A Rare Case of Oropharyngeal Teratoma Diagnosed Antenatally with MRI
A 25-year-old female (gravida 2 para 1) was seen by a radiologist for evaluation of polyhydraminos. Her previous anomaly scan reports were normal. Ultrasound evaluation of the fetus revealed no significant abnormalities []. Fetal spine and facial structure were normal. Fetal stomach bubble was seen and was found to be relatively small in size. Placenta was normal. Amniotic fluid volume was greater than normal, amniotic fluid index (AFI) measured 45 cm. Some problem in fetal swallowing due to small stomach and polyhydraminos was suspected. A fetal magnetic resonance imaging (MRI) was done to evaluate cause of acute polyhydramnios and relatively small size of the stomach.\nFetal MRI done on 1.5 T Philips Achieva magnet with T2W turbo spin echo sequences and balanced turbo field echo sequences. Sagittal [] and axial [] images show well-defined mixed intensity lesion with cystic component measuring about 4.5 × 3.5 cm in the oropharyngeal region. No obvious sign of invasion of hard palate or nasopharynx was noted []. No other significant abnormality was noted in the fetus. No destruction of facial structure was found. Large amount of amniotic fluid was seen []. The lower and mid regions of the trachea were well visualized. The mandible appeared normal [].\nBecause of polyhydramnios and severe maternal discomfort, cesarean section was done at 35 weeks. After birth, the baby was found to be hypoxic with difficulty in breathing. Baby was intubated and airway was maintained. Surgery for tumor removal was planned and done on the fourth day after birth. At surgery, well-defined lobulated tumor measuring about 4.5 × 3.4 cm arising from palate was resected [] and sent for histopathology examination. Post surgery, baby recovered well. Histopathology report proved it as immature teratoma [Figures and ]. After 4 weeks, the baby's serum alfa-feto-proteins were found to be elevated to 600 ng/ml. Parents were advised to consult a medical oncologist, who advised follow-up after 6 months. After 6 months, positron emission tomography - computed tomography [] was done to rule any recurrence. The scan showed no signs of any recurrence or metastasis. Serum alpha-feto-protein was repeated and found to be 180 ng/ml. Medical oncologist advised chemotherapy and radiation but the parents did not agree to this treatment. Presently, the boy is 27 months old and doing well without any clinical symptoms.