Sacrococcygeal teratoma

Imane Benchiba, Nessiba Abdelkader , Nissrine Mamouni , Sanaa Errarhay, Chahrazed Bouchikhi , Abdelaziz Banani


Obstetrics and Gynecology I - HASSAN II University Hospital – Fez- Morocco

Introduction
Sacrococcygeal teratoma a common and benign fetal tumor. Yet, fetuses with sacrococcygeal tumors that are predominantly solid and highly vascularized have a high risk of hydrops and tumor hemorrhage, associated with a higher risk of fetal death. They develop at the expense of totipotent embryonic cells in the sacrococcygeal region and are usually benign during the antenatal period. However, their removal must be performed during the first year of life to avoid degeneration. The hyper vascularized forms are the most serious and may benefit in some cases from in utero surgical or endoscopic management. The management of delivery depends on associated anomalies, tumor vascularity and size.

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Discussion

The objective of the prenatal diagnosis of these tumors is twofold: to issue a fetal prognosis according to the type, the size and the composition of the tumor, and to evaluate the risk of complications by the tumor growth and extension.Although usually an isolated malformation. not part of a polymalformative syndrome, associated malformations may be present in 5 to 26% of cases depending on the series. MRI analyzes more precisely than ultrasound the tumor extensionAntenatal surveillance: Ultrasound is used to assesses the size and especially the tumoral growth and the associationd with an increased risk of fetal cardiac decompensationIn utero fetal therapeutics: only in the presence of major complications. These different treatments aim to reduce tumor vasculature in uteroFetal surgery to "open uterus"; this invasive approach consists of a maternal laparotomy with hysterotomy that provides access to the fetus with a high risk of premature rupture of the membranes and premature deliveryEndoscopic Fetal Surgery: The advantage of this endoscopic therapeutic approach is to limit uterine trauma and maintain the fetus in its natural environment.

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