Introduction:
One type of tumor is sacrococcygeal teratoma (SCT). It begins to form before birth and grows from the newborn's coccyx or tailbone. As the most prevalent congenital tumor, an SCT is present from birth; up to one in 10,000 babies results in SCT. It is four times more common for female fetuses than male ones to have an SCT. The majority of embryonic sacrococcygeal teratomas are not cancerous because they are not malignant.
What Are the Types of Sacrococcygeal Teratomas?
Sacrococcygeal tumors come in a variety of forms. Their location and intensity determine the kind.
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Type I SCT Tumors: Almost entirely external (outside the body) and linked to the baby's tailbone are type I SCT tumors.
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Type II SCT Tumors: Primarily external, with a tiny yet noticeable portion growing inside the body.
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Type III SCT Tumors: Type III SCT tumors are visible from the outside, but they grow in the pelvis and spread into the belly.
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Type IV SCT Tumors: Entirely internal.
The appearance of sacrococcygeal tumors varies as well:
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Cystic SCT: Clusters of fluid-filled, sparsely vascularized regions are seen in cystic SCT.
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Solid SCT: Dense tumors with numerous blood vessels are known as solid SCTs.
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Mixed SCT: Solid and cystic regions can coexist in mixed SCT.
A newborn diagnosed with SCT will have different results according to the appearance, size, and location of the tumor. In some cases, SCTs can be fatal if left untreated. For this reason, a timely and precise diagnosis is crucial.
What Are the Causes of Sacrococcygeal Teratoma?
Sacrococcygeal teratoma has an unknown etiology. Some research suggest that the germ cells may give rise to the tumor. The cells that give rise to the embryo and comprise both men's and women's reproductive systems are known as germ cells.
What Are the Signs and Symptoms of Sacrococcygeal Teratoma?
Certain neonates may exhibit signs of SCT, such as a buildup of fluid in the skin, scalp, chest, or abdomen. Fetal hydrops is the term for this. With the dangers of both maternal mirror syndrome and fetal loss, one should seek an immediate assessment at a high-volume fetal center if this arises throughout the pregnancy. When a mother has mirror syndrome, she too accumulates fluid in the body. It may result in additional issues as well as dangerously elevated blood pressure.
Normal prenatal ultrasounds are typically used to detect sacrococcygeal teratomas. There is a chance the ultrasonography technician will see a mass of tissue. This mass could be developing inside the baby's abdomen or from the baby's tailbone.
What Is the Evaluation and Diagnosis of Sacrococcygeal Teratoma?
One can examine the fetal anatomy and SCT with high-resolution fetal ultrasonography to assess the health of the fetus.
Ultrafast fetal magnetic resonance imaging enables physicians to observe the SCT in even greater depth and assess whether it may be encroaching on the spinal region.
Fetal echocardiography makes it possible to examine the anatomy and physiology of the heart.
These specific tests assist physicians in identifying the kind, extent, and position of the SCT. They also enable us to:
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Examine the placenta.
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Assess the baby's amniotic fluid level and look for any effects on the heart that can lead to hydrops (fluid buildup).
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Assess the degree of risk associated with the current pregnancy. To achieve this, the doctor computes the ratio of the tumor volume to the baby's weight, or the size of the tumor to the baby's size, when the fetus is less than 24 weeks old.
What Is the Management of Sacrococcygeal Teratoma?
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This is a result of the frequent early delivery of SCT newborns. This is particularly true if the baby exhibits symptoms of hydrops or if the tumor grows more quickly.
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Surgery is used as part of SCT treatment to remove the tumor. The diagnosis and extent of the tumor in the child will determine when to begin therapy. They might have tumor resection surgery after birth, or they might have fetal surgery to remove the SCT before delivery.
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Certain SCTs have few blood arteries and are cystic or filled with fluid. Regardless of where they are located, these are normally well tolerated during pregnancy.
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Big, solid tumors with lots of blood vessels can be dangerous for the unborn child and the unborn mother. To sustain both the baby's body and the blood arteries within the tumor, the baby's heart must pump blood. The heart has to beat significantly harder than usual because of this. Fetal hydrops, or fluid accumulation, may occur if the fetus's heart is unable to meet the demands.
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A fetus with hydrops may experience cardiac failure. The mother's health may also be impacted by hydrops. The baby's symptoms may "mirror" those of the mother. Changes in blood pressure and edema may be part of this. These alterations necessitate prompt evaluation and attention.
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Physicians regularly monitor fetuses with large, solid SCTs that have a lot of blood arteries because of these dangers.
Intervention during pregnancy for sacrococcygeal teratoma:
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Certain SCTs are external, sizable, solid, and have a substantial blood flow. In some situations, the tumor may be removed entirely or in part before the baby's birth.
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This procedure to remove a fetal SCT is known as maternal-fetal surgery. A group of exceptionally talented fetal surgeons and experts in maternal-fetal medicine are involved. To remove as much of the SCT from the baby's tailbone as possible, surgeons cut up the mother's abdomen and uterus. Doctors monitor the pregnancy after surgery until the baby is delivered.
On occasion, a vaginal delivery is possible. In other circumstances, a more specific delivery strategy is required.
How Is the Delivery of Infants With SCT and Postpartum Surgery Done?
The process of delivering a newborn by cesarean birth (C-section) to immediate neonatal resection. The tumor is then immediately removed during surgery in a nearby room.
Neonatal Resection: This is a very skilled task. The placenta remains connected to the baby during a C-section birth. As the pediatric surgeon removes as much of the tumor as possible, they continue to receive oxygen through the umbilical cord. Physicians finish the birth and take the infant to the Newborn or Infant Intensive Care Unit (N/IICU) following surgery.
The infant's surgical demands, the mother's gestational age at delivery, and the number of weeks the mother was pregnant when the baby was born determine the length of the newborn's stay in the intensive care unit. A baby's parents play a critical role in their team. The baby will be in the N/IICU along with the parents at all times. As much as possible, doctors encourage parents to be there for their babies and to interact with them.
Conclusion
The survival rate of sacrococcygeal teratomas is relatively high. It is unlikely that the majority of fetal sacrococcygeal teratomas will be malignant (cancerous). Following tumor excision, the prognosis is usually favorable; nevertheless, continuous monitoring is required for the first three years of life.
