Clinical outcomes of germ cell tumors arising around fetal and neonatal upper airways

Abstract

The aim of this study was to assess the clinical outcomes and problems in fetuses and neonates with germ cell tumors arising around the upper airway. A retrospective study was carried out for ten patients with germ cell tumors arising around the upper airways in the fetal and neonatal periods, who received treatment at our institution between 1989 and 2018. The diagnoses were epignathus in seven patients and cervical teratoma in three patients. The pathological diagnoses were mature teratoma in five patients and immature teratoma in five patients. Giant neck masses were prenatally diagnosed in six patients with epignathus or cervical teratoma. The ex utero intrapartum treatment (EXIT) procedure was performed in four patients with evidence of tracheal compression by the tumors, but not in two patients because of intrauterine fetal death or death due to respiratory failure after birth. Although airway management under the EXIT procedure was successful in three patients, it failed in one patient. All patients with mature teratoma survived to discharge, whereas four of the five patients with immature teratoma did not survive to discharge. Only the patients whose tumors were resected after birth survived to discharge. We concluded that the EXIT procedure was effective for the airway management of fetuses prenatally diagnosed with neck masses arising around the airway. In patients with giant neck masses, not only the airway management at delivery, but also the treatment strategy for the tumor itself should be considered.