Sacrococcygeal teratoma: Difference between revisions

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{{Sacrococcygeal teratoma}}
{{Sacrococcygeal teratoma}}
{{CMG}}
{{CMG}}{{AE}}{{MGS}}{{sab}}
 
{{SK}} Fetiform Teratoma, Fetus in fetu


==[[Sacrococcygeal teratoma overview|Overview]]==
==[[Sacrococcygeal teratoma overview|Overview]]==


==[[Sacrococcygeal teratoma natural history, complications, and prognosis|Natural history, Complications, and Prognosis]]==
==[[Sacrococcygeal teratoma historical perspective|Historical Perspective]]==
==[[Sacrococcygeal teratoma differential diagnosis|Differentiating Sacrococcygeal teratoma from other Diseases]]==


==Diagnosis==
==[[Sacrococcygeal teratoma classification|Classification]]==
==[[Sacrococcygeal teratoma history and symptoms|History & Symptoms]]==
==[[Sacrococcygeal teratoma physical examination|Physical Examination]]==
==Lab tests==
==[[Sacrococcygeal teratoma echocardiography or ultrasound|Echocardiography or Ultrasound]]==


==Treatment==
==[[Sacrococcygeal teratoma pathophysiology|Pathophysiology]]==
The preferred first treatment for SCT is complete surgical removal (ie, complete resection). The preferred approach to a small SCT is through the [[perineum]]; a large SCT may require an additional approach through the [[abdomen]].  Resection should include the coccyx and may also include portions of the [[sacrum]]. The surgery should include reattachment of the small muscles and ligaments formerly attached to the coccyx, in effect reconstructing the posterior perineum.


SCTs are classified morphologically according to how much of them is outside or inside the body:
==[[Sacrococcygeal teratoma causes|Causes]]==
*Altman Type I — entirely external, sometimes attached to the body only by a narrow '''stalk'''
*Altman Type II
*Altman Type III
*Altman Type IV — entirely internal;  this is a '''presacral teratoma'''


The Altman Type has a significant influence on management, surgical approach, and complications of SCT.  Serial ultrasound and MRI monitoring of SCTs in fetuses [[in utero]] has demonstrated that the Altman Type can change over time.
==[[Sacrococcygeal teratoma differential diagnosis|Differentiating Sacrococcygeal teratoma from other Diseases]]==


Regardless of location in the body, [[teratoma]]s are classified according to a [[cancer staging]] system.  This indicates whether [[chemotherapy]] or [[radiation therapy]] may be needed.
==[[Sacrococcygeal teratoma epidemiology and demographics|Epidemiology and Demographics]]==


==Management of fetal SCTs==
==[[Sacrococcygeal teratoma risk factors|Risk Factors]]==


Management of most fetal SCTs involves [[watch and wait]], also known as [[expectant management]].  An often used [[decision tree]] is as follows:
==[[Sacrococcygeal teratoma screening|Screening]]==


*Perform detailed ultrasound exam including fetal [[echocardiogram]] and [[Doppler]] [[Data-flow analysis|flow analysis]]
==[[Sacrococcygeal teratoma natural history, complications and prognosis|Natural History, Complications and Prognosis]]==
**If fetal high output failure, placentomegaly, or [[hydrops]]
***If fetus not mature, perform [[pregnancy termination]] or [[fetal intervention]]
***Else fetus mature, perform emergency [[Cesarean section]]
**Else no emergent problems, perform serial [[non-stress test]]s and ultrasound [[biophysical profile]]s and plan delivery
***If emergent problems develop, return to top of decision tree
***Else if SCT over 5–10cm or [[polyhydramnios]], perform early (37 weeks gestation) [[Caesarean delivery on maternal request|elective Cesarean]] section
***Else SCT small and no complications, permit term [[spontaneous vaginal delivery]]


Emergent problems include maternal [[mirror syndrome]], [[polyhydramnios]], and [[preterm labor]].  Poor management decisions, including interventions that are either premature or delayed, can have dire consequences.<ref name="pmid11965727">{{cite journal
==Diagnosis==
| author = Mazneĭkova V, Dimitrova V
[[Sacrococcygeal teratoma history and symptoms|History & Symptoms]] | [[Sacrococcygeal teratoma physical examination|Physical Examination]] | [[Sacrococcygeal teratoma laboratory tests|Laboratory Tests]] | [[Sacrococcygeal teratoma pelvis x ray|Pelvis X Ray]] | [[Sacrococcygeal teratoma CT|CT]] | [[Sacrococcygeal teratoma MRI|MRI]] | [[Sacrococcygeal teratoma echocardiography or ultrasound|Echocardiography or Ultrasound]] | [[Sacrococcygeal teratoma other imaging findings|Other Imaging Findings]] | [[Sacrococcygeal teratoma other diagnostic studies|Other Diagnostic Studies]]
| title = [Prenatal ultrasonographic diagnosis of four cases of sacrococcygeal teratoma]
==Treatment==
| language = Bulgarian
[[Sacrococcygeal teratoma medical therapy|Medical Therapy]] | [[Sacrococcygeal teratoma surgery|Surgery]] | [[Sacrococcygeal teratoma primary prevention|Primary Prevention]] | [[Sacrococcygeal teratoma secondary prevention|Secondary Prevention]] | [[Sacrococcygeal teratoma cost-effectiveness of therapy|Cost-Effectiveness of Therapy]] | [[Sacrococcygeal teratoma future or investigational therapies|Future or Investigational Therapies]]
| journal = Akusherstvo i ginekologii͡a
| volume = 38
| issue = 1
| pages = 64-9
| year = 1999
| pmid = 11965727
| doi =  
| issn =  
}}</ref><ref name="pmid17525561">{{cite journal
| author = Sheil AT, Collins KA
| title = Fatal birth trauma due to an undiagnosed abdominal teratoma: case report and review of the literature
| journal = The American journal of forensic medicine and pathology : official publication of the National Association of Medical Examiners
| volume = 28
| issue = 2
| pages = 121-7
| year = 2007
| pmid = 17525561
| doi = 10.1097/01.paf.0000257373.91126.0d
| issn =
}}</ref>


In many cases, a fetus with a small SCT (under 5 or 10 cm) may be delivered vaginally.<ref name="pmid12475573">{{cite journal
==Case Studies==
| author = Anteby EY, Yagel S
| title = Route of delivery of fetuses with structural anomalies
| journal = Eur. J. Obstet. Gynecol. Reprod. Biol.
| volume = 106
| issue = 1
| pages = 5-9
| year = 2003
| pmid = 12475573
| doi =
| issn =
}}</ref><ref name="pmid11336088">{{cite journal
| author = Ruangtrakool R, Nitipon A, Laohapensang M, ''et al''
| title = Sacrococcygeal teratoma: 25 year experience
| journal = Journal of the Medical Association of Thailand = Chotmaihet thangphaet
| volume = 84
| issue = 2
| pages = 265-73
| year = 2001
| pmid = 11336088
| doi =
| issn =
}}</ref><ref name="pmid8458172">{{cite journal
| author = McCurdy CM, Seeds JW
| title = Route of delivery of infants with congenital anomalies
| journal = Clinics in perinatology
| volume = 20
| issue = 1
| pages = 81-106
| year = 1993
| pmid = 8458172
| doi =
| issn =
}}</ref><ref name="pmid2205995">{{cite journal
| author = Kainer F, Winter R, Hofmann HM, Karpf EF
| title = [Sacrococcygeal teratoma. Prenatal diagnosis and prognosis]
| language = German
| journal = Zentralblatt für Gynäkologie
| volume = 112
| issue = 10
| pages = 609-16
| year = 1990
| pmid = 2205995
| doi =
| issn =
}}</ref>


==Complications==
[[Sacrococcygeal teratoma case study one|Case #1]]


==See also==
==See also==
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{{Pathology|state=collapsed}}
{{Pathology|state=collapsed}}
{{Joints of torso|state=collapsed}}
{{Joints of torso|state=collapsed}}
{{SIB}}


[[Category:Congenital disorders]]
[[Category:Congenital disorders]]
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Latest revision as of 19:24, 31 July 2019

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]Associate Editor(s)-in-Chief: Mirdula Sharma, MBBS [2]Sabawoon Mirwais, M.B.B.S, M.D.[3]

Synonyms and keywords: Fetiform Teratoma, Fetus in fetu

Overview

Historical Perspective

Classification

Pathophysiology

Causes

Differentiating Sacrococcygeal teratoma from other Diseases

Epidemiology and Demographics

Risk Factors

Screening

Natural History, Complications and Prognosis

Diagnosis

History & Symptoms | Physical Examination | Laboratory Tests | Pelvis X Ray | CT | MRI | Echocardiography or Ultrasound | Other Imaging Findings | Other Diagnostic Studies

Treatment

Medical Therapy | Surgery | Primary Prevention | Secondary Prevention | Cost-Effectiveness of Therapy | Future or Investigational Therapies

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Case #1

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