NORD gratefully acknowledges N. Scott Adzick, MD, Surgeon-in-Chief at the Children's Hospital of Philadelphia, C. Everett Koop Professor of Pediatric Surgery at the University of Pennsylvania School of Medicine, for his assistance in creating this report.
Cervical teratomas are extremely rare germ cell tumors (neoplasm) that occur in the neck. The majority of teratomas occur in the testes or ovaries (gonads) or the lower back (sacrococcygeal region). In rare cases, other areas such as the neck may be affected. Most cervical tumors occur in children and are non-cancerous (benign). In extremely rare cases, cervical teratomas occur in adults and are usually cancerous (malignant).
The term "cancer" refers to a group of diseases characterized by abnormal, uncontrolled cellular growth that invades surrounding tissues and may spread (metastasize) to distant bodily tissues or organs via the bloodstream, the lymphatic system, or other means. Different forms of cancer are be classified based upon the cell type involved, the specific nature of the malignancy, and the disease's clinical course.
Teratomas are germ cell tumors that, in rare cases, occur in the head and neck region. Some researchers differentiate between cervical and primary thyroid teratomas. For a diagnosis of primary thyroid teratoma one of three conditions must be met: a tumor must occupy a portion of the thyroid gland, a direct connection must exist between the tumor and the thyroid, or a teratoma is accompanied by the absence of the thyroid. However, most cervical teratomas have some type of relationship with the thyroid and the clinical picture and prognosis between these tumors is the same. Therefore, many researchers have abandoned separating these tumors and classify all neck teratomas as cervical teratomas.
Symptoms of cervical teratomas may vary from case to case. The tumors may be non-cancerous (benign) or cancerous (malignant). Cervical teratomas are more common in children than adults. In children they are usually benign; in adults they are usually malignant.
The specific symptoms associated with cervical teratomas in children vary depending upon the size of the tumor. Small tumors may not cause any symptoms (asymptomatic). However, a large teratoma may cause disfigurement and compress nearby structures such as the windpipe (trachea). Such large tumors may cause additional symptoms including a wheezing or whistling sound when breathing (stridor), difficulty breathing, or shortness of breath (dyspnea). These tumors can also compress the esophagus, inhibiting swallowing. Eventually, compression of vital structures may cause life-threatening complications such as respiratory distress.
Cervical teratomas in adults are extremely rare. In most cases, they are malignant and may spread (metastasize) to nearby lymph nodes and other organs of the body, especially the lungs. As in children, cervical teratomas in adults can compress nearby structures such as the windpipe resulting in respiratory distress and additional symptoms.
The exact cause of cervical teratomas is unknown. These tumors appear to occur randomly for no apparent reason (sporadic). Investigators are conducting ongoing basic research to learn more about the many factors that may result in tumor formation.
Cervical teratomas are germ cell tumors. Germ cells are the cells that develop into the embryo and later on become the cells that make up the reproductive system of men and women. Most germ cell tumors occur in the testes or ovaries (gonads) or the lower back (sacrococcygeal region). When these tumors occur outside of the gonads, they are known as extragonadal tumors.
Teratomas consist of cells foreign to the part of the body where the teratoma forms. They consist of cells from the three major tissue layers of an embryo: ectoderm, endoderm, and mesoderm. These embryonic layers eventually give rise to the various cells and structures of the body. Researchers do not know how extragonadal germ cell tumors form. Several theories have been proposed.
One theory suggests that germ cells accidentally migrate to unusual locations early during the development of the embryo (embryogenesis). Normally, such misplaced germ cells degenerate and die, but in cases of extragonadal teratomas researchers speculate that these cells continue to undergo mitosis, the process where cells divide and multiply, eventually forming a teratoma.
Cervical teratomas affect men and women in equal numbers. Germ cell tumors account for 3-5 percent of all tumors in childhood. Cervical teratomas are much more common in newborns than adults. Fewer than 50 cases of cervical teratomas in adults have been reported in the medical literature.
The diagnosis of a cervical teratoma is based upon a thorough clinical evaluation, identification of characteristic physical findings, a detailed patient history, and a variety of specialized tests. Such testing includes microscopic evaluation of tumor cells.
Prenatal diagnosis of cervical teratomas is possible via ultrasound, a procedure during which reflected sound waves create an image of the developing fetus. Large tumors may be readily apparent on a fetal ultrasound, the neck may appear hyper-extended, or associated findings such as excessive amniotic fluid (polyhydramnios) may be detected. In adults, a mass may be detected in the neck during a routine physical exam.
To confirm a diagnosis of cervical teratoma a variety of tests may be performed including fine-needle aspiration (FNA). FNA is a diagnostic technique in which a thin, hollow needle is passed though the skin and inserted into the nodule to withdraw small samples of tissue from the nodule. The collected tissue is then studied under a microscope.
In some cases, FNA may prove inconclusive and physicians may perform a biopsy. During a biopsy, a small sample tissue is surgically removed and sent to a pathology laboratory where it is processed and studied to determine its microscopic structure and makeup (histopathology).
In addition to ultrasound, additional specialized imaging techniques may be used to help evaluate the size, placement, and extension of a tumor and to serve as an aid for future surgical procedures. Such imaging techniques may include computerized tomography (CT) scanning and magnetic resonance imaging (MRI). During CT scanning, a computer and x-rays are used to create a film showing cross-sectional images of certain tissue structures. An MRI uses a magnetic field and radio waves to produce cross-sectional images of particular organs and bodily tissues.
In approximately 50 percent of cases, the appearance of clusters of calcium (calcifications) can be detected on x-rays, a finding suggestive of a teratoma. Laboratory tests and specialized imaging tests may also be conducted to determine possible infiltration of regional lymph nodes and the presence of distant metastases.
The therapeutic management of individuals with cervical teratomas may require the coordinated efforts of a team of medical professionals, such as physicians who specialize in the diagnosis and treatment of cancer (medical oncologists), specialists in the use of radiation to treat cancer (radiation oncologists), specialists in maternal-fetal health (perinatologists), specialists in the ear, nose and throat (otolaryngologists), pediatric surgeons, oncology nurses, and other specialists.
Specific therapeutic procedures and interventions may vary, depending upon numerous factors, such as primary tumor location, extent of the primary tumor (stage), and degree of malignancy (grade); whether the tumor has spread to lymph nodes or distant sites; individual's age and general health; and/or other elements. Decisions concerning the use of particular interventions should be made by physicians and other members of the health care team in careful consultation with the patient, based upon the specifics of his or her case; a thorough discussion of the potential benefits and risks; patient preference; and other appropriate factors.
In most individuals with a cervical teratoma, surgical removal of the tumor and affected tissue is performed. Although most teratomas in children are benign, they can compress the windpipe and nearby structures necessitating their removal.
In cases diagnosed before birth (prenatally), a procedure known as ex utero intrapartum treatment (EXIT) may be performed. In this procedure, surgery is performed as an affected baby is born via Cesarean section. The baby remains attached to the placenta so normal blood flow exchange occurs while physicians perform necessary surgical procedures.
In order to secure the airway, physicians may need to insert a breathing tube (endotracheal tube). In some cases, physicians may perform a tracheostomy, a surgical procedure in which an incision is made in the windpipe (trachea) to create a temporary opening to allow the passage of air.
Adults with a cervical teratoma are treated by complete surgical removal of the tumor. Radiation therapy may be used before surgery (to decrease tumor size) or after surgery as an adjuvant therapy. Chemotherapy immediately after surgery has also been used to treat individuals with cervical teratomas.
Surgical removal of a cervical teratoma may involve the removal of a portion of or the entire thyroid. In such cases, affected individuals must go on hormone replacement therapy to obtain the hormones normally produced by the thyroid.
Infants with a benign cervical teratoma rarely experience recurrence of the tumor. Malignant cervical teratomas such as those found in adults recur more often. Affected individuals must be monitored periodically to check for recurrence.
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Contact for additional information about cervical teratoma:
N. Scott Adzick, MD
C. Everett Koop Professor of Pediatric Surgery
University of Pennsylvania School of Medicine
Children’s Hospital of Philadelphia
34th Street and Civic Center Boulevard
Philadelphia, Pa. 19104
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