Progressive Feeding Intolerance Secondary to a Congenital Spinal Teratoma in a Four-week-old Female

Abstract

A poorly feeding neonate presents the clinician with a diagnostic challenge. Feeding difficulties and irritability may be due to sepsis, congenital heart disease, inborn errors of metabolism, non-accidental head trauma, as well as a vast variety of other pathologies. Teratomas are rare pediatric tumors that can occasionally present in the immediate neonatal period and can manifest in the infant's central nervous system (CNS) with non-specific symptoms of poor feeding, lethargy, and somnolence. Operative resection remains the cornerstone of treatment; however, there is no well-defined role for adjuvant chemotherapy or radiation in these treatments. We report a case of a four-week-old female presenting with progressive feeding intolerance secondary to a near holocord thoracic spinal teratoma. Her tumor was surgically resected and she was treated with adjuvant chemotherapy and radiation for 13 months and is now in clinical remission. While rare, intramedullary spinal cord lesions should be considered in the differential diagnosis of infants presenting with poor feeding and hypotonia.

Keywords: hospital medicine; neurosurgery; oncology; pediatrics; teaching hospital; teratoma.

Figure 1. MRI Brain.

MRI of the brain demonstrating abnormal signal enhancement in the proximal cervical spinal cord. MRI: Magnetic resonance imaging

Figure 2. MRI Spine.

MRI of cervical, thoracic, and lumbar spine demonstrating a near holocord hemorrhagic, intramedullary mass consistent with a congenital immature teratoma. MRI: Magnetic resonance imaging