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Joseph Junewick, MD FACR
over 6 years ago
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Cystic Sacrococcygeal Teratoma

Case Detail

Anatomy: Genitourinary
Junewick
Joseph Junewick, MD FACR
Diagnostic Category: Neoplasia Benign
Created: over 7 years ago
Updated: over 6 years ago
Tags: PEDS
Modality/Study Types: US MR
Activities:
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History

Newborn with prenatal history of hydronephrosis.


Case Images


Diagnosis

Cystic Sacrococcygeal Teratoma – Type IV

Findings

US – Multilocular cystic mass containing low level echoes, posterior to catheterized urinary bladder.

MR – Dominant presacral cystic mass with smaller peripheral daughter cysts.

Discussion

The vast majority of teratomas occur in the sacrococcygeal region. The mortality rate for infants with preneonatally diagnosed sacrococcygeal teratomas is worse than those diagnosed at birth. Prenatal hydrops (from arteriovenous shunting and high-output cardiac failure) in patients with sacrococcygeal teratoma indicates a high likelihood of a poor outcome. Complications related to sacrococcygeal teratoma include premature delivery, dystocia, intratumoral hemorrhage, or tumor avulsion with fetal exsanguination. Prognosis seems to be related not to the size of the mass but rather to its content and extent. Solid hypervascularized masses carry a poorer prognosis than purely cystic masses. Sacrococcygeal teratomas are classified according to the amount of mass present externally versus internally (type I – totally external, type II – predominantly external with extension into the presacral space, type III – internal component extends into the abdominal cavity, and type IV – totally internal). The risk of malignant transformation increases with time; external masses lend themselves to prompt diagnosis and consequently carry a smaller risk of malignant transformation.

Reference

Avini FE, Guibaud L, Robert L, et al. MR Imaging of Fetal Sacrococcygeal Teratoma. AJR (2002); 178:179-183.

Woodward PJ, Sohaey R, Kennedy A, Koeller KK. From the Archives of the AFIP A Comprehensive Review of Fetal Tumors with Pathologic Correlation. RadioGraphics (2005), 25, 215-242.



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