TERATOMAS

Teratomas contains tissues derived from the three embryonic layers (endoderm, mesoderm, and ectoderm), found in a locus that does not normally harbor such tissues. It is not always possible to find tissue in each teratoma that is derived from all three embryonic layers.

Sacrococcygeal teratoma (SCT) is the most common extragonadal germ cell tumor in neonates with an incidence of one in 30-40,000 live births. Three-fourth are females. SCT present as a large, firm or more commonly cystic masses that arise from the anterior surface of the sacrum or coccyx, protruding and forming a large external mass. Histology consist of tissue from the three germ cell layers. SCT is classified as: mature, immature, or malignant (endodermal sinus) and produces alpha-feto protein (AFP).

Prenatal sonographic diagnostic severity criteria are: tumor size greater than the biparietal diameter of the fetus, rapid tumor growth, development of placentomegaly, polyhydramnios and hydrops. Large tumors should benefit from cesarean section to avoid dystocia or tumor rupture.

Management consist of total tumor resection with coccyx (recurrence is associated with leaving coccyx in place). Every recurrence of SCT should be regarded as potentially malignant. Malignant or immature SCT with elevated AFP after surgical resection will benefit from adjuvant chemotherapy. Survival is 95% for mature/immature tumors, but less than 80% for malignant cases.

Follow-up should consist of
(1) meticulous physical exam every 3-6 months for first three years,
(2) serial AFP determination,
(3) fecal/urodynamic functional studies. Long term F/U has found a 40% incidence of fecal and urinary impairment associated to either tumor compression of pelvic structures or surgical trauma.