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IMAGES  
Year : 2014  |  Volume : 57  |  Issue : 1  |  Page : 148-149
Expansile congenital soft-tissue mass: A massive presentation


1 Department of Dentistry, Yashwant Chavan Memorial Hospital, Pimpri, Pune, Maharashtra, India
2 Departments of Oral Pathology and Microbiology, Institute of Dental Sciences, 'SOA' University, Kalinganagar, Ghatikia, Bhubaneswar, Odisha, India
3 Departments of Oral Pathology and Microbiology, D.Y. Patil Vidyapeeth's Dr. D.Y. Patil Dental College and Hospital, Pimpri, Pune, Maharashtra, India

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Date of Web Publication17-Apr-2014
 

How to cite this article:
Ingale I, Routray S, Kheur SM. Expansile congenital soft-tissue mass: A massive presentation. Indian J Pathol Microbiol 2014;57:148-9

How to cite this URL:
Ingale I, Routray S, Kheur SM. Expansile congenital soft-tissue mass: A massive presentation. Indian J Pathol Microbiol [serial online] 2014 [cited 2020 Feb 19];57:148-9. Available from: http://www.ijpmonline.org/text.asp?2014/57/1/148/130931


A healthy 5-month-old female child was reported to the out-patient department of our institution with a swelling in the upper lip region which measured about 10 cm × 10 cm in size. Patient's parents gave a history of a small growth of about 1 cm × 1 cm present in the same region at birth and there was gradual increase in size. Clinical examination revealed a growth appearing to arise from palatal tissue, which was firm in nature with no tenderness or palpitations [Figure 1]. All vital signs and investigations were found to be normal. Non-contrast computed tomography scan was carried out, which gave an impression of hypodense mass seen arising from bony palate with fatty component and tiny speck of calcifications within suggestive of dermoid cyst or teratoma [Figure 2]. For further confirmation excisional biopsy of the whole mass was performed. The palatal mass was removed successfully under general anesthesia [Figure 3]. Histopathological examination confirmed it to be teratoma as typical components like immature neural glial tissue was also identified in the tissue mass [Figure 4]. Patient's recovery was fine and there was no recurrence reported until 3 months follow-up.
Figure 1: A 5-month-old female neonate with a swelling in the upper lip region which measured about 10 cm 10 cm approximately attached to the premaxilla

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Figure 2 (a-c): Non-contrast computed tomography scan showed focal linear midline defect of premaxilla as the likely point of origin of the lesion. The lesion had heterogeneous internal components (soft-tissue and fatty) and tiny specks of calcifications were also seen

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Figure 3: Gross palatal specimen which histologically showed immature neural glial along with disorganized mixture of adipose tissue, mucin secreting glands, etc.

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Figure 4 (a-c): H and E, sections show immature neural glial along with disorganized mixture of adipose tissue, mucin secreting glands, etc., under 10 magnification

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Teratomas have a reported incidence of 1:4000 live births with around 2-9% in head and neck sites and congenital teratomas of the oropharyngeal region are usually described as epignathus. 1],[2] We hereby describe a massive expansile mass of congenital origin from the anterior hard palate in a female neonate, diagnosed histopathologically as oral teratoma that was successfully treated with surgery. The etiology of oral teratoma varies, it can be a derivative of the totipotential cells sequestered during embryogenesis or the germ cells giving rise to teratomas by parthenogenetic development. [3] Finally, it may also originate from incomplete formation of Siamese twins also. The differential diagnosis is limited, but includes hamartoma, dermoid cyst and heterotopic gastrointestinal cyst.[4] As large teratomas in the head and neck are associated with obstruction of airway and difficulty in intubation, mortality rate are generally high in the absence of a well-prepared resuscitation team or meticulous delivery planning to secure the airway. In our case the tumor was attached to the premaxilla with an extending stalk and was removed with no tissue destruction. Later the histopathology evaluation showed typical components like immature neural glial along with disorganized mixture of adipose tissue, mucin secreting glands, etc., confirming it to be an oral teratoma [Figure 4]. As the histopathological diagnosis was confirmatory to rule out all other differential diagnosis no further special immunohistochemical analysis was required. Recurrence was not seen after a 3 months follow-up.

 
   References Top

1.Vandenhaute B, Leteurtre E, Lecomte-Houcke M, Pellerin P, Nuyts JP, Cuisset JM, et al. Epignathus teratoma: Report of three cases with a review of the literature. Cleft Palate Craniofac J 2000;37:83-91.  Back to cited text no. 1
    
2.Weaver RG, Meyerhoff WL, Gates GA. Teratomas of the head and neck. Surg Forum 1976;27:539-42.  Back to cited text no. 2
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3.Beutel K, Partsch CJ, Jänig U, Nikischin W, Suttorp M. Oral mature teratoma containing epididymal tissue in a female neonate. Lancet 2001;357:283-4.  Back to cited text no. 3
    
4.Takeuchi K, Masuda Y, Narita F, Kiyoshi K, Mizutori M, Maruo T. Prenatal evaluation of bidirectional epignathus: Comparison of ultrasonography and magnetic resonance imaging. Fetal Diagn Ther 2003;18:26-8.  Back to cited text no. 4
    

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Correspondence Address:
Samapika Routray
Department of Oral Pathology and Microbiology, Institute of Dental Sciences, 'SOA' University, Sector-8, Kalinganagar, Ghatikia, Bhubaneswar - 751 030, Odisha
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0377-4929.130931

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    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4]



 

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