A Clinical Analysis of the Diagnosis and Treatment of Fetal Sacrococcygeal Teratomas

Abstract

Objective The present study aims to discuss the clinical features, treatment, and prognosis of fetal sacrococcygeal teratomas (SCTs) to improve the standard of diagnosis and treatment. Methods The clinical data of 15 pregnant females with fetal SCT, admitted to Fujian Maternity and Child Health Hospital from January 2013 to January 2020, were retrospectively analyzed with respect to clinical characteristics, imaging features, complications, treatment options, and pregnancy outcomes. Results The 15 cases of fetal SCT were all detected by color ultrasonography. There were two cases of cystic tumors and 13 cases of solid cystic tumors. In terms of tumor blood supply, there was one case without blood flow signal, eight cases with little blood flow signal, and six cases with abundant blood flow. At the time of delivery, there were two cases with a tumor diameter less than 5 cm, five cases with a diameter of 5−10 cm, and eight cases with a diameter of more than 10 cm. In terms of tumor shape and location, there were two cases of type I, ten cases of type II, and three cases of type III. There were six cases with an increased fetal heart to chest ratio, four cases of fetal edema, three cases of placental edema, four cases of excessive amniotic fluid, one case of insufficient amniotic fluid, three cases of fetal distress, one case of stillbirth, two cases of gestational diabetes mellitus, two cases of mirror syndrome, and two cases of postpartum hemorrhage. According to the pathological diagnosis, there were seven cases of mature teratoma, seven cases of immature teratoma, and one case of mixed germ cell tumor. There were six cases of induced delivery, nine cases of cesarean section, one case of premature birth, and two cases of mild neonatal asphyxia. Conclusion Fetal SCT was generally diagnosed by prenatal ultrasonography. The tumor blood supply, growth rate, size, nature of the tumor, clinical type, pathology, and maternal-fetal complications are all closely correlated with the prognosis. The timing and manner of the termination of pregnancy should be determined on the basis of the pregnant female, the fetus, and the tumor.

A single-center experience of magnetic resonance imaging findings of fetal sacrococcygeal teratomas

“…Those presenting in older infants tend to have a higher malignant potential and those presenting in utero have a poor prognosis due to complications. It has been reported that fetal mortality is higher if the gestational week at the time of diagnosis is early in SCT [ 18 ]. Mass size, the solid component, and the vascularity of the mass are reported to be more important on prognosis than the gestational age at the time of diagnosis [ 18 ].…”

“…It has been reported that fetal mortality is higher if the gestational week at the time of diagnosis is early in SCT [ 18 ]. Mass size, the solid component, and the vascularity of the mass are reported to be more important on prognosis than the gestational age at the time of diagnosis [ 18 ]. The prognosis of SCTs detected in the prenatal period is to be worse than those detected in the neonatal period which may be due to the fact that larger tumors are more likely to be detected in fetal life, and tumors detected in early pregnancy have greater growth potential [ 19 ].…”

Immature Sacrococcygeal Teratoma: A Case Report and Extensive Review of the Literature

“…The selection of articles required the English and French languages, clinical trials, case presentations, and case series. In total, 39 published articles were identified according to the inclusion criteria and are presented in Table 5 [3,5,10,11,13,18,19,21,22,24,25]. Following the analysis of the series of 226 cases with immature SCT, 19 G1, 29 G2, and 50 G3 were identified according to the Gonzales-Crussi classification, and 9 TI, 12 TII, 5 TIII, and 1 TIV cases according to the Altman classification; for the other cases, no data were available.…”

“…Teratomas are considered rare fetal tumors, with an incidence varying between 1.3 and 2.2 in 1000 pregnancies, derived from the three germ layers [1]. Since 1975, when Santos-Ramos and Duenhoelter [2] described sonographically sacrococcygeal teratoma (SCT), the imaging technology of the prenatal diagnosis of this malformation has been continuously improved, this being highlighted by the increase in the detection rate from 50% in 2008 [3,4] to 100% in 2020 [5]. SCTs are the most common congenital tumors, arising from the multipotential cells of Hensen's node towards the end of the second week and the beginning of the third week of gestation [6].…”

Fetal Sacrococcygeal Teratoma: A Case Report of a Giant Tumor with an Excellent Outcome

“…SCT can be detected on ultrasound as early as the first trimester, presenting as a large mass originating from the sacrococcygeal area, with or without an intrapelvic component [ 6 ], [ 7 ]. It is recommended to perform serial ultrasonography, including Doppler ultrasonography, to monitor the tumor’s growth and vascularization over time.…”