 Teratoma
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A teratoma is generally regarded as a congenital (developing prior to birth) tumor formed by tissue represented by the three layers: ectoderm, entoderm and mesoderm. Teratomas in newborns are generally benign and local in their growth behavior. Teratomas can be malignant, depending on the maturity and other types of cells that may be involved. Benign teratomas tend to grow aggressively, although they do not spread, while malignant teratomas are characterized by mestastis (spread of a tumor to another part of the body) along with local aggressive growth.
In the newborn, the most common congenital tumor is a sacrococcygeal (tail bone, or distal end of the spinal column) teratoma. Because these sacrococcygeal tumors are often visible from the outside of the body, diagnosis is made early and treatment and/or surgery are initiated early, making the prognosis for this type of germ cell tumor very favorable.
Treatment for sacrococcygeal teratoma may begin before a baby is born. When diagnosed early in gestation and when of considerable size, these tumors may result in birth defects or fetal death. When this occurs later in pregnancy, fetal intervention in carefully selected cases can be used to remove most of the tumor. In these circumstances, Caesarean delivery may be the best choice.
The preferable treatment of a sacrococcygeal teratoma is complete removal soon after the baby is born, which includes removal of the coccyx. Depending on the development of the tumor's cells, no further treatment may be needed, or your child's physician may determine that additional chemotherapy may be necessary. For more information about how this kind of teratoma is diagnosed and treated, see Sacrococcygeal Teratoma.
Teratomas may also occur at other germ cell sites including the ovary, testicle, and in such unusual sites as the neck, stomach, and retroperitoneum. Tumors found in the neck, known as cervical teratomas, are particularly challenging in the neonatal period because of a location that distorts and obstructs the airway. Surgical and other treatment may be needed before the baby is born. For more information on fetal intervention, see Cervical Teratoma.
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The cause of most teratomas is not completely understood. A number of inherited defects have also been associated with an increased risk of developing germ cell tumors including the central nervous system and genitourinary tract malformations, and major malformations of the lower spine.
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The following are the most common symptoms of a teratoma. However, each child may experience symptoms differently. Symptoms vary depending on the size and location of the tumor. Symptoms may include:
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- a tumor, swelling, or mass that can be felt or seen
- elevated levels of alpha-fetoprotein (AFP)
- elevated levels of beta-human chorionic gonadotropin (B-HCG)
- constipation, incontinence, and leg weakness, if the tumor is in the sacrum (a segment of the vertebral column that forms the top part of the pelvis) compressing structures
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Teratomas in the newborn are often detected on prenatal ultrasound. Other diagnostic procedures can include:
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- biopsy - a sample of tissue removed from the tumor and examined under a microscope.
- complete blood count (CBC) - a measurement of size, number, and maturity of different blood cells in a specific volume of blood.
- additional blood tests - may include blood chemistries, evaluation of liver and kidney functions, and genetic studies.
- multiple imaging studies, including:
- computerized tomography scan (also called a CT or CAT scan) - a diagnostic imaging procedure that uses a combination of x-rays and computer technology to produce cross-sectional images (often called slices), both horizontally and vertically, of the body. A CT scan shows detailed images of any part of the body, including the bones, muscles, fat, and organs. CT scans are more detailed than general x-rays.
- magnetic resonance imaging (MRI) - a diagnostic procedure that uses a combination of large magnets, radiofrequencies, and a computer to produce detailed images of organs and structures within the body.
- x-ray - a diagnostic test which uses invisible electromagnetic energy beams to produce images of internal tissues, bones, and organs onto film.
- ultrasound (also called sonography) - a diagnostic imaging technique which uses high-frequency sound waves and a computer to create images of blood vessels, tissues, and organs. Ultrasounds are used to view internal organs as they function, and to assess blood flow through various vessels.
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Specific treatment for teratoma depends on the type of teratoma. For specific information, see Cervical Teratoma, Sacrococcygeal Teratoma.
Treatment generally includes:
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