Most newborns with Sacrococcygeal Teratoma (SCT) survive and do well. Malignant tumors are unusual. Fetuses with large cystic SCTs rarely develop hydrops and therefore are rarely candidates for fetal intervention/surgery. These cases are best handled with surgical removal of the tumor after delivery. A Cesarean-section delivery of the baby may be necessary if the tumor is larger than 10 cm (4 inches).
Because all sacrococcygeal teratomas require complete surgical resection after birth, arrangements should be made for the infant to be born at a specialized hospital with pediatric surgery expertise. Fetuses with large mostly solid tumors need to be monitored frequently between 18 and 28 weeks of gestation for rapid growth of the tumor and the development of excessive blood flow and heart failure (hydrops). A small number of these fetuses with large solid tumors develop hydrops, due to extremely high blood flow through the tumor. These fetuses may be candidates for fetal intervention.
Fetal intervention is only offered to women in whom there is evidence of heart failure in the fetus. Heart failure is usually diagnosed by ultrasound. The fetus may have abdominal ascites (fluid in the abdomen), pleural or pericardial effusions (excess fluid around the heart or lungs), and skin or scalp edema (excess fluid under the skin or scalp). The mother may have polyhydramnios (too much amniotic fluid), or a slightly thickened placenta (placentomegaly). Women who have fetuses with advanced hydrops-placetomegaly or maternal pre-eclampsia (high blood pressure, protein in the urine) are not candidates for fetal intervention as we have found that these symptoms (the so-called “mirror syndrome”) indicate an irreversible situation.
Fetuses who develop evidence of heart failure (hydrops) require fetal intervention. If late enough in pregnancy, past 32 weeks, the fetus may be delivered for intensive management after birth. Before that, fetal intervention may be advised to reverse the otherwise fatal heart failure. Open fetal surgery is performed in which the SCT is removed. This procedure was developed at the UCSF Fetal Treatment Center, and has proven successful in a number of cases.
As with all fetal interventions, we have tried to develop minimally invasive methods to treat this condition without opening the uterus, in this case, by stopping the high blood flow to the tumor. Instead of surgically opening the uterus and removing the tumor, a needle is inserted through the mother’s abdomen and the uterine wall and into the blood vessels that feed the tumor. Radiofrequency waves are can destroy the blood vessels and, without blood flow, the tumor does not grow and the heart failure (hydrops), is reversed. However, damage caused by the probe itself. may be difficult to control. Another method of cutting off blood flow to the tumor is injection of drugs (for example, alcohol) that cause blood to clot. None of these methods has so far proven effective in all cases.
All babies with Sacrococcygeal Teratoma should be delivered at a specialized hospital with pediatric surgery expertise. Tumors larger than 10 cm in diameter will require C-section delivery. The neonatologist will provide support in the intensive care nursery until the baby is stable enough for surgery. Surgical removal of small tumors is straightforward, but removal of large tumors can be very difficult and dangerous. The baby may require a blood transfusion(s) and intensive support for days or weeks after surgery. Most will get through this difficult period and enjoy a normal life. All babies should have yearly blood tests for elevated alpha feto-protein, which can signal recurrence of the tumor and possibly a malignancy. If the tumor is quite large and the surgeon performs an extensive complicated removal, there is an increased likelihood of longterm issues. A few babies may have difficulty with urination or stooling.
Mother tells the story of her experience of the diagnosis of SCT, and the care in the ICN.
Baby Sarah Elizabeth has a very successful recovery from an SCT which is removed while she is still a fetus.
During the scan the ultrasound technician discovered a mass at the base of the baby's tailbone...