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Letters to the Editor
February 1999

Adherence of Benign Cervical Teratomas to Surrounding Soft Tissue

Arch Otolaryngol Head Neck Surg. 1999;125(2):236-237. doi:

I read with interest the observation by Bikhazi et al1 that the dissection of a benign cervical teratoma in a 10-year-old boy "was made more difficult by the adherence of its capsule to the surrounding soft tissue." I recently reported a case of a benign cervical teratoma in an adult that was notable because it was densely adherent to the structures of the carotid sheath, the innominate vein, the trachea, and the prevertebral fascia.2 This type of tissue reaction is frequently encountered in benign mediastinal teratomas. In an article describing the Mayo Clinic experience with 86 cases of benign mediastinal teratomas, Lewis and colleagues3 reported that virtually every tumor was densely adherent to vital intrathoracic structures, including the pericardium, the pleura, the lung, the great vessels, and the chest wall; and for this reason, in 7 cases, only partial removal could be accomplished. Cases involving the spontaneous rupture of benign mediastinal teratomas into the pleural space, the lung, the pericardial cavity, and the tracheobronchial tree have resulted in serious complications, including pleural effusions, lipoid pneumonia, expectoration of oily substances or hair, hemoptysis, pneumothorax, pericardial effusions, and acute cardiac tamponade.4 It has been postulated that benign mediastinal teratomas adhere to and erode into surrounding structures because of the action of proteolytic enzymes produced by salivary and pancreatic tissues within the tumor.5

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