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KEY POINTS
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Key Points

  • Cervical teratomas are often large, solid, and cystic lesions with calcifications.

  • Polyhydramnios occurs from esophageal compression, predisposing to preterm delivery.

  • Vascular malformations, including lymphangiomas and arteriovenous malformations, are the main differential diagnoses.

  • The EXIT procedure is indicated to secure the airway.

  • Delivery should occur in a tertiary center with expertise in the EXIT procedure.

  • Cervical teratomas can arise in the thyroid. Postoperative hypothyroidism or hypoparathyroidism can occur.

  • Close follow-up after resection is indicated, as residual or recurrent teratoma is at risk for malignant transformation.

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CONDITION
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Cervical teratoma is a rare tumor. Approximately 300 congenital cases have been described (Riedlinger et al., 2005; Oka et al., 2007). Since the first prenatal diagnosis of fetal cervical teratoma in 1978, there have been only a few dozen published reports of cervical masses detected in utero (Schoenfeld et al., 1978; Patel et al., 1982; Suita et al., 1982; Kagan, 1983; Thurkow et al., 1983; Trecet et al., 1984; Pearl et al., 1986; Cunningham et al., 1987; Hitchcock et al., 1987; Holinger and Birnholz, 1987; Roodhooft et al., 1987; Jordan and Gauderer, 1988; Kelly et al., 1990; Zerella and Finberg, 1990; Baumann and Nerlich, 1993; Liechty et al., 1997; O’Callaghan et al., 1997).

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As in other teratomas, cervical teratomas are composed of tissues foreign to their normal anatomic sites. All three germ layers are represented within the tumor. Neural tissue is the most common histologic component, with cartilage and respiratory epithelium also observed (Schoenfeld et al., 1982). Thyroid tissue occurs in 30% to 40% but it is uncertain whether this represents actual involvement of the gland or ectopic thyroid tissue (Jordan and Gauderer, 1988). Theories regarding the origin of cervical teratoma include derivation from totipotential germ cells or abnormal development following cleavage of monozygous twins with fetus in feta (Ashley, 1973; Hitchcock et al., 1987).

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INCIDENCE
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Cervical teratomas are rare with an incidence ranging from 1 in 20,000 to 1 in 40,000 livebirths (Azizkhan et al., 1995).

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Cervical teratomas account for 3% to 6% of teratomas (Azizkhan et al., 1995, Jordan and Gauderer, 1988). There is no apparent relationship to maternal age or parity (Hitchcock et al., 1987). Unlike other teratomas, males and females are equally affected (Batsakis et al., 1964; Tapper and Lack, 1983) and there is no racial predilection (Suita et al., 1982).

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SONOGRAPHIC FINDINGS
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On ultrasound examination, cervical teratomas are typically asymmetric, unilateral, mobile, and well demarcated (Figures 110-1 to 110-3). Most are multiloculated, irregular masses with solid and cystic components (Figure 110-1). As many as 50% have calcifications ...

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