anus and to create an anus in a normal position and to shape the buttocks as close to normal as possible. If the tumor has only grown outward, it is removed with an incision over the mass, if it has also grown into the abdomen, the mass should be removed completely by making an abdominal incision and an incision over the mass.

If the mass can be completely removed during surgery, surgery is the first option. Patients who cannot be completely removed and are diagnosed with malignant teratoma after biopsy should be given drug treatment (chemotherapy) first and surgery should be performed after the mass shrinks.

If benign and immature masses can be completely removed, surgical treatment is sufficient for recovery. Chemotherapy is not required.

In benign teratomas, organ-sparing surgery is preferred, i.e., only removing the mass is sufficient. For example, testicles and ovaries should not be removed.

How is Post-Operative Monitoring Done in Teratomas?

After surgery, the mass is examined pathologically. If it is a benign tumor, no other treatment is required. However, examinations of the genital and anal regions are performed every 2-4 months and then every 6 months, and the patient's urinary and fecal control is monitored until the age of 3. In sacrococcygeal teratomas, urinary incontinence and fecal incontinence may occur in the future. It should be monitored.

As a result of a malignant tumor, the baby needs to receive chemotherapy (drug therapy). Long-term monitoring should be performed by pediatric surgery and pediatric oncology departments every 3-6 months in terms of recurrence of the mass. If the mass recurs in the same area or another area, it should be surgically removed and chemotherapy should be administered again. Long-term survival outcomes are worse in such patients.

Do Teratomas Spread to Distant Organs in Children or Do They Recur?

Distant organ spread and recurrence are rarely seen in benign teratomas. If seen, this means that the teratoma is malignant and if they need to be removed, medication and radiation therapy are applied.

*** The information provided here and the content of the website are designed to inform visitors, especially families. No information should be considered as advice by visitors and should not lead to any decision or action. The patient should definitely be examined by a pediatric surgeon on the subject, and a decision should be made by consulting him/her and consulting his/her personal knowledge.