This case study describes a 13-year-old male patient who presented with throat pain and difficulty swallowing for 4 months. Examination revealed a 4x4 cm mass in the right tonsillar fossa. Imaging and biopsy revealed the mass to be an oropharyngeal teratoma arising from the right tonsil. The teratoma was removed surgically and found to be a benign, immature type teratoma on histopathological examination. Teratomas are rare tumors composed of multiple tissue types that can develop in various locations including the head and neck region.

1. A CASE STUDY OF
TONSILLAR TERATOMA
DR. KRISHNA MAKADIA DR. SUSIL G. JHA
1st Year Resident Prof. and Head of the Dept.
Mobile No. : 8238024725
Email : makadiakrishna42@gmail.com
Department of Otorhinolaryngology
and Head & Neck Surgery
Sir T hospital, govt. Medical College, Bhavnagar.

2. INTRODUCTION
• The teratoma is a germ cell neoplasms composed of endoderm ,
mesoderm , ectoderm.
• They could rarely produce and have different clinical picture,
depending upon different germinal cells.
• The teratomas are commonly seen in neonatal period or after first
decade of life.
• They are associated with high level of mortality, especially because of
respiratory distress.
• They are commonly benign and asymtomatic arising most commonly
from sex organs, ovaries and testes.

3. • The sacrococcygeal teratoma is most common extragonadal origin.
• Other localization : head area,orbital,nasopharynx, thyroid, cervical
and mediastinal.
• The nasopharyngeal teratoma causes aerodigestivetract obstruction.
• The first case reported in Thailand in neaonatal female having
immature teratoma of nasopharynx extending to soft palate and right
side tonsillar fossa.

4. AIMS AND OBJECTIVE

5. SIGNS AND SYMPTOMS
• People with teratoma may not show any symptoms at first.
• But causes symptoms like:Thorat pain,Difficulty in
swallowing,earachae,

6. CASE STUDY
• A case of 13 year old male patient residing at Bhavnagar.
• Patient presented with a complaint of throat pain and difficulty in swallowing since 4 months.
• Associated occasionally with vomiting, common cold , coughing and right ear discharge.
• ON EXAMINATION :
• ORAL CAVITY : Approximately 4*4 cm single nonwarm, nontender, soft , smooth , freely mobile
globular mass palpable over right side tonsillar fossa.
• EAR : Right : Small central perforation Left : Intact / Normal drum
• NOSE : No any abnormality found

7. INVESTIGATION
• Patient underwent CECT NECK : S/O Possibility of
OROPHARYNGEAL TERATOMA arising from right sided tonsillar
fossa.
• Patient was planned to be operated under general anaesthesia so all
routine investigations was done.

8. OPERTATIVE PROCEDURE
• Patient was given tonsillar position.
• The tonsillar teratoma was removed with coldstealed method.
• The excised teratoma was sent for frozen section and histopathological
study.

9. POST OPERATIVE
• Frozen section is suggestive of benign lesion most likely teratoma with
predominant lipomatous components with all margins free.
• Histopathological report: Gross and Microscopic appearence
suggestive of specimen containing white solid area with teeth like
structures in between dense fibrous tissue with normal minor salivary
tissue. Impression : Benign soft tissue lesion with ossifying fibro-
lipoma S/O Oropharyngeal immature type of Teratoma

10. CONCLUSION
• The extra cranial head and neck teratoma are rarely affected
accounting for less than 5% of all reported cases.
• The teratoma of nasopharynx/oropharynx typically induces obstruction
of the proximal oro-respiratory tract, which requires rapid airway
management and often associated with distinct deformities of the
cranial and facial structures.
• The authors remind that immature or mature part of teratomatous
tumor is not that much important factor in head neck region but size of
a teratoma is the major problem leading to mechanical airway
obstructiсn and secondary infection.[3],[6]

11. REFERENCES
• 1. KH. Neonatalneoplasia. In AGM Campbell, Neil, eds.MCINTOSHForfar and Arneil's Text Book
oflivingstone. 1998: 290-291.2.
• 2. Lavis CF, Carachi R, Young DG Neonatal Tumour: Glasgow Ar DisChildi ood 1955–1986; 63:
1075 1078
• 3. Chuaan-Tiech Chew Nasopharynx (the post nasal space). In Alan G. Kerred. Scott-Brown's
Otolaryngology, 6th ed. Oxford, Ox2 8DP; Butterworthheinemann, 1997:5, 13, 25.
• 4. Cotran, Kumar, Robbins. Rubbins Pathologic Basis of disease, 5th ed. Aprism indian edition,
Bangalore. 16. W.B. Saunders Company. 1994; 457458.******
• 5.Ferronob Ballenger, James B. SnowOtorhinolaryngology, Head & NeckSurgery, 15th ed. A Lea
& Febinger Book Williams & Wilkins; 1996; 216.
• 6.Ferron JA, Munro IR, Bruce DA, Whitaker LA. AI: Massiveeratomainvolving the cranial base.
Treatmentand outcome: a two center report.Plast Reconst Surg 1993; 91: 223.
• 7. Kozart PR, iwane A, Kulkarni B; Congenital nasopharyngealteratomawith cleft palate. Indian
Assoc Pediat Surg 2004; 9: 42-45.