A Case of Mediastinal Teratoma as a Cause of Nonimmune Hydrops Fetalis, and Literature Review

 

 Buy Article Permissions and Reprints

ABSTRACT

This article reviews the current literature of mediastinal tumors as the cause of nonimmune hydrops fetalis (NIHF), the outcomes of reported cases, and a general overview of NIHF including diagnosis, workup, and a management algorithm, with particular attention made to intrathoracic lesions and gestation age. We present a unique case report of a premature neonate who initially presented with NIHF at birth and was subsequently diagnosed with a germ cell mediastinal teratoma as the etiology of NIHF. The patient survived for 50 days while having undergone surgical resection and chemotherapy during the hospital course. The patient represents the first reported case of a mediastinal tumor as the etiology of NIHF in the neonatal period and only one of three cases that have been reported to survive in the neonatal period. Survival is dependent on the thoracic lesion's size, location, resectability, impact on the growth and development of other vital organs, and in the case of tumors, malignant potential. Though the combination of mediastinal teratoma and NIHF is rare, it should be included in the diagnostic evaluation of a newborn with NIHF.

REFERENCES

• 1 Tollens T, Casselman F, Devlieger H et al.. Fetal cardiac tamponade due to an intrapericardial teratoma.  Ann Thorac Surg. 1998;  66 559-560
  CrossrefPubMedGoogle Scholar
• 2 Merchant A M, Hedrick H L, Johnson M P et al.. Management of fetal mediastinal teratoma.  J Pediatr Surg. 2005;  40 228-231
  CrossrefPubMedGoogle Scholar
• 3 Lallemand A V, Doco-Fenzy M, Gaillard D A. Investigation of nonimmune hydrops fetalis: multidisciplinary studies are necessary for diagnosis: review of 94 cases.  Pediatr Dev Pathol. 1999;  2 432-439
  CrossrefPubMedGoogle Scholar
• 4 Murphy J H. Nonimmune hydrops fetalis.  NeoReviews. 2004;  5 e5-e15
  CrossrefPubMedGoogle Scholar
• 5 Weinraub Z, Gembruch U, Fodisch H J, Hansmann M. Intrauterine mediastinal teratoma associated with non-immune hydrops fetalis.  Prenat Diagn. 1989;  9 369-372
  CrossrefPubMedGoogle Scholar
• 6 Lindinger A, Boos R, Pistorius K, Limbach H G, Jesberger H J, Hoffmann W. Mediastinal cystic lymphangioma as a cause of hydrops fetalis.  Klin Padiatr. 1992;  204 118-122
  Article in Thieme ConnectPubMedGoogle Scholar
• 7 Dolkart L A, Reimers F T, Kuonen C A. Intrathoracic congenital fibrosarcoma. A case report.  J Reprod Med. 1995;  40 391-393
  PubMedGoogle Scholar
• 8 Teal L N, Angtuaco T L, Jimenez J F, Quirk Jr J G. Fetal teratomas: antenatal diagnosis and clinical management.  J Clin Ultrasound. 1988;  16 329-336
  PubMedGoogle Scholar
• 9 Billmire D F, Grosfeld J L. Teratomas in childhood: analysis of 142 cases.  J Pediatr Surg. 1986;  21 548-551
  PubMedGoogle Scholar
• 10 Chervenak F A, Isaacson G, Toulounkian R, Tortora M, Berkowitz R L, Hobbins J C. Diagnosis and management of fetal teratomas.  Obstet Gynecol. 1985;  66 666-671
  PubMedGoogle Scholar
• 11 Dehner L P. Gonadal and extragonadal germ cell neoplasia of childhood.  Hum Pathol. 1983;  14 493-511
  CrossrefPubMedGoogle Scholar
• 12 Kuller J A, Laifer S A, Martin J G, MacPherson T A, Mitre B, Hill L M. Unusual presentations of fetal teratoma.  J Perinatol. 1991;  11 294-296
  PubMedGoogle Scholar
• 13 Seibert J J, Marvin Jr W J, Rose E F, Schieken R M. Mediastinal teratoma: a rare cause of severe respiratory distress in the newborn.  J Pediatr Surg. 1976;  11 253-255
  CrossrefPubMedGoogle Scholar
• 14 Haller J A, Shermeta D W, Donahoo J S, White J J. Life-threatening respiratory distress from mediastinal masses in infants.  Ann Thorac Surg. 1975;  19 365-370
  PubMedGoogle Scholar
• 15 Mogilner J G, Fonseca J, Davies M R. Life-threatening respiratory distress caused by a mediastinal teratoma in newborn.  J Pediatr Surg. 1992;  27 1519-1520
  PubMedGoogle Scholar
• 16 Adler R H, Taheri S A, Weintraub D H. Mediastinal teratoma in infancy.  J Thorac Cardiovasc Surg. 1960;  39 394-404
  PubMedGoogle Scholar
• 17 Isaacs Jr H. Perinatal (fetal and neonatal) germ cell tumors.  J Pediatr Surg. 2004;  39 1003-1013
  CrossrefPubMedGoogle Scholar
• 18 Gobel U, Calaminus G, Engert J et al.. Teratomas in infancy and childhood.  Med Pediatr Oncol. 1998;  31 8-15
  CrossrefPubMedGoogle Scholar
• 19 Martino F, Avila L F, Encinas J L et al.. Teratomas of the neck and mediastinum in children.  Pediatr Surg Int. 2006;  22 627-634
  CrossrefPubMedGoogle Scholar
• 20 Marina N M, Cushing B, Giller R et al.. Complete surgical excision is effective treatment for children with immature teratomas with or without malignant elements: a Pediatric Oncology Group/Children's Cancer Group Intergroup Study.  J Clin Oncol. 1999;  17 2137-2143
  PubMedGoogle Scholar
• 21 Froberg M K, Brown R E, Maylock J, Poling E. In utero development of a mediastinal teratoma: a second-trimester event.  Prenat Diagn. 1994;  14 884-887
  PubMedGoogle Scholar
• 22 Schild R L, Plath H, Hofstaetter C, Hansmann M. Prenatal diagnosis of a fetal mediastinal teratoma.  Ultrasound Obstet Gynecol. 1998;  12 369-370
  PubMedGoogle Scholar
• 23 Zembala-Nozynska E, Oslislo A, Zajecki W, Kaminski K, Radzioch J. Mediastinal tumor as a cause of fetal hydrops.  Wiad Lek. 2005;  58 462-465
  PubMedGoogle Scholar

Agnieszka WesolowskiM.D. 

Department of Perinatal-Neonatal Medicine, Emory University

2015 Uppergate Drive, 3rd Floor, Atlanta, GA 30322

Email: awesolowskiaugust@yahoo.com