Extra-Gonadal Teratomas in Atypical Sites in Neonates and Children – Our Experience and Review of the Literature

Background: Extra-gonadal teratomas are rare tumors in Pediatric surgical practice. We studied the teratomas of atypical sites attended in our tertiary care center. Aim: Aim of the study was to find out the incidence of pediatric teratomas in atypical sites, clinical presentation and histological variation. Material and Methods: Over 15 years (January 2005 to December 2020), 29 cases of pediatric teratomas in atypical sites were studied. These sites included neck (number-one), retroperitoneum (number-fourteen), adrenal gland (number-two), renal (number-two), gastric(number-three), pancreas (number-one), pulmonary (number-one), floor of the mouth(number-one), oral (number-two), abdominal wall (numberone) and the mesentery (number-one). Patients were treated in the Department of Pediatric Surgery and specimens were reviewed in the Department of Pathology. Age, sex, clinical presentation, investigations (all patients had complete blood examination and alpha-fetoprotein) and imaging (USG of the local part and CECT as guided by the organ of involvement). Results: 29 pediatric teratomas in uncommon sites were reviewed. Out of 14 cases of retroperitoneal teratoma, three were immature. Cervical teratoma in a neonate was mature. Three cases of gastric teratomas were reported as mature. Two cases of adrenal teratomas also showed the histological features of mature teratoma. Renal teratomas (two) were benign. One each of pulmonary teratoma, pancreas and floor of the mouth were reported as mature. Two patients presented with oral teratoma were reported as mature teratomas. One patient had teratoma arising from the abdominal wall and was resected completely (mature teratoma). Teratoma arising from the mesentery also underwent complete resection. Conclusion: A small percentage of Pediatric teratomas occur in atypical sites. In our series, retroperitoneal tumors were predominant. Early surgical excision is the treatment of choice. Malignant change is known to occur in Pediatric teratoma and the patients need long term follow-up.