|Year : 2020 | Volume
| Issue : 2 | Page : 217-218
Fetal immature sacrococcygeal teratoma
Amal George1, UV Akshay Viswanath1, Abraham Mammen2, A Binesh2
1 Department of General Surgery, Aster Malabar Institute of Medical Sciences (MIMS), Calicut, India
2 Department of Paediatric Surgery, Aster Malabar Institute of Medical Sciences (MIMS), Calicut, India
|Date of Submission||29-Jul-2020|
|Date of Decision||13-Aug-2020|
|Date of Acceptance||02-Oct-2020|
|Date of Web Publication||07-Nov-2020|
Dr. Amal George
Department of General Surgery, Aster Malabar Institute of Medical Sciences(MIMS), Calicut
Source of Support: None, Conflict of Interest: None
Sacrococcygeal teratoma (SCT) is an unusual congenital tumour that arises from embryologically multipotent cells in the Hensen's node, which is located in the coccyx. Neonatal SCT is rare, with an incidence of one in 35,000 live births with a female predominance (3:1–4:1 ratio). It generally presents in two distinct fashions: (a) Newborns with large predominantly external masses, which are noted in utero or at the time of delivery and are rarely malignant, and (b) older infants and young children presenting with tumours predominately confined to the pelvis with a much higher rate of malignancy. Most SCTs are diagnosed prenatally because of the routine obstetric ultrasonography. Here, we are reporting the case of newborn with SCT presenting as external mass.
Keywords: Newborn, sacrococcygeal teratoma, teratoma
|How to cite this article:|
George A, Akshay Viswanath U V, Mammen A, Binesh A. Fetal immature sacrococcygeal teratoma. Kerala Surg J 2020;26:217-8
| Introduction|| |
Sacrococcygeal teratoma (SCT) is a congenital tumour arising from all three germ cell layers with an incidence of 1 to 2 per 40,000 deliveries with isolated reports in literature. Ten percent of these may be malignant at delivery. They may grow to a large size, affecting foetal outcome and labour management. Most SCTs in foetuses can be managed by planned delivery and postnatal resection. Identification of foetuses at risk for hydrops is important because timely foetal intervention may reverse the pathophysiology, salvage foetuses affected before viability, and prevent maternal mirror syndrome. A rare case is reported in this paper.
| Case Report|| |
A full-term female neonate, with uneventful antenatal history and delivered vaginally, with birth weight of 3.7 kg, was detected to have a swelling in the lower back at birth. On examination of the swelling, there was a large lobulated sacrococcygeal mass of 7 cm × 6 cm, firm to hard in consistency located posterior to the anus [Figure 1]a and [Figure 1]b. The anus was displaced anteriorly contrast-enhanced computed tomography of the abdomen and pelvis was and done reported as type 1 sacrococcygeal teratoma (SCT) [Figure 2]a and [Figure 2]b. Serum alpha-foetoprotein (AFP) was found to be grossly elevated (41,708 ng/ml). The sacrococcygeal mass was excised along with the tip of the inferior aspect of the sacrum. Intraoperatively, there was no pelvic extension for the lesion. The histopathology report was Grade 2, immature SCT. Serum AFP declined and became normal a few months after surgery. The post-operative period and follow-up done every 3 months were uneventful.
|Figure 1: (a and b) Pre-operative image of soft-tissue mass in sacrococcygeal area|
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|Figure 2: (a and b) Computed tomography image of soft-tissue mass in sacrococcygeal region (marked with yellow arrow)|
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| Discussion|| |
Teratomas in children originate most commonly in the sacrococcygeal region, but they may also occur in the gonads, the retroperitoneal region or even in the liver or brain. In more than 50% of cases of SCT, diagnosis is made based on antenatal ultrasound scan. SCT is classified into four types based on its anatomical location and extension. Type I is primarily external with a minimum presacral component. Type II is also external however with substantial intrapelvic expansion. SCT Type III is mostly external but primarily pelvic, which extends into the abdomen. Type IV does not consist of an external part and is presacral. Teratomas are divided into mature and immature tumours depending on the number of immature elements in them, mostly neuroepithelium. Sometimes, patients with SCT may present with sacral and presacral anomalies (Currarino's triad), with symptoms of bowel or bladder involvement. The management of SCT is mainly surgical. A better prognosis is associated with early diagnosis and surgical treatment. To prevent recurrence, a complete surgical excision of the tumour comprising coccygectomy should be performed.
Declaration of patient consent
The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.
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Conflicts of interest
There are no conflicts of interest.
| References|| |
Lahdenne P, Wikström S, Heikinheimo M, Marttinen E, Siimes MA. Late urologic sequelae after surgery for congenital sacrococcygeal teratoma. Pediatr Surg Int 1992;7:195-8.
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Currarino G, Coln D, Votteler T. Triad of anorectal, sacral, and presacral anomalies. AJR Am J Roentgenol 1981;137:395-8.
[Figure 1], [Figure 2]