Pediatric Teratomas and Other Germ Cell Tumors Clinical Presentation

Updated: Jul 31, 2019
  • Author: E Stanton Adkins, III, MD; Chief Editor: Max J Coppes, MD, PhD, MBA  more...
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Presentation

History and Physical Examination

The clinical presentation of pediatric germ cell tumors depends on the location of the tumor.

Sacrococcygeal teratomas may be diagnosed antenatally as an incidental finding on ultrasonography (US); they may occur in an infant who is large for age, is premature, or has fetal hydrops. Fetal hydrops is an ominous sign, typically due to high flow through the tumor with high-output cardiac failure and placentomegaly. A teratoma larger than 5 cm is likely to cause dystocia and possible rupture; elective cesarean delivery should be performed. Sacrococcygeal teratomas that are not diagnosed antenatally may be noted at delivery, within the first few weeks after birth, or discovered late.

Ovarian masses typically cause abdominal pain, mass, distention, or emesis. Two thirds of affected girls present with pain as their primary symptom. Acute and chronic pain occur with equal frequency. In situations of acute pain, the diagnosis is often related to torsion of the ovary with consequent compromise of the blood supply. Palpable masses are less frequent and appear later in the clinical course.

Testicular tumors typically occur as a scrotal mass with or without pain. The differential diagnosis may include hydrocele because some cystic teratomas may transilluminate. In some situations, the tumor may cause symptomatic metastasis; this is more common in older patients.

The distribution of the patients' age at presentation for testicular tumors is bimodal. In the youngest children (0-4 years), teratomatous lesions and yolk sac tumors are predominant. In children older than 10 years, teratomas are increasingly rare. Yolk sac tumors are still predominant, but other malignant germ cell types start to become clinically relevant.