What is cervical teratoma?

The word ‘teratoma’ means “ Monster” in Greek. Teratomas are germ cell tumours which arise from tissues of ectoderm, mesoderm, and endoderm.² All 3 tissues play an important role in giving rise to different organs, and muscles in our body.

Teratoma consists of 3 embryonic germ layers- ectoderm, mesoderm, and endoderm. The ectoderm produces Skin, teeth, nails, ependymal, and neurons. Mesoderm produces adipose tissue, bone, cartilage, and muscle. The endoderm creates respiratory and intestinal epithelium. Teratomas are classified as mature and immature depending upon the degree of cell differentiation. Mature teratoma is a common form and it consists of skin, hair, cartilage, and bone. Immature Teratoma contains neuroepithelial tissue (tissues which differentiate into neurons, and form the central nervous system).⁴

Cervical Teratomas are extremely rare germ cell tumours that occur in the neck region but normally they are considered as benign (not harmful). The majority of teratoma occurs in the gonads (testes and ovaries) or lower back and it is very rare that the area like neck is affected.¹ It generally occurs in children, and is non-harmful but in rare cases, it happens in adults and it is cancerous ( malignant).¹

Understanding this condition is crucial as early detection and treatment can improve the outcomes. 

In this article, we will dive deeper into the symptoms, causes and diagnosis of this rare condition.  we will also explore different treatment options which are less known to the general public. 

Cause of cervical teratoma

The exact reason is unknown. They happen to occur spontaneously without any reason. Researchers are trying to find out factors that might contribute to the tumour formation. 

Cervical Teratomas are germ cell tumours. Germ cells are the cells that develop into embryos and later convert to the reproductive system. Most germ cell tumours occur in gonads ( testes and ovaries). Sometimes these cells are found in the neck, a location foreign to the cells.

One theory states that germ cells mistakenly move to another location during early embryonic development. Normally such kinds of cells degenerate and die, but in the case of teratomas formed out of the gonads, these germ cells grow by mitosis, a process by which cells divide and multiply.¹

Cervical Teratomas affect mostly men and women. It is more common in newborns. A few 50 cases of cervical Teratoma have been reported in medical literature.¹

Signs and symptoms 

Symptoms may vary from case to case. The tumours can be non-cancerous (benign) or cancerous (malignant). 

The specific symptoms vary on the size of the tumour in children. Small tumours may not show any symptoms. Large tumours can cause disfigured structures where it is formed. Additional symptoms are a wheezing or whistling sound while breathing, difficulty breathing, or shortness of breath.

Clinical presentation

Cervical teratomas in children are benign (non-harmful). Cervical Teratoma can cause respiratory distress(tumours can cause difficulty in breathing) and the patient should be fed in a particular way.³ Prenatal diagnosis is possible through ultrasound as neck mass is visible. 

Diagnosis and imaging techniques 

The diagnosis of cervical teratoma depends upon thorough clinical evaluation,  physical examination, patient history, and results of a few tests.

• Prenatal diagnosis- This is possible through an ultrasound, it is a procedure in which an image of the fetus is created by reflecting waves. Large tumours might be easily detected through ultrasound, the neck may appear extended, or there might be the presence of excessive amniotic fluid 
• FNA - A test carried out to confirm the diagnosis of cervical teratoma, this needle is inserted through the skin into the nodule, a sample of tissue is withdrawn, and studied under the microscope
• Postnatal diagnosis- Imaging techniques can be used to identify the size and placement of the tumours. Imaging techniques like Computerised tomography (CT scan), and MRI (magnetic resonance imaging) can be used
• Some laboratory tests may also be conducted to determine the possibility of cervical teratoma¹  

Treatment and management

The treatment of cervical teratomas depends upon the size of the tumour, the location of the tumour, its stage, the patient's condition, and appropriate factors.

• Surgical removal - In most cases the primary option is the removal of teratoma by surgery. Surgical removal of teratoma involves the removal of a portion or entire thyroid. Individuals might have to take hormone replacement therapy to obtain hormones produced by the thyroid. Although in babies teratomas are benign they can compress the windpipe so it is also necessary to remove it. In order to secure the airway, physicians may insert a breathing tube. Infants with cervical teratoma rarely experience recurrence of the tumour, malignant tumours in adults often reoccur¹
• EXIT - A treatment that is performed if the case is diagnosed before the birth of the baby, in The baby is removed through a caesarean section but is still attached to the placenta so it gets the blood supply, and doctors perform the surgery to remove the tumour

Affected individuals must be taken care of, and their health should be periodically monitored to check the occurrence of the tumour.

Prognosis 

The prognosis depends upon the tumour's characteristics. 

• Benign- Here there is a high survival rate with surgical removal of tumours
• Malignant- Here, immature teratomas have a poorer prognosis, but they can be treated with chemotherapy and radiation

Early diagnosis and detection can potentially increase good outcomes. 

Summary 

Cervical Teratomas are germ cell tumours that occur in the neck region, normally they are considered as benign in children but if they occur in adults then they might be malignant. The exact reason for this disorder is not fully known but one theory states that the germ cells might migrate to another location, normally these cells degenerate but here they may keep multiplying, forming a tumor. The disease can be identified by some laboratory tests, by MRI or CT scan. Treatment for this disease depends upon size, location, and condition of the patient but the primary treatment is the surgical removal of the tumour. Patients need to be monitored regularly to check the occurrence of the tumour. If you see any signs mentioned above visit a healthcare professional as soon as possible.

FAQs

How common is cervical teratoma?

Answer- It is very rare representing 3 to 5% of total teratoma. Frequently detected cases are mostly in children. 

What is the difference between mature and immature teratomas? 

Answer- The difference is that mature teratomas are benign which means they are fully developed and not harmful whereas immature teratomas are not fully developed and can be malignant (cancerous).

Can cervical teratoma be detected during pregnancy?

Answer- Yes, Cervical Teratoma can be detected during the second trimester of the pregnancy. If a large mass is seen on the neck further tests like MRI can help to get more information. 

Can a child with cervical teratoma lead a normal life after surgery?

Answer- yes, normally it is seen that in most cases children lead a happy life after the tumour is removed. They might require some follow-up but most children recover fully and do not experience any complications.