Description, Causes and Risk Factors:
Teratomas are neoplasms originating in pluripotent (able to develop into various different cell types) cells. They are composed of a wide diversity of tissues representing all three germ cell layers. The sacrococcygeal area is the most common extragonadal site. A sacrococcygeal teratoma is the commonest teratoma presenting in the neonatal period.
Sacrococcygeal teratoma is a nonseminomatous germ cell tumour, which occurs in the new born. The presentation is classical and it is eminently treatable. Clinicians need to screen mothers with clinical features of sacrococcygeal teratoma during antenatal period to make early diagnosis. Delay in diagnosis and treatment may lead to development of complications, fetal loss and increased perinatal mortality? Clinical features and principle of management are highlighted in this study.
Sacrococcygeal teratoma may be cystic, solid or mixed. The solid tumor is more vascular and associated with complications such as hydrops, urinary obstruction, stillbirths, and dystocia. The extent of sacrococcygeal teratoma was classified by American Academy of Pediatrics as follows:
Type 2: Tumours have both an external mass and significant pre-sacral pelvic extension (34 percent) and have a 6 percent metastases rate.
Type 3: Tumours are visible externally, but the predominant mass is pelvic and intra-abdominal (8.6 percent). A 20 percent rate of metastases was found in this group.
Type 4: Tumours are not visible externally, but are entirely presacral (9.6 percent) and have an 8 percent metastases rate. About 80% of sacrococcygeal teratoma are types 1 and 2 and have the least chance of metastasis. Type 3 has the highest chance of metastasis and worst prognosis, whereas types 1 and 2 have the best prognosis. Immunohistochemistry of sacrococcygeal teratoma suggests that and PCNA (proliferating cell nuclear antigen) may affect proliferative activity of these tumors. Further evaluation of these markers and PCNA is required to determine their predictive value with respect to biologic behavior of sacrococcygeal teratoma.
Type 1: Tumours are predominantly external, attached to the coccyx, and may have a small presacral component (45.8%) associated with this group.
It's the most common tumor in newborns — it affects 1 in every 35,000 babies. These are usually non-malignant when diagnosed after birth. After treatment, your baby should make a full recovery.
Sacrococcygeal teratomas can cause a variety of symptoms, the most common being a mass protruding from the sacrococcygeal region of the body. Other symptoms can develop from the internal growth of the tumor, which can cause blockage of the urinary tract or the gastrointestinal tract. Obstruction of the urinary system can cause decreased urination, blood in the urine, or kidney failure. Blockage of the gastrointestinal tract can result in bowel obstruction, which causes symptoms such as abdominal distension, vomiting, constipation, and pain.
Prenatal diagnosis of sacrococcygeal teratoma is oftenmade in many centers nowadays because of frequentultrasonographic examination of pregnant women on clinical suspicion. Cystic and solid component of sacrococcygeal teratoma as well as the degree of vascularity can be determined prenatally, which will influence subsequent management. Onset of complications such as, urinary tract obstruction, fetal hydrops, placentomegaly, and polyhydramnios can be detected, on ultrasonography.Color Dopplerultrasonography and ultra fast fetal magnetic resonanceimaging techniques have enhanced the accuracy ofprenatal evaluation, which is traditionally made by ultrasonography alone when fetal surgery is being considered. Lateral view X-ray of the pelvis and computed tomography (CT) determine theintrapelvic extension of SCT (spinal computed tomography) and thus classify the tumor.Sacrococcygeal teratoma can be distinguished frommeningocele, myelomen
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