Home Print this page Email this page Small font sizeDefault font sizeIncrease font size
Users Online: 56
 
About us Editorial board Search Ahead of print Current issue Archives Submit article Instructions Subscribe Contacts Advertise Login 
     


 
 Table of Contents  
CASE REPORT
Year : 2017  |  Volume : 6  |  Issue : 2  |  Page : 109-111

Nasopharyngeal teratoma: An unusual cause for respiratory distress in a neonate


1 Consultant Neonatologist and HOD division of Neonatology, Manipal hospital, Bengaluru-560017, Karnataka, India
2 Fellow in Neonatology, Manipal hospital, Bengaluru, Karnataka, India
3 Consultant Histopathologist, Manipal hospital, Bengaluru, Karnataka, India

Date of Web Publication13-Apr-2017

Correspondence Address:
Iyer Harohalli Venkatesh
Consultant Neonatologist, HOD Division of Neonatology, Manipal Hospital, Bengaluru - 560 017, Karnataka
India
Login to access the Email id

Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jcn.JCN_104_16

Rights and Permissions
  Abstract 

A term male neonate weighing 2.9 kg was brought to emergency room with increasing respiratory distress. On examination, a mass was identified in the nasopharynx. Magnetic resonance imaging of head and neck revealed lobulated polypoidal abnormal soft tissue signal mass lesion occupying the nasopharynx extending inferiorly in the upper part oropharynx. The mass was excised and biopsy suggested nasopharyngeal teratoma.

Keywords: Histopathology, magnetic resonance imaging, management, nasopharynx, respiratory distress, teratoma


How to cite this article:
Venkatesh IH, Venkatesha L, Sathi V, Rakshit SH. Nasopharyngeal teratoma: An unusual cause for respiratory distress in a neonate. J Clin Neonatol 2017;6:109-11

How to cite this URL:
Venkatesh IH, Venkatesha L, Sathi V, Rakshit SH. Nasopharyngeal teratoma: An unusual cause for respiratory distress in a neonate. J Clin Neonatol [serial online] 2017 [cited 2019 Sep 19];6:109-11. Available from: http://www.jcnonweb.com/text.asp?2017/6/2/109/204502


  Introduction Top


Respiratory distress is a common clinical pathology needing NICU care. Most of the respiratory pathology is related to lower respiratory tract. Unless the baby manifests stridor, no ENT evaluation would be done commonly. The index case manifested like lower respiratory pathology but noted to have a mass in the nasopharynx requiring surgery.


  Case Report Top


A 1-day-old male neonate was admitted into neonatal intensive care unit because of respiratory distress noticed 1 h after the delivery. The baby was delivered by normal vaginal delivery in another hospital at term gestation. Birth weight was 3000 g with APGAR score of 8 and 10 at 1 and 5 min, respectively. There was no history of consanguineous marriage. The baby was referred to our hospital in view of respiratory distress with desaturation noted an hour after the delivery. The baby was transported by ambulance by road with endotracheal tube in situ and connected to transport ventilator. On examination, he was maintaining saturation above 95% on FiO2 of 0.3. Head circumference, length, and weight were between 25th and 50th percentile. Oropharyngeal examination revealed a mass in the nasopharynx extending into the oropharynx [Figure 1]. Chest Roentgenogram was normal. Echocardiography showed no abnormality. Magnetic resonance imaging demonstrated a pedunculated soft tissue mass occupying the nasopharynx extending inferiorly into the oropharynx [Figure 2] and [Figure 3]. It measured approximately 16 mm × 24 mm. The pedunculated mass was excised [Figure 4] and sent the specimen for histopathological examination which demonstrated ectodermal, mesenchymal, and glial tissue suggestive of nasopharyngeal teratoma [Figure 5],[Figure 6],[Figure 7]. He was extubated on the 3rd day of life and the course in the hospital was uneventful. He continued to be hemodynamically stable on direct breastfeeding before got discharged well on the day 6 of life.
Figure 1: A nasopharyngeal mass obstructing the air way passage

Click here to view
Figure 2: MRI Head and neck-coronal view demonstrating lobulated polypoidal soft tissue mass occupying the nasopharynx extending inferiorly to upper part of oropharynx

Click here to view
Figure 3: MRI Head and neck – Sagittal view demonstrating lobulated polypoidal soft tissue occupying the nasopharynx extending to upper part of of oropharynx

Click here to view
Figure 4: Morphology of nasopharyngeal pedunculated mass

Click here to view
Figure 5: Histopathological examination of biopsy specimen Demonstrating A- . sheets of epithelium

Click here to view
Figure 6: Histopathological examination of biopsy specimen demonstrating B-mesenchymal component

Click here to view
Figure 7: Histopathological examination of biopsy specimen demonstrating C-glial tissue

Click here to view



  Discussion Top


In general, the respiratory distress in a neonate is due to pulmonary cause. Upper air way anomalies should be considered in the differential diagnosis of any neonate presents with respiratory distress. Usually, the upper airway anomaly manifestation ranges from Simple stridor to a significant life threatening event. The index case manifests neither of these signs but demonstrated progressive respiratory distress. Neonatal airway tumors are rare and approximately seen 1 in 1200–25,000 newborn babies.[1] Teratoma is the most common mass encountered in neonates.[2] This mass is derived from more than one embryonic layer-ectoderm, mesoderm, and endoderm.[3],[4],[5] Nasopharyngeal and oropharyngeal tumors constitute <10% of all neonatal germ cell tumors. This case underscores the importance of acknowledging the upper airway anomaly with absent classical upper airway signs.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
  References Top

1.
Moore SW, Satgé D, Sasco AJ, Zimmermann A, Plaschkes J. The epidemiology of neonatal tumours. Report of an international working group. Pediatr Surg Int 2003;19:509-19.  Back to cited text no. 1
    
2.
Orbach D, Sarnacki S, Brisse HJ, Gauthier-Villars M, Jarreau PH, Tsatsaris V, et al. Neonatal cancer. Lancet Oncol 2013;14:e609-20.  Back to cited text no. 2
    
3.
Isaacs H Jr. Perinatal (fetal and neonatal) germ cell tumors. J Pediatr Surg 2004;39:1003-13.  Back to cited text no. 3
    
4.
Manchali MM, Sharabu C, Latha M, Kumar L. A rare case of oropharyngeal teratoma diagnosed antenatally with MRI. J Clin Imaging Sci 2014;4:15.  Back to cited text no. 4
[PUBMED]  [Full text]  
5.
Maartens IA, Wassenberg T, Halbertsma FJ, Marres HA, Andriessen P. Neonatal airway obstruction caused by rapidly growing nasopharyngeal teratome. Acta Paediatr 2009;98:1852-4.  Back to cited text no. 5
    


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5], [Figure 6], [Figure 7]



 

Top
 
 
  Search
 
Similar in PUBMED
  Search Pubmed for
  Search in Google Scholar for
Related articles
Access Statistics
Email Alert *
Add to My List *
* Registration required (free)

 
  In this article
Abstract
Introduction
Case Report
Discussion
References
Article Figures

 Article Access Statistics
    Viewed940    
    Printed10    
    Emailed0    
    PDF Downloaded70    
    Comments [Add]    

Recommend this journal