Images in neonatal medicine Arch Dis Child Fetal Neonatal Ed July 2011 Vol 96 No 4 F258 Yaseen Joolay, 1 Chantal Stewart 2 1 Department of Neonatal Medicine, Groote Schuur Hospital, Cape Town, South Africa 2 Department of Obstetrics and Gynaecology, Groote Schuur Hospital, Cape Town, South Africa Correspondence to Dr Yaseen Joolay, Department of Neonatal Medicine, H46 Old Main Building, Groote Schuur Hospital, Observatory, 7925 Cape Town, South Africa; yaseen.joolay@uct.ac.za Competing interests None. Patient consent Obtained. Provenance and peer review Not commissioned; externally peer reviewed. Accepted 1 March 2011 Published Online First 22 March 2011 Arch Dis Child Fetal Neonatal Ed 2011;96:F258. doi:10.1136/adc.2011.214411 REFERENCES 1. Sahu S, Maurya R, Rao Y, et al. Multiple congenital epulis in newborn—a rare presentation. J Oral Maxillofac Pathol 2009;13:78–80. 2. Celik M, Akkaya H, Arda IS, et al. Congenital teratoma of the tongue: a case report and review of the literature. J Pediatr Surg 2006;41:e25–8. 3. Hassan S, Sidek DS, Shah Jihan WD, et al. Massive lingual teratoma in a neonate. Singapore Med J 2007;48:e212–14. 4. Said S, Breathanch F, Fleming A, et al. Prenatal diagnosis of massive fetal tongue teratoma followed by successful, ex-utero intra-partum treatment. J Obstet Gynaecol 2009;29:55–7. 5. Shetty SJ, Bansal S, Kulkarni SR, et al. Benign teratoma of the tongue in a neonate: a case report and review of the literature. Pediatr Dent 2010;32:245–9. Congenital cystic mass of the tongue We present a rare case of a congenital lingual teratoma found antenatally by fetal ultrasound. A 25-year-old pregnant patient was seen at our Fetal Medicine Unit at 21 weeks’ gestation with a fetal anom- aly. A 19 mm mass was visible in the mouth of the fetus on ultrasound. The mass consisted of two distinct cystic components (figure 1) which occupied the entire oral cav- ity. No other abnormalities were seen. The patient was fol- lowed up with regular ultrasound scans. The fetus was seen to have sucking movement and absence of polyhydramnios suggested intact swallowing, but there was concern about airway obstruction after birth. A female infant was deliv- ered at 38 weeks by elective caesarean section with normal Apgar scores. An ENT surgeon was present for emergency airway management but this was not required. The infant was comfortable with no respiratory distress when placed prone. The cystic mass was affi xed to the tongue and tran- silluminated (fi gure 2). Needle aspiration of the cyst was done, following which the infant was able to breastfeed comfortably. Surgery was performed at 3 weeks of age; two separate cystic structures measuring 25 and 20 mm in diameter were found and excised completely. The histology of one cyst was in keeping with a foregut duplication cyst, the other having features consistent with a benign mature teratoma. The differential diagnosis of congenital oral tumours of the mouth include congenital epulis, teratomas, encephalocele, lymphatic malformation, haemangiomas and neuroecto- dermal tumours. 1 Congenital lingual teratomas are rare—a PubMed search produced only 19 other cases. 2–5 Airway obstruction, feeding and swallowing difficulties are the most common associated problems. Images in neonatal medicine Figure 1 Cystic mass in oral cavity. Figure 2 Transilluminated lingual cystic mass.