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Neurosurgery Journal

FACIAL  MATURE  TERATOMA

Andi Fittrani dr., Untung Alifianto DR.dr. Sp.BS., Hanis Setyono dr. Sp.BS., Ferry Wijanarko dr. Sp. BS. Neurosurgery Departement- Moewardi Hospital Surakarta Indonesia

 Abstract                                                                           

Facial teratoma in neonates is a rare type of teratoma which it’s rarely found. Teratoma found in 3 % from all of malignancy cases in infants and children. Mature teratomas contain tissue that normally is not found in the tumor area grows , which consists of three embryonic germ layers are well differentiated

Keywords : Neonatal tumors, teratomas, Mature teratomas, facial teratoma.

Introduction

Teratoma is a third most found germ cell tumor malignancy after dysgerminomas and endodermal sinus tumor . In addition, there also have a certain component (usually squamous) which undergo malignant transformation, but rarely found. Teratoma is a germ cell tumor that generally consists of several types of cells derived from one or more of the three germ layers endoderm, mesoderm and ectoderm. Teratomas word comes from the Greek 'teraton' which means monster. Teratomas are divided into three categories: mature teratomas (benign), immature teratoma, and teratoma monodermal with specific differentiation. Variation of Teratoma from a benign form of cystic lesions which are well differentiated (mature) to a solid form and malignant (immature). Generally cystic teratoma is benign and the solid one is malignant. 

Case Report

A baby boy, named Baby Ny.E. age 6 days, come to the neurosurgeon with mass on the right head which present since he was born. ANC history done by midwife, never had a USG examination during pregnancy, childbirth history with Sectio Caesaria. From physical examination found a mass at frontotemporoparietal region until right mandible, cysctic palpable, flat edge, skin colurs like.

From head CT scan examination found mixed density lesion hypodense firm boundaries with regular edges in peripheral capsule with a size of 10.6 x 7.7 cm in the right frontotemporoparietal region which extends up to the region of the right mandible. From MRI found hypervascular at vascular bed of Right Meningeal Artery, right occuli bulb towards to medioanterior, right auricula inferolateral to the left and right frontotemporal lobe to the media .

When Patients under excision of the tumor found cystic consistence and solid tumors. Cystic part obtained yellow colored liquid with cytology results obtained columnar cells among serous , there are no malignant cells . Microscopic result found solid consistency of tumor tissue which composed of various elements of the mature among other brain tissue which composed of cells of astrocytes and structure of the papillary - like plexus choroideus, tubular structures and glands lined ephitel piston digestive tract , connective tissue, fat tissue and muscle tissue striped, no found signs of malignant teratoma and diagnosed as Matur Teratoma PA.

Discussion 

Teratomas incidence found in 1 from 40,000 births. Tumors found in cervicofacial region in newborns most as lymphangioma (25%), rhabdomyosarcoma (22.6%) and the third is a teratoma (16.6%). Predilection teratoma in the male gender is 1 : 4 compared to women. Incident teratoma in the cranial region lower than the region of sacrococigeal which it is only 2-4 % of all occurrences teratoma .

Tumor mass located in the region of frontotemporoparietal in newborns can be diagnoses as a meningoenchepalocele, hygroma, lymphangioma, chondroma and neuroblastoma metastase. 

In these patients histopathological results obtained the presence of mature tissues derived from all three layers of ectodermal (astrocyte cell), mesoderm (striated muscle tissue) and endodermal (digestive tract tissue) that according to the Anatomical Pathology diagnosed as Matur Teratoma. The tumor indicates a good prognosis. Mature teratomas is complete differentiated teratoma which was formed like  adult tissues. Removal of the whole tumor will improve the prognosis of patients and decrease the recurrence rate of the teratoma tumor. Teratoma tumor which located at craniofacial commonly has a benign hispatologic examination . Examination by Alfa Feto Protein (AFP) after post- operation is advisable to know the further prognosis of the teratoma tumor recurrence. Examination will have done after 3 months after excision of the tumor teratoma. In the 2 years study about cervicofacial regio teratoma with whole tumor excision as a treatment, and the result no recurrence of the teratoma after surgery.