Indian Journal of Radiology Indian Journal of Radiology  

   Login   | Users online: 1475

Home Bookmark this page Print this page Email this page Small font sizeDefault font size Increase font size     

 

LETTER TO EDITOR Table of Contents   
Year : 2003  |  Volume : 13  |  Issue : 2  |  Page : 231-232
Antenatal diagnosis of sacrococcygeal teratoma : Ultrasonographic diagnosis


Dept. of Radiodiagnosis, Govt. Medical College, Nagpur, India

Click here for correspondence address and email
 

How to cite this article:
Taori K B, Khurana S D, Gyanchandani M, Patil V. Antenatal diagnosis of sacrococcygeal teratoma : Ultrasonographic diagnosis. Indian J Radiol Imaging 2003;13:231-2

How to cite this URL:
Taori K B, Khurana S D, Gyanchandani M, Patil V. Antenatal diagnosis of sacrococcygeal teratoma : Ultrasonographic diagnosis. Indian J Radiol Imaging [serial online] 2003 [cited 2019 Sep 21];13:231-2. Available from: http://www.ijri.org/text.asp?2003/13/2/231/28666
Sir,

ACCURATE PRENATAL sonographic diagnosis of many congenital anomalies is now possible. We would like to report a case of benign sacrococcygeal teratoma diagnosed antenatally on the basis of Ultrasonographic findings.

A 27-year female patient was referred for routine antenatal ultrasonographic examination, from the obstetric department. Her past obstetric and gynecologic history was uneventful. The Ultrasonographic examination revealed an intrauterine fetal demise in which the regular measurements of head, abdomen and long bones corresponded to approximately 28 weeks of gestational age. There was a large, complex, hyperechoic mass showing multiple anechoic areas and multiple small calcific foci within the mass seen in the fetal sacrococcygeal region [Figure - 1]. Mass was containing both solid and cystic components [Figure - 2]. However no intrapelvic component could be identified. It was diagnosed as a case of fetal sacrococcygeal teratoma Altman type I, on obstetric ultrasound study. After discussion with the referring obstetrician about the sonographic picture, induction of labour was done. Patient delivered a dead female baby with a large sacrococcygeal teratoma, which was ruptured during labour [Figure - 3]. Tumour was of Altman type I as diagnosed on obstetric ultrasound. Histopathology confirmed the diagnosis of benign sacrococcygeal teratoma.

Sacrococcygeal teratoma (SCT) is the most common congenital neonatal tumor, has an incidence of 1-2 per 40,000 deliveries [1].

The incidence of malignancy when the diagnosis was made before 2 months of age is 10% in boys and 7% in girls. And after 2 months, 67% in boys and 47% in girls [2]. Malignant transformation is most likely to occur between 4 months and 5 years of age and all children should be followed up long term [1].

Sacrococcygeal teratoma usually present as a mass protruding between the coccyx and the rectum, nearly always arising from the tip of the coccyx. Benign teratomas usually produce no functional impairment. 15% of patients have associated congenital anomalies like imperforate anus, sacral bone defects, duplication of uterus or vagina, spina bifida, meningomyelocele. The tumor markers are AFP and b -HCG. In contrast to the SCT in infancy, presacral teratoma in adult are extremely rare [3].

Altman, Randolph and Lilly's Classification of presentation of SCT [2].

Type I: Predominantly external on the buttocks with a minimal presacral component.

Type II: External with a significant intrapelvic component.

Type III: External with the predominant pelvic mass with extension into the

abdomen.

Type IV: Entirely presacral without external presentation or significant pelvic extensions.

The presence of a teratoma in the fetus may be accompanied by polyhydramnios, a uterine size larger than the expected gestational age, elevated levels of alpha-fetoprotein in amniotic fluid and associated with increased risk of - stillbirths, fetal hydrops, high output cardiac failure presumably as a result of vascular shunting through the tumour.

Neonatal sacrococcygeal teratoma is a rare tumor and it being potentially malignant tumor the early diagnosis helps in management. The diagnostic imaging studies help to confirm the diagnosis of a clinically palpable sacrococcygeal mass, determine its relationship to other structures and detect metastases [4]. Although in our case it was an intrauterine fetal demise but neonatal sacrococcygeal teratomas can be associated with a very good prognosis by utilizing prenatal diagnosis, proper intrapartum management, detailed neonatal preoperative delineation, and complete surgical excision of the tumor.

 
   References Top

1.M Feldman, P Byrne, MA Johnson, J Fischve and G Lees : Neonatal sacrococcygeal teratoma : Multiimaging modality assessment. Journal of Pediatric surgery 1990 June; 25(6) : 675-678.  Back to cited text no. 1    
2.David Tapper, Robert Sawin, James A O'Neill, Jr, M.D., Marc I Rowe, Jay L Grosfeld, Eric W Fronkalsrud, Arnold G Coran: Chapter 29 Teratomas and other germ cell tumours. Pediatric surgery 5th edition; volume 1: pg 447-459.  Back to cited text no. 2    
3.Harold D Head, MD Maj, ML, Jared D Gerstein, Robert W Muir: Presacral teratoma in the adult. The American Surgeon 1975 April; 240-248.   Back to cited text no. 3    
4.Chan FL, Cheng CS, Tam PK, Saing H : Sacrococcygeal teratoma: computed tomography evaluation. J Comput Tomogr 1987 Apr ; 11(2) : 200-4.  Back to cited text no. 4    

Top
Correspondence Address:
K B Taori
Dept. of Radiodiagnosis, Govt. Medical College, Nagpur
India
Login to access the Email id

Source of Support: None, Conflict of Interest: None


Rights and PermissionsRights and Permissions


    Figures

[Figure - 1], [Figure - 2], [Figure - 3]



 

Top
 
  Search
 
    Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
    Email Alert *
    Add to My List *
* Registration required (free)  


    References
    Article Figures

 Article Access Statistics
    Viewed3495    
    Printed186    
    Emailed1    
    PDF Downloaded2    
    Comments [Add]    

Recommend this journal