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A noteworthy case of an immature teratoma of tongue in a fetus Shigli FN, Siddeeque A, Shigli NA



How to cite this article:
Shigli FN, Siddeeque A, Shigli NA. A noteworthy case of an immature teratoma of tongue in a fetus. Indian J Pathol Microbiol 2022;65:492-4




Dear Editor,

Teratomas have been the subject of numerous reviews.[1] In fetus and infants, most of them are extragonadal.[1] Majority being sacrococcygeal and ovarian teratomas.[1] Head and neck teratomas constitute mere 5%.[1] The most common site of occurrence in head and neck is nasopharynx and cervical region.[2] Teratomas of tongue are rare, till date only 18 cases have been reported.[3] Here is a case of Immature teratoma in oral cavity of a fetus arising from tongue.

A 31-year-old female with gravida- 2, para-1, with gestational age of 20 weeks and 5 days, conceived naturally of non-consanguineous marriage. With her first pregnancy she has a female child born with atrial septal defect, corrected surgically and now is 5 years old. She is hypothyroid and has gestational diabetes mellitus treated with metformin.

On her anomaly scan, the fetus was appropriate for gestational age with normal placenta and appropriate amount of amniotic fluid. An irregular mixed solid-cystic mass measuring 5.5 × 4.5 × 2.3 cm was noted arising from the oral cavity. The stalk of the tumor was seen attaching to the left side of the tongue. No prominent vascularity was noted. Fetal swallowing movements observed. No associated anomaly was detected. A presumptive diagnosis of teratoma was made.

The pregnancy was terminated and a biopsy from the lesion was received in 10% formalin. The specimen consisted of two pieces of gray-white to gray brown solid and mucoid tissue altogether measuring 2 × 1.5 × 1 cm. Cut surface shows gray-white to gray-brown areas. Sections were given in two blocks. On microscopy, mature embryonic tissue derived from all the three germ cell layers was observed composing of stratified squamous epithelium with pilar structures, melanocytes with abundant melanin pigment, mature chondroid tissue, mature osteoid, glial, odontogenic, neural tissue. Admixed among mature elements are clusters of immature neuroepithelium in aggregates around neural and odontogenic epithelium. These cells have high nuclear to cytoplasmic ratio, hyperchromatic nucleus, and scant cytoplasm. A diagnosis of ”Immature teratoma ” Grade 2 (>1 but <3 low power fields in any slide) was made.

Teratomas of head and neck are rare congenital lesions, seen predominantly in females.[4] The most common sites in head and neck are the cervical, nasopharyngeal, and oropharyngeal in the order of predominance.[4] Oropharyngeal teratomas constitute only 2% of all teratomas.[4] Infrequently they are seen in the tongue proper.[3] In the tongue, the teratoma may result from totipotent primordial germ cells from tuberculum impar [Figure 1], [Figure 2], [Figure 3], [Figure 4].[5]

Figure 1: 20 week 5 days aborted female fetus with a mass arising from oral cavity measuring 5.5 × 4.5 × 2.3 cm, mass is polypoidal irregular mixed solid and cystic

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Figure 2: (a): Low power view showing chondroid tissue and melanocytes. (b): Low power view showing odontogenic tissue surrounded by undifferentiated blast cells

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Figure 3: (a and b): High power view showing odontogenic epithelium surrounded by layers of mature neural tissue in turn surrounded by undifferentiated blast cells

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Figure 4: (a and b): High power and low power view of immature neuroepithelium in aggregates

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Oropharyngeal, cervical teratoma may cause polyhydarmnios more severe respiratory symptoms after birth.[6] Our case had adequate amniotic fluid and normal fetal swallowing movements. Out of the 18 cases of tongue teratoma diagnosed previously only three were detected prenatally our case is the fourth one.

The most important prognostic factors in teratoma of newborn period are the presence and absence of yolk sac component, site, and completeness of excision.[1] In our case, absence of yolk sac component makes it a good prognostic factor.

Treatment of choice for immature teratoma in neonates is surgical excision and follow-up.[7]

Acknowledgment

ARMC AEGIS hospital, Perinthalmanna, Dr. Seneesh Kumar for early diagnosis and referring the sample to our department.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 

   References   Top


1.
Charles AK. Congenital tumors. In: Kong TY, Malcomson RD. Keelings Fetal and Neonatal Pathology. 5th ed. New York: Cham Heidelberg; 2015. p. 456-9.  Back to cited text no. 1
    
2.
Huang Y, Pan H. A fetus with a mass in the oral cavity: A rare case of oral immature teratoma. Int J Clin Exp Pathol 2017;10:7890-2.  Back to cited text no. 2
    
3.
Eddib A, Rodgers B, Lawler J, Yeh J. Tongue teratoma-a rare form of fetal extragonadal teratoma diagnosed at 30 weeks gestation. Ultrasound Obstet Gynecol 2006;28:735-41.  Back to cited text no. 3
    
4.
Celik M, Akkaya H, Arda IS, Hicsonmez A. Congenital teratoma of the tongue: A case report and review of literature. J of Pediatric Surg 2006;4:25-8.  Back to cited text no. 4
    
5.
Uchida K, Urata H, Suzuki H. Teratoma of the tongue in neonates; report of a case and review of literature. Pediatric Surg Int 1998;14;79-81.  Back to cited text no. 5
    
6.
Kolekar SS, Chincholi T, Nangare N, Patankar R. Oral teratoma. Int J Appl Basic Med Res 2016;6;54-6.  Back to cited text no. 6
    
7.
Khanolkar CA, Thakkar CN, Sarin KY. Sacrococcygeal teratoma with yolk sac component in a neonate. J Neonatal Surg 2015;4(Suppl 3):33.  Back to cited text no. 7
    



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Correspondence Address:
Farheen Naaz Shigli
House No 59, Taj Nagar, Unkal, Hubli 580031, Karnataka
India
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/IJPM.IJPM_1430_20

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[Figure 1], [Figure 2], [Figure 3], [Figure 4]

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