In utero Decompression of a Cystic Grade IV Sacrococcygeal Teratoma

Abstract

Sacrococcygeal teratomas (SCT) are the most common congenital tumors in the newborn. The prevalence rate is approximately 1 per 40,000 births, with 80% occurring in females. The majority of these tumors are external, protruding from the perineal region. Intrapelvic SCTs, by contrast, are extremely rare and difficult to diagnose in utero. Only 15% of the SCTs are entirely cystic, the majority being mixed or solid tumors. We describe a case of a fetal cystic presacral (grade IV) SCT, discovered at 22 weeks of gestation, which resulted in bilateral ureteral obstruction and hydronephrosis. This is the first known reported case of prenatally decompressing a cystic SCT via an amniotic catheter to alleviate a mass effect in the fetus.

Spontaneous Rupture of Fetal Sacrococcygeal Teratoma

“…Timely in utero excision of SCT in hydropic fetuses results in reversal of hydrops, diminution of descending aortic fl ow on Doppler echocardiography and decrease in placental thickness [13] . Amnioreduction, aspiration or shunting of cyst and surgical debulking are potentially life-saving interventions [7,[15][16][17][18][19] . Mothers who develop hypertension, respiratory compromise and renal impairment, termed maternal mirror syndrome [20] , are not candidates for fetal surgery and should undergo termination of the pregnancy or early delivery, depending on the gestational age.…”

The laparoscopic approach to sacrococcygeal teratomas

“…Such a procedure could have prevented the conversion in patient 2. Antenatal decompression of mainly cystic SCT by transabdominal puncture has been described as a means of enabling vaginal delivery [7,11]. One could dispute the wisdom of this approach with respect to malignancy, but malignancy is rare in the newborn, especially when the lesion is mainly cystic.…”

Tératome sacrococcygien de la taille du fœtus: surveillance anténatale, thérapeutique fœtale in utero et prise en charge obstétricale

“…Toutefois, la Les autres thérapeutiques foetales in utero sont symptomatiques. L'amniodrainage et la ponction de la partie kystique de la tumeur sont envisagés par certaines équipes en cas de volumineuses tumeurs ou d'hydramnios entraînant une menace d'accouchement prématuré [12,13]. Nous avons réalisé ces deux procédures afin de réduire le risque de surdistention uté-rine.…”

“…La présence d'une prééclampsie ou mirror syndrome impose la réalisation d'une extraction foetale immédiate quel que soit le mode d'accouchement [7,16]. En revanche, l'accouchement par voie basse est possible pour les tumeurs de moins de 10 cm purement kystiques (avec si nécessaire un drainage percutané du kyste au préalable) [13]. En cas d'hydramnios, un amniodrainage par ponction échoguidée peut être réalisé afin de diminuer le risque d'hémorragie du post-partum liée à la surdistention utérine.…”