Cervical Teratoma and Cystic Hygroma in Nigerian Infants: Case Studies of Two Differential Diagnoses of Neonatal Neck Mass and Review of the Literature

Abstract

Congenital neck masses include branchial cleft cysts, thyroglossal duct cysts, thymus cysts, dermoid and teratoma, vascular abnormalities, and lymphatic malformations such as cystic hygroma. Cervical Teratomas (CTs) are rare true neoplasm of the neck composed of tissues derived from at least two of the three embryonic germ layers but foreign to the anatomic site of occurrence. CTs occur on the anterolateral surface of the neck, extending midline from the thyroid gland. They are asymmetric and multinodular with a cystic-solid consistency. In contrast, Cystic Hygromas (CHs) are benign multiloculated, compressible, painless lymphatic lesions with a doughy consistency. CHs can occur in the submental triangle, with extension into the floor of mouth. Early neonatal presentation with aero-digestive obstruction is the norm for large CTs and CHs. We present two infants with huge CT and CH delivered in two consecutive years at our facility in south-western Nigeria by unrelated families. Definitive prenatal diagnoses were not made and deliveries were not pre-planned. Both infants had severe respiratory compromise and unfavorable outcome. This report aims to enhance clinical recognition of these rarities, highlight their occurrence in our locale and reiterate the associated management challenges in resource-limited settings. Relevant literatures are also reviewed.