Benign Teratoma of the Tongue in a Neonate: A Case Report and Review of the Literature

Resident’s Name: Jessica Wilson

Program: Lutheran Medical Center - Providence

Article title: Benign Teratoma of the Tongue in a Neonate: A Case Report and Review of the Literature

Author(s): Shetty et al.

Journal: Pediatric Dentistry

Year. Volume (number). Page #’s: 2010. 32:3. 245-249.

Major topic: Benign Teratoma of Tongue

Overview of method of research: Case Report

Background:
Teratomas are neoplasms with the ability to grow continuously and are the most common extragonadal germ cell tumors of childhood. The cause of these neoplasms are unknown. Teratomas of the tongue are very rare and may develop from misplaced cells from the tuberculum impar.

Case Report:
A 6-week-old male presented in India for evaluation of a congenital lesion that had remained unchanged since birth. He was experiencing difficulty swallowing and breast-feeding, but no breathing problems. Clinical exam revealed a 2x1.5x1.5 cm pedunculated mass with smooth surface and normal coloring on the anterior 2/3 of the dorsum of the tongue. The patient experienced severe ankyloglossia and also polydactyly in all 4 limbs.
A team of oral and maxillofacial surgeons and pediatric dentists excised the mass under nasotracheal intubation with a circumferential incision including a few millimeters of healthy tissue. The lesion was cauterized and primary closure was obtained and a frenectomy was performed to correct the ankyloglossia. Histopathological exam revealed fibrous connective tissue, adipose tissue, mixed salivary glands, sebaceous glands, striated muscle, chondroid tissue and blood vessels and there was no evidence of malignancy.

Discussion:
Teratomas are classified into 4 different types:
1. dermoid- epidermal and mesodermal elements, most common
2. teratoid- ectodermal, mesodermal and endodermal, but poorly differentiated
3. true teratoma- 3 germ layers and differentiated
4. epignathus- highly differentiated into recognizable organs/limbs, high mortality rate
There have only been 20 documented cases of tongue teratoma since 1966. 75% experienced difficulty eating, but only 35% had problems breathing. Although the majority of cases are benign, 20% possessed histological evidence of malignancy.
Differential diagnosis: lymphangioma, hemangioma, granular cell myoblastoma, gastric mucosal cyst, lingual thyroid, thyroglossal duct cyst, ectodermal inclusion body, heterotropic gastric mucosal mucosal cyst, congenital rhabdomyosarcoma, encephalocele, glioma and neurofibromatosis.
Surgical excision is the treatment of choice and recurrence is rare.

Assessment of Article:
A well written article and good overview of teratomas, their clinical presentation, differential diagnosis and treatment.