Sonography of benign sacral teratoma in utero

Correlação entre os achados ultra-sonográficos e de ressonância magnética no teratoma sacrococcígeo fetal

OBJETIVO: Correlacionar os achados ultra-sonográficos e de ressonância magnética no teratoma sacrococcígeo fetal. MATERIAIS E MÉTODOS: Três pacientes com idade gestacional entre 30 e 35 semanas, com diagnóstico ultra-sonográfico suspeito de teratoma sacrococcígeo fetal, foram submetidas a ressonância magnética e, posteriormente, a ultra-sonografia para correlação dos achados. Tanto na ressonância magnética quanto na ultra-sonografia foram avaliadas as dimensões, a localização, a extensão e os conteúdos dos tumores. RESULTADOS: A ultra-sonografia e a ressonância magnética obtiveram resultados semelhantes em relação à localização, ao tamanho e ao conteúdo dos tumores. Todas as lesões localizavam-se na região sacrococcígea, com dimensões médias de 6,0 cm x 9,0 cm. Quanto ao conteúdo dos tumores, um dos casos era completamente cístico e dois eram sólidos e císticos. A extensão exata das lesões foi mais bem avaliada pela ressonância magnética do que pela ultra-sonografia, mostrando de forma adequada o acometimento pélvico nos três casos. CONCLUSÃO: A ressonância magnética fetal é capaz de complementar os achados ultra-sonográficos do teratoma sacrococcígeo fetal, uma vez que determina com melhor precisão o conteúdo e a extensão do tumor, auxiliando na conduta terapêutica e aumentando as chances de cura desses fetos.

Sacrococcygeal teratomas in the fetus and newborn

Two cases of fetal sacrococcygeal teratomas, both resulting in obstructed labor and intrauterine death, are presented. A suggested scheme of antenatal and intrapartum management of these rare tumors is recommended. The diagnosis can be made antenatally by ultrasound examination. The mode of delivery depends on the tumor size and the fetal condition. Fetal prognosis is excellent if an atraumatic delivery is followed by appropriate and timely surgery in a tertiary center.

Antenatal sonographic diagnosis of fetal sacrococcygeal teratoma with hydrops--(a case report)

A rare case of sacrococcygeal teratoma (SCT) associated with hydrops diagnosed on prenatal ultrasound and subsequently confirmed on parturition is presented.

Ultrasound diagnosis and evaluation of fetal tumors

Fetal tumors represent a rare and heterogeneous group of abnormalities. A significant proportion of them can now be diagnosed by using modern high resolution ultrasonic equipment. During 15 years there were 57 fetal tumours detected prenatally. Hygroma colli is the most frequent fetal tumor. It should be emphasized that cystic hygroma generally carries poor prognosis, and after an early diagnosis, termination of pregnancy is most logical approach. Contrary to the general opinion our own experience showed that there are cases in which prognosis could be much better as illustrated with our 4 cases. All of the treated fetuses, after surgical resection, had normal development and are now on the age of 5, 4, 3 and 2 years of life. An ovarian cyst can be suspected if a fluid-filled structure is visualized next to a fetal kidney and female external genitalia are recognizable. The ultrasound finding suggestive of an ovarian cyst is that of a pelvic cystic or complex mass in a female fetus with normal kidneys and urinary bladder and a normal gastrointestinal tract. In most cases, the normal course of fetal ovarian cyst is a spontaneous intrauterine or postnatal involution. Prenatal diagnosis improves neonatal outcome by allowing an appropriate choice of the optimal time, mode and place of delivery in order to avoid accidental and unexpected intrapartum and postnatal complications. The management of a fetus affected by an ovarian cyst depends on the size and on the echo-pattern of the cyst. It remains unclear whether in utero puncture of the cyst and evacuation of its content should be justified in cases of particularly large ovarian cyst. In our opinion intrauterine procedure can be attempted in the presence of large cyst fulfilling the fetal abdomen. We have treated actively two cases of large ovarian cysts by ultrasonically guided puncture before delivery and both fetuses underwent surgery later without complications. If properly performed puncture of the cyst seems to be a low risk procedure in comparison to potential problems that cyst may cause to the fetus or by causing dystocia. Sacrococcygeal teratoma represents the most frequent tumor in the fetuses and newborns. Prenatal diagnosis is usually simple and based on the visualization of tumor of variable size and internal structure. Tumors may appear as completely cystic, mixed or predominantly solid with obvious calcifications. Cystic and calcified tumors are most likely to be benign. Obstetrical management of sacrococcygeal teratoma depends on numerous parameters which include size and texture of the tumor, and gestational age.(ABSTRACT TRUNCATED AT 400 WORDS)

Sacrococcygeal teratoma: prenatal diagnosis and management

Although sacrococcygeal teratoma is a rare and potentially malignant tumor, 10 cases were documented during a 5-year period at the University of Toronto Perinatal Complex. Diagnosis was made in the six cases in which prenatal ultrasound examination was performed. One patient with twins elected to terminate the pregnancy at 19 weeks. In three of the cases diagnosed prenatally, serial ultrasound was performed. There was a 75% cesarean section rate. In all cases diagnosed prenatally, the large tumor size affected the mode of delivery. In the four cases without prenatal diagnosis, two infants were delivered vaginally, and two were delivered abdominally for obstetric reasons. There was one case of neonatal morbidity where tumor vascularity and rupture resulted in hypovolemic shock. All tumors were resected and found to be benign. A plan of management is recommended and, with appropriate obstetric and pediatric care, a good outcome can be anticipated in most cases.

Real-time sonographic display of caudal spinal anomalies

Real-time computerized ultrasonography with 3.5 and 5.0 MHz sector and linear array transducers (Acuson) depicts spinal anatomy and pathology more clearly than was possible with previous ultrasonic equipment. Split screen (dual image) techniques display increased lengths of spine in a single image. Articulated arm, B-mode sonography remains useful for older patients in whom the pathology lies far from the transducer and in a few post-operative patients in whom dense scar frustrates real-time examination. Sonography is a very useful screening tool for subcutaneous pathology, meningoceles and lipomas, but, thus far, has failed to demonstrate consistently the presence of hydromyelia, intracanalicular (epi)dermoid tumors and dermal sinus stalks ascending toward conus medullaris.

Fetal sacrococcygeal teratoma

Sacrococcygeal teratoma (SCT) is being diagnosed before birth with increasing frequency. We were recently consulted about management of a 22-week fetus with SCT and reviewed our experience (6 cases) and the literature. We found that most fetal SCT present from 22 to 34 weeks gestation with a uterus enlarged by the tumor and/or associated polyhydramnios; although the American Academy of Pediatrics Surgical Section clinical classification is an important prognostic indicator in neonatal SCT, it does not appear to predict outcome in fetal SCT; associated chromosomal abnormalities or life threatening anomalies are rare; presentation after 30-weeks gestation is a relatively good prognostic sign with fetal survival, after planned cesarean delivery, in 6 of 8 cases; and hydrops and/or placentomegaly in association with fetal SCT predicts fetal demise soon after diagnosis with 7 of 7 cases dying in utero.

Sonographic demonstration of fetal sacrococcygeal teratoma

Six cases of sonographically diagnosed fetal sacrococcygeal teratoma (SCT) are presented and illustrate the variable features of fetal SCT. The sonographic findings assisted the parents and perinatal team in making decisions, and in two of the cases the children survived after elective Cesarean section and prompt neonatal resection of the tumors. None of the patients showed signs of malignant degeneration of the teratoma or metastases. Fetal SCT no longer should be considered a uniformly fatal condition. The literature on sacrococcygeal teratoma detected after birth indicates that the mortality rate is correlated with the degree of extension of the tumor. Therefore, the classification of sonographically diagnosed fetal SCT according to its size and position is important for decisions regarding pregnancy management.

Maternal ultrasonography for the antenatal diagnosis of surgically significant neonatal anomalies

The increased use of ultrasonography in the management and evaluation of pregnancy has provided a unique opportunity to observe the anatomy of the developing fetus from 12 weeks gestation until term. Twenty-eight surgically important anatomic abnormalities have been diagnosed in utero by sonographic examinations at our affiliated institutions over the past three and a half years. These include ascites (five cases), gastroschisis (four cases), omphalocele (three cases), sacrococcygeal teratoma, cystic hygroma, hydrocele, duodenal atresia, multicystic kidney (two cases each), and one each of jejunal atresia, conjoined twins, ureteropelvic junction obstruction, urethral valves, urethral agenesis, and hydronephrosis secondary to reflux. Prenatal diagnosis by ultrasonographic examination has signifcantly improved perinatal management. Elective caesarean section has benefited infants with lesions causing dystocia, such as sacrococcygeal teratoma, omphalocele, and conjoined twins. Advance notification of surgeons and neonatalogists has reduced the delays of postnatal evaluation and treatment that contribute, significantly, to complications and death. In addition, transfer of the pregnant mother carrying an infant with a significant surgical anomaly to a center with facilities for neonatal surgery and specialized postoperative care can be properly planned for in advance. In the near future, intrauterine fetal surgery or palliative intervention may provide increased salvage of patients with obstructive uropathy and diaphragmatic hernia, both of which carry high mortality rates secondary to in utero damage. Sonography has proven useful in following the dilatation of either intestinal or urinary tract structures in utero. In our hands, maternal sonography has improved the surgical care of the newborn and may open a new frontier of intrauterine fetal surgery in the future.