Antenatal and histological diagnostics of cystic sacrococcygeal teratoma. Clinical case and literature review

Abstract

Objectives The congenital embryonic tumor known as sacrococcygeal teratoma (SCT) affects 1 in 35.000–40.000 newborns and is more prevalent in female fetuses and neonates. A total of 25–50% of SCTs are diagnosed by an ultrasound (US) examination during the second trimester of pregnancy. Planning the manner of delivery, determining the risk of negative outcomes, and choosing treatment options depend on the results of antenatal differential diagnosis. Case presentation This is a unique case of a 29-year-old second gravida, suspected of having a fetal sacrococcygeal dysplasia differentiable between Type 2 SCT and terminal myelocystocele. An MRI revealed no typical SCT changes, as a matter of course, the diagnosis of myelocystocele could not have been excluded. The results of the genetic examination allowed to exclude the chromosomal pathology. Punctuation of the external component of the formation and a cytological examination were suggested. Nevertheless, the patient and her partner refused further studies and insisted on the termination of pregnancy. Medical abortion was induced and histological findings confirmed fetal morphology to be mature SCT. Conclusions Cystic sacrococcygeal teratoma is an unusual malformation of fetal development. In the antenatal period SCT is diagnosed based upon an ultrasound evaluation, an MRI, and a multidisciplinary assessment of clinical experts. Differential diagnosis based upon clinical imaging during the gestational period is elaborate. The final medical diagnosis needs to be verified by a histological evaluation of pathological tissue. An antenatal medical diagnosis of fetal dysplasia is considerable for the further prognosis of fetal and newborn development.

The Sonographic Diagnosis and Clinical Management of a Fetal Sacrococcygeal Teratoma: A Case Report

“…7 Rapid growth of the mass may cause pressure on adjacent organs, such as rectum or bladder resulting in organ dysfunction (e.g., fecal or urine incontinence). 12 Several parameters can be used to predict the prognosis of SCT. Gestational age at diagnosis is one parameter indicating the earlier the gestational age at diagnosis, the worse the prognosis.…”

“…6 A 3-year postoperative surveillance should include serum AFP, beta-human chorionic gonadotropin, and physical examination, every 3 to 6 months, as well as assessing the risk for surgical complications, recurrence, residual tumor, and malignancy. 7,9,12 Long-term surgical complications have been reported, including urologic and anorectal dysfunction with an incidence of 33% and 29%, respectively. 5 This case report discussion has the limitation that sources published in English were used for references, which may have resulted in missing information and or knowledge gaps.…”

“…7 Rapid growth of the mass may cause pressure on adjacent organs, such as rectum or bladder resulting in organ dysfunction (e.g., fecal or urine incontinence). 12…”

“…6 If a teratoma is suspected, a multidisciplinary team, including obstetricians, neonatologists, pediatric neurosurgeons, pediatric surgeons, radiologists, and oncologists, must establish a combined diagnostic and treatment plan. 12…”

The Importance of Prenatal Diagnosis for the Early Detection of Fetal Abnormalities in Rural Area

“…1,29 Medical diagnosis during the antenatal period has a major in uence on the further prognosis of the developing fetus and newborn. 30 The building of awareness of prenatal diagnosis in rural area begins with a positive attitude so that patients are willing to come to the hospital and have appropriate expectations of the services at the hospital. 31,32 A study states that the consistent provision of prenatal care is an important quality indicator for pregnant women.…”