Paediatric Teratomas in a Tertiary Hospital in Nigeria: Management Challenges

Background: Teratoma is a complex tumour that originates from primordial pluri-potent gem cell. It consists of tissues derived from more than one primitive germ cell layer, at least one of which is foreign to the anatomic site in which it occurs. The extra-gonadal tumors develop along the pathway of germ cell migration to the gonads. Teratomas occur in the ovaries, testes and sacrococcygeal region. It may be mature or immature, benign or malignant and are more common in females. .

Cancer survival remains low in resource poor countries like ours due majorly to late presentation, diagnostic challenges, lack of and high cost of treatment.

Objective: To highlight the delays, complications and challenges encountered in the management of teratoma to increase its awareness

Method:

CASE 1 was a 7 month old male transferred to our unit following a histology report suggestive of immature teratoma. He was born with midline lower back swelling that increased rapidly in size from two months of age. He received chemotherapy with no response. He was then referred to a tertiary centre with radiotherapy facility.

CASE 2 is an 8 year old girl who presented two years ago with features of bladder outlet obstruction and low back swelling from infancy, later complicated with urethral strictures. She had pre sacral benign teratoma type 3. She is currently on admission for stage two surgery to address urethral stricture.

CASE 3: A 9 year old female who presented with right ovarian mass which was excised and histopathology confirmed mature teratoma. She was commenced on chemotherapy.

Conclusion: All three cases described above presented late, in advanced stage with complications and poor outcome. These were attributable to ignorance, poverty, poor response to chemotherapy and lack of some treatment facilities. We therefore, recommend awareness creation, collaborations and twining with any developed country.