Mechanisms of sudden death in patients with congenital teratoma

Abstract

Patients with congenital teratomas usually have a favourable prognosis provided that adequate surgical excision is performed early in life and that no malignancy is detected within the excised tissue. Three patients who died suddenly and unexpectedly as a result of the critical locations of their congenital teratomas demonstrate an alternative outcome. The clinicopathological features and mechanisms of death are described. A 4.8-kg, term boy failed to establish normal respiration and died after 1 h. At autopsy the chest cavity was almost completely occupied by a grossly distended pericardial sac that contained a large teratoma arising from the root of the aorta. A 31-week-gestation boy who was delivered by caesarean section for fetal distress died after 1 h of respiratory distress due to upper airway obstruction caused by a large anterior cervical teratoma. A 1.7-kg, 36-week-gestation girl who was admitted in a moribund state died during attempted surgical removal of a large sacrococcygeal teratoma that had caused marked haemorrhage during delivery. Antenatal diagnosis had not been made in any of the patients. These cases demonstrate that sudden death due to variable mechanisms such as cardiorespiratory compromise, airway obstruction, pulmonary hypoplasia, and traumatic haemorrhage should always be considered as possible complications of congenital teratoma that may occur prior to definitive surgery.