Sacrococcygeal teratoma: Difference between revisions

Jump to navigation Jump to search
Line 114: Line 114:


==Complications==
==Complications==
Maternal complications of '''pregnancy''' may include [[mirror syndrome]].<ref name="pmid17465292">{{cite journal
| author = Finamore PS, Kontopoulos E, Price M, Giannina G, Smulian JC
| title = Mirror syndrome associated with sacrococcygeal teratoma: a case report
| journal = The Journal of reproductive medicine
| volume = 52
| issue = 3
| pages = 225-7
| year = 2007
| pmid = 17465292
| doi =
| issn =
}}</ref>  Maternal complications of '''delivery''' may include a [[Cesarean section]] or, alternatively, a vaginal delivery with mechanical [[dystocia]].<ref name="pmid17469451">{{cite journal
| author = Nalbanski B, Markov D, Brankov O
| title = [Sacrococcygeal teratoma--a case report and literature review]
| language = Bulgarian
| journal = Akusherstvo i ginekologii͡a
| volume = 46
| issue = 2
| pages = 41-5
| year = 2007
| pmid = 17469451
| doi =
| issn =
}}</ref>
Complications of the mass effect of a teratoma in general are addressed on the [[teratoma]] page.  Complications of the mass effect of a large SCT may include [[hip dysplasia]], [[bowel obstruction]], [[urinary obstruction]], [[hydronephrosis]] and [[hydrops fetalis]].  Even a small SCT can produce complications of mass effect, if it is presacral (Altman Type IV).<ref name="pmid15750911">{{cite journal
| author = Galili O, Mogilner J
| title = Type IV sacrococcygeal teratoma causing urinary retention: a rare presentation.
| journal = J. Pediatr. Surg.
| volume = 40
| issue = 2
| pages = E18-20
| year = 2005
| pmid = 15750911
| doi = 10.1016/j.jpedsurg.2004.10.003
| issn =
}}</ref>  In the fetus, severe hydronephrosis may contribute to inadequate lung development.  Also in the fetus and newborn, the [[anus]] may be [[imperforate anus|imperforate]].
Later complications of the mass effect and/or surgery may include [[neurogenic bladder]], other forms of [[urinary incontinence]], [[fecal incontinence]], and other chronic problems resulting from accidental damage to or sacrifice of nerves and muscles within the pelvis.<ref name="pmid3439358">{{cite journal
| author = Engelskirchen R, Holschneider AM, Rhein R, Hecker WC, Höpner F
| title = [Sacral teratomas in childhood. An analysis of long-term results in 87 children]
| language = German
| journal = Zeitschrift für Kinderchirurgie : organ der Deutschen, der Schweizerischen und der Osterreichischen Gesellschaft für Kinderchirurgie = Surgery in infancy and childhood
| volume = 42
| issue = 6
| pages = 358-61
| year = 1987
| pmid = 3439358
| doi =
| issn =
}}</ref>  [[coccygectomy|Removal of the coccyx]] may include additional complications.  In one review of 25 patients,<ref>[http://www.ncbi.nlm.nih.gov/sites/entrez?cmd=Retrieve&db=PubMed&list_uids= 16373161&dopt=AbstractPlus PubMed]</ref> however, the most frequent complication was an unsatisfactory appearance of the surgical scar.
===Late effects===
Pelvic scarring may necessitate that [[Pregnancy|pregnant women]] who are SCT survivors deliver their babies by [Cesarean section].{{Fact|date=June 2007}}
Complications of not removing the coccyx may include both recurrence of the teratoma<ref name="Lahdenne+1993">{{cite journal
| author = Lahdenne P, Heikinheimo M, Nikkanen V, Klemi P, Siimes MA, Rapola J
| title = Neonatal benign sacrococcygeal teratoma may recur in adulthood and give rise to malignancy.
| journal = Cancer
| volume = 72
| issue = 12
| pages = 3727-31
| year = 1993
| pmid = 8252490
| doi =
| issn =
}} Synopsis:  45 survivors of infant SCT were followed up.  Two reported recurrent benign teratoma and one reported metastatic adenocarcinoma originating from the residual coccyx.  They were aged 21-43 at diagnosis.</ref> and [[Metastasis|metastatic cancer]].<ref name="Lahdenne+1993"/><ref name="Lack+1993">{{cite journal
| author = Lack EE, Glaun RS, Hefter LG, Seneca RP, Steigman C, Athari F
| title = Late occurrence of malignancy following resection of a histologically mature sacrococcygeal teratoma. Report of a case and literature review.
| journal = Arch. Pathol. Lab. Med.
| volume = 117
| issue = 7
| pages = 724-8
| year = 1993
| pmid = 8323438
| doi =
| issn =
}} Synopsis:  A 40 year old man has widely metastatic [[adenocarcinoma]] arising from the residual coccyx remaining after surgical removal of an apparently benign SCT at age 2 months.</ref>  Late malignancies usually involve incomplete excision of the coccyx and are [[adenocarcinoma]].


==See also==
==See also==

Revision as of 19:01, 13 January 2012

For patient information click here

Sacrococcygeal teratoma Microchapters

Home

Patient Information

Overview

Historical perspective

Classification

Pathophysiology

Causes

Differentiating Sacrococcygeal teratoma from other Diseases

Epidemiology and Demographics

Risk Factors

Screening

Natural history, Complications and Prognosis

Diagnosis

Diagnostic Study of Choice

History & Symptoms

Physical Examination

Laboratory Findings

Electrocardiogram

X-ray

Echocardiography and Ultrasound

CT scan

MRI

Other Imaging Findings

Other Diagnostic Studies

Treatment

Medical Therapy

Surgery

Primary Prevention

Secondary Prevention

Cost-Effectiveness of Therapy

Future or Investigational Therapies

Case Studies

Case #1

Sacrococcygeal teratoma On the Web

Most recent articles

Most cited articles

Review articles

CME Programs

Powerpoint slides

Images

American Roentgen Ray Society Images of Sacrococcygeal teratoma

All Images
X-rays
Echo & Ultrasound
CT Images
MRI

Ongoing Trials at Clinical Trials.gov

US National Guidelines Clearinghouse

NICE Guidance

FDA on Sacrococcygeal teratoma

CDC on Sacrococcygeal teratoma

Sacrococcygeal teratoma in the news

Blogs on Sacrococcygeal teratoma

Directions to Hospitals Treating Sacrococcygeal teratoma

Risk calculators and risk factors for Sacrococcygeal teratoma

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Overview

Natural history, Complications, and Prognosis

Differentiating Sacrococcygeal teratoma from other Diseases

Diagnosis

History & Symptoms

Physical Examination

Lab tests

Echocardiography or Ultrasound

Treatment

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:

  • 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.

Regardless of location in the body, teratomas are classified according to a cancer staging system. This indicates whether chemotherapy or radiation therapy may be needed.

Management of fetal SCTs

Management of most fetal SCTs involves watch and wait, also known as expectant management. An often used decision tree is as follows:

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.[1][2]

In many cases, a fetus with a small SCT (under 5 or 10 cm) may be delivered vaginally.[3][4][5][6]

Complications

See also

References

  1. Mazneĭkova V, Dimitrova V (1999). "[Prenatal ultrasonographic diagnosis of four cases of sacrococcygeal teratoma]". Akusherstvo i ginekologii͡a (in Bulgarian). 38 (1): 64–9. PMID 11965727.
  2. Sheil AT, Collins KA (2007). "Fatal birth trauma due to an undiagnosed abdominal teratoma: case report and review of the literature". The American journal of forensic medicine and pathology : official publication of the National Association of Medical Examiners. 28 (2): 121–7. doi:10.1097/01.paf.0000257373.91126.0d. PMID 17525561.
  3. Anteby EY, Yagel S (2003). "Route of delivery of fetuses with structural anomalies". Eur. J. Obstet. Gynecol. Reprod. Biol. 106 (1): 5–9. PMID 12475573.
  4. Ruangtrakool R, Nitipon A, Laohapensang M; et al. (2001). "Sacrococcygeal teratoma: 25 year experience". Journal of the Medical Association of Thailand = Chotmaihet thangphaet. 84 (2): 265–73. PMID 11336088.
  5. McCurdy CM, Seeds JW (1993). "Route of delivery of infants with congenital anomalies". Clinics in perinatology. 20 (1): 81–106. PMID 8458172.
  6. Kainer F, Winter R, Hofmann HM, Karpf EF (1990). "[Sacrococcygeal teratoma. Prenatal diagnosis and prognosis]". Zentralblatt für Gynäkologie (in German). 112 (10): 609–16. PMID 2205995.

Template:Congenital malformations and deformations of nervous system Template:Tumors Template:Epithelial neoplasms Template:Pathology Template:Joints of torso Template:SIB

de:Steißbeinteratom it:Teratoma sacro-coccigeo

Template:WikiDoc Sources