TERATOMA

Introduction
 Teratomas are tumors comprising more than a single
cell type derived from more than one germ layer

 Teratomas range are :

 benign

 well-differentiated cystic lesions (mature)

 solid and malignant (immature)

 Pathophysiology
 Teratomas are made up of a variety of parenchymal
cell types representative of more than a single germ
layer
 Teratoma arise from totipotential cells, which
typically are midline or paraxial
 The most common location is sacrococcygeal (57%).
 The frequency of sacrococcygeal teratomas is 1 per
20,000-40,000 births.
Sacrococcygeal Teratoma
 Sacrococcygeal teratomas more common in females
than in males with ratio of approximately 3-4:1
 Can be diagnosed in the prenatal period
 Complications may occur in utero or during or after
birth
 Approximately 10% of sacrococcygeal teratomas are
associated with other congenital anomalies,
primarily defects of the hindgut and cloacal region.
 Clinical Findings
 Sacrococcygeal teratomas not diagnosed antenatally
present in 2 patterns
 neonates, who present with a large, predominantly benign
tumor protruding from the sacral area
 the newborn may exhibit only asymmetry of the buttocks
or present when aged 1 month to 4 years with a presacral
tumor that may extend into the pelvis.
 The latter group is at higher risk for malignancy.
 Differential diagnosis
Sacrococcygeal teratomas should be differentiated from
 neural tube defects (meningoceles or meningomyeloceles)
 epidermoid cysts
 anal duct or pilonidal cysts
 rectal abscesses
 Lymphangiomas
 imperforate anus
 rectal prolapse.
 Workup
 Level of serum AFP and beta HCG may indicating
benign or malignant teratomas
 CT scanning of the abdomen and pelvis before
surgical exploration can further delineate
sacrococcygeal tumor from normal anatomic
features.
 Fine-needle aspiration or core biopsy can be used to
differentiate benign from malignant mediastinal
masses in 90% of cases.
 Type I Staging
 tumors are predominantly external, attached to the coccyx, and
may have a small presacral component (45.8%)
 No metastases were associated with this group.
 Type II tumors
 have an external mass and significant presacral pelvic extension
(34%)
 have a 6% metastases rate.
 Type III
 tumors are visible externally, but the predominant mass is pelvic
and intraabdominal (8.6%).
 20% rate of metastases was found in this group.
 Type IV
 lesions are not visible externally but are entirely presacral (9.6%)
and have an 8% metastases rate.
 Treatment
 The treatment of mature teratomas is largely surgical
 may benefit from in utero surgery
 should be resected electively in the first week of life,
 Complete excision with chevron-shaped buttock incision,
with preservation of the muscles of the rectal sphincter.
 The coccyx always should be resected with the tumor, to
prevent recurrency
 Hemorrhage from the middle sacral vessels and
hypogastric arteries is the most common complication.