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| LETTER TO THE EDITOR |
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| Year : 2014 | Volume
: 7
| Issue : 3 | Page : 403-404 |
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Congenital teratoma of the face
Dinesh S Chauhan, Yadavalli Guruprasad
Department of Oral and Maxillofacial Surgery, AME'S Dental College Hospital and Research Centre, Raichur, Karnataka, India
| Date of Web Publication | 18-Mar-2014 |
Correspondence Address:
Yadavalli Guruprasad
Department of Oral and Maxillofacial Surgery, AME'S Dental College Hospital and Research Centre, Raichur, Karnataka
India
 Source of Support: None, Conflict of Interest: None  | Check |
DOI: 10.4103/0975-2870.129011
How to cite this article:
Chauhan DS, Guruprasad Y. Congenital teratoma of the face. Med J DY Patil Univ 2014;7:403-4 |
Sir,
Teratomas are neoplasms composed of 3 germinal layers of the embryo that form tissues not normally found in the organ in which they arise. Teratomas of facial region are interesting because of their obscure origin, bizarre microscopic features, different morphology, location, and often dramatic clinical presentation. [1] They are true neoplasms, composed of mixture of tissues, which are not native to the area where the tumor occurs. These are benign tumors composed of tissue elements of bidermal or tridermal origin. Teratomas are most commonly located in the sacrococcygeal region, followed by the ovaries, testes, anterior mediastinum, retroperitoneum, and finally the head and neck. [1] Teratomas in the face are extremely rare, which account for less than 6%. Teratomas in the head and neck region usually were discovered during neonatal period, whereas teratomas in other anatomic regions usually are discovered in the second decade of life. [1]
A 3-month-old male child was referred to the Department of Oral and Maxillofacial Surgery for evaluation of facial swelling with multiple finger-like projections. On further history baby boy was born vaginally as a full-term spontaneous delivery, with birth weight of around 3.2 kg. His parents had been aware of the swelling for 3 months, but delayed evaluation as they come from rural area and because of economic circumstances. The infant had a partly soft and partly hard swelling over the left side of the upper lip measuring around 3 × 2 cm diameter and numerous finger-like skin projections on the left lower part of the cheek and zygomatic region [Figure 1]. His parents had been aware of the swelling for 3 months, but delayed evaluation as they come from rural area and because of economic circumstances. Based on the clinical history and incisional biopsy reports, diagnosis of teratoma was made and surgical excision of the tumor and finger-like skin projections was done under general anesthesia [Figure 2]. The excised specimen was subjected to histopathologic examination, which revealed skin with adnexal structure (sebaceous glands), bundles of smooth muscle fibers, mature adipose tissue, nerve bundles, mature bone, and cartilage tissue, suggestive of mature teratoma [Figure 3] and those of skin tags showed fibroepithelial polyp confirming with incisional biopsy report. | Figure 1: Clinical photograph showing multiple fi nger-like projections on right side of the face and swelling over the upper lip in a 3-monthold male child
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 | Figure 2: Photograph showing excised specimen along with fi nger-like skin projections
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 | Figure 3: Photomicrograph showing mature teratoma cells with squamous epithelium and keratinous debris, adipose tissue with ductlike and glandular elements
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The term teratoma is often used to describe any of the 4 types of tumor that constitute tissue foreign to the area in which it is located. These include dermoids (hairy polyps), teratoid, true teratomas, and epignathi. Teratoma in the head and neck region are very rare, with the incidence 2-9% of all teratomas. [1] They are true neoplasm composed of an assemblage of tissue often alien to the site in which it arises. Biglioli et al. have reported a case of teratoma on left infraorbital region, which resembled a small breast-like growth. The lesion was enucleated and showed no recurrence after 18 months. [1] Head and neck teratomas reportedly occur in 1 of 40,000 births. [2] The degree of histologic differentiation of teratoma is high and they can be classified as mature, immature, and with malignant differentiation. [2] Microscopic examination of excised specimen of this case showed a well-defined organoid structures arranged in disorganized manner, suggestive of mature teratoma. [3] Teratomas are partly undiagnosed at the time of birth. Diagnostic aids, such as computed tomography scan and magnetic resonance imaging show anatomic relations of the tumor, extension, and margins. Proper diagnosis is important before deciding on the operation. The multidisciplinary and staged surgical approach to the management of the lesion in this patient was essential to the successful outcome.
| References | |  |
| 1. | Biglioli F, Gianni AB, Di Francesco A. Congenital teratoma of the cheek: Report of case. Int J Oral Maxillofac Surg 1996;25:208-9. 
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| 2. | Becker S, Schon R, Gutwald R, Otten JE, Maier W, Hentschel R, et al. A congenital teratoma with a cleft palate: Report of a case. Br J Oral Maxillofac Surg 2007;45:326-7.
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| 3. | Tolentino MM, Oconer JN, Almazan Aguilar NA. Large nasopharyngeal true teratoma in a Filipino newborn: A case report. Philippine Journal of Otolaryngology Head & Neck Surgery 2005;20:59-65.
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[Figure 1], [Figure 2], [Figure 3]
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