Cervical Cystic Teratoma: An Unusual Cause of Airway Obstruction in the Pediatric Population

Abstract

Cystic teratoma is a germ cell tumor, which usually involves the gonads. However, it can be located occasionally in other organs. The most common extragonadal sites for germ cell tumors include midline structures such as the retroperitoneum, mediastinum, pineal body, and supra-sellar space. Here, we describe a case of a patient who presented with a cystic teratoma involving the anterior aspect of the neck. The chief complaints of the patient consisted of a large swelling in front of the neck, difficulty in breathing, and frequent regurgitation of milk during feeding. Initially, a diagnosis of cystic hygroma was instituted for which the patient underwent sclerotherapy utilizing bleomycin. However, no improvement was observed in the patient's condition. A detailed evaluation was planned, starting with a CT scan of the head and neck that suggested cystic teratoma as the likely etiology. Surgical excision of the mass was performed, and an excisional biopsy for histopathological examination was taken. A final diagnosis of cervical cystic teratoma was established based on the histopathological findings. The purpose of reporting this case is to raise awareness among fellow healthcare professionals that cystic teratoma can also present with a large swelling in the anterior neck with obstructive features.

Keywords: airway obstruction; anterior neck mass; case report; cervical cystic teratoma; extragonadal germ cell tumor; infants; mature cystic teratoma; non-seminomatous germ cell tumors.

Figure 1. A large anterior neck swelling with overlying erythema as marked by the arrow. It extends from the left temporomandibular joint to the clavicle and encroaches towards the angle of the right mandible.

Figure 2. The CT scan of the head and neck shows a large exophytic mass with solid and cystic components on the left side of the neck as marked by the arrow. The mass is compressing adjacent structures.