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  Table of Contents    
LETTER TO EDITOR  
Year : 2012  |  Volume : 55  |  Issue : 3  |  Page : 418-419
Fetal immature teratoma causing intrauterine death


1 Department of Pathology, Govt. Medical College, Amritsar, Punjab, India
2 Department of Obstetrics and Gynaecology, Shri Guru Teg Bahadur Hospital, Amritsar, Punjab, India

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Date of Web Publication29-Sep-2012
 

How to cite this article:
Choudhry S, Kataria A S, Sharma S, Singh H. Fetal immature teratoma causing intrauterine death. Indian J Pathol Microbiol 2012;55:418-9

How to cite this URL:
Choudhry S, Kataria A S, Sharma S, Singh H. Fetal immature teratoma causing intrauterine death. Indian J Pathol Microbiol [serial online] 2012 [cited 2019 Sep 20];55:418-9. Available from: http://www.ijpmonline.org/text.asp?2012/55/3/418/101766


Sir,

Teratomas are defined as the tumors derived from more than a single embryonic germ layer occurring in gonads, sacrococcygeal area, retroperitonium, mediastinum, or intracranially. Sacrococcygeal teratoma is the most common presacral germ cell tumor in children and the most common solid tumor in neonates reported in about 1 in 35--40 thousand live births. [1] Females to males ratio of occurrence of this tumor is 4:1. [2] Embryologically, they are thought to arise from the totipotent cells of the Hansen's node or primitive germ cells during their migration from yolk sac to genital ridge. [3] Sacrococcygeal teratomas may be benign mature cystic teratoma and malignant immature teratoma. Fifteen percent of the cases may be associated with some congenital anomalies as sacral bone defects and spina bifida.

We describe a case of immature sacrococcygeal teratoma which led to intrauterine death of the fetus. It was detected on ultrasound [Figure 1]a as a large sacrococcygeal mass with cystic and solid areas at 20 weeks of gestation. Patient presented with premature labor pains at 24 weeks and a normal vaginal delivery was expedited by which a dead male baby was born without the sacrococcygeal mass [Figure 1]b that got detached and was removed manually followed by delivery of placenta. Grossly, the mass [Figure 1]c was large soft, cystic to firm in consistency weighing 450 g and measuring 8 × 6 × 5 cm. On cutting, cut surface showed many solid gray white areas and cystic areas [Figure 1]d.
Figure 1: (a) Ultrasound at 20 weeks 4 days duration a large heterogenous mass close to the sacrum having multiple cystic and solid areas within. (b) Fetus delivered dead with detached sacrococcyeal mass. (c) Gross photograph of tumor. (d) Cut-surface showing solid and cystic areas

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Microscopically, mature and immature elements originating from all the three germ layers were seen. The immature elements originating from neuroectoderm show neural tube formation [Figure 2]a and rossettes. Immature cartilaginous tissue, immature liver tissue, [Figure 2]b cardiac muscle [Figure 2]c, and immature myxomatous mesenchyme were also observed. The mature elements found were mature glial tissue, mature cartilage, stratified squamous epithelium [[Figure 2]d] and gastrointestinal glands. The case was diagnosed as Type I immature teratoma according to the following classification given by Altmann [4] based on tumor location and grade III according to the presence of mature and immature tissues seen on histopathology. [5]
Figure 2: (a) Neuroectoderm show neural tube formation. (b) Immature cartilaginous tissue and immature liver tissue. (c) Cardiac muscle. (d) Stratified Squamous epithelium

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Type Description

I(47%): Predominantly external, attached to the coccyx. No evidence of metastases.

II (35%): External mass and significant presacral pelvic extension, minimal metastases rate.

III (8%): Tumors visible externally, mass is pelvic and intrabdominal. 20% rate of metastases.

IV (10%): Tumors not visible externally, entirely presacral.

Grading is done as follows:

Grade 0: Only mature tissue present, no immature element seen.

Grade I: Mainly mature tissue present, immature element seen only in 1 LPF/slide

Grade II: When immature tissue is seen in <4 LPF/slide

Grade III: When immature tissue is present in >4 LPF/slide

SCT is frequently diagnosed incidentally on ultrasonography but it may also lead to fetal complications such as spontaneous haemorrhage in the mass, nonimmune hydrops fetalis, malignancy, bladder outlet obstruction, high output cardiac failure and obstetric complications such as polyhydroamnios, preterm labor, and dystocia.

To conclude, sacrococcygeal teratomas are common tumors but immature teratomas are rare. Once detected prenatally, should be followed up otherwise the complications like preterm labour or cardiac failure may arise and may lead to death of the fetus as happened in our case.

 
   References Top

1.Wells RG, Sty JR. Imaging of sacrococcygeal germcell tumors. RadioGraphics 1990;10:701-13.  Back to cited text no. 1
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2.Rescorla FJ, Sawin RS, Coran AG, Dillon PW, Azizkhan RG. Long-term outcome for infants and children with sacrococcygeal teratoma: A report from the Childrens Cancer Group. J Pediatr Surg 1998;33:171-6.  Back to cited text no. 2
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3.Moazam F, Talbert JL. Congenital anorectal malformations: Harbingers of sacrococcygeal teratomas. Arch Surg 1985;120:856-9.  Back to cited text no. 3
[PUBMED]    
4.Altman RP, Randolph JG, Lilly JR. Sacrococcygeal teratoma: American Academy of Pediatrics Surgical Section Survey-1973. J Pediatr Surg 1974;9:389-98.  Back to cited text no. 4
[PUBMED]    
5.Bond SJ, Harrison MR, Schmidt KG, Silverman NH, Flake AW, Slotnick RN, et al. Death due to high-output failure in fetal sacrococcygeal teratomas. J Pediatr Surg 1990;25:1287-91.  Back to cited text no. 5
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Correspondence Address:
Sakshi Choudhry
D/o Dr. Vijay Pal Choudhry, C/o "Anukampa", 2, Civil Lines, Shahjahanpur, PIN - 242 001, Uttar Pradesh
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0377-4929.101766

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