Sacrococcygeal Teratoma (SCT)

What are the symptoms of a sacrococcygeal teratoma?

There are rarely any symptoms.

How is sacrococcygeal teratoma diagnosed?

A sacrococcygeal tumor is usually diagnosed during pregnancy by a highly specialized prenatal ultrasound.

• You may be referred to a doctor who specializes in this kind of an ultrasound if the levels of alpha-fetoprotein (AFP) in your blood are high. A blood test to determine AFP levels is a routine part of prenatal care and is usually taken sometime between the 15th and 20th week of pregnancy.
• You may also be referred for this kind of an ultrasound if your uterus is larger than it should be during that particular week of pregnancy. If an SCT is causing the enlarged uterus, an increase in amniotic fluid or the large size of the tumor is usually to blame.

What the ultrasound shows

If there's a sacrococcygeal teratoma, the ultrasound will show a large mass.

• The mass may be either cystic (filled with liquid) or solid in appearance; it's commonly a mixture of both.
• Measurements will be taken to determine how far into the abdomen the teratoma extends and what organs it may have affected.
• Many times the mass can cause pressure on internal organs like the bladder, and may lead to obstruction and enlargement of the kidneys.

Special concerns relating to a solid tumor

A tumor that is mostly solid has a large amount of blood vessels, and this causes the fetus' heart to pump extra hard to circulate blood through both his body and the tumor.

This extra work may cause the fetus to develop heart failure (hydrops). This will be monitored closely by fetal echocardiography, which looks directly at fetal heart function.

How is a sacrococcygeal teratoma treated?

If your baby is born with a SCT, she will undergo surgery to remove the mass and reconstruct the perineum after birth. Your baby should do very well.

A small number of babies, however, experience progressive enlargement of the tumor very quickly prior to birth, which can lead to heart failure. If this happens to your baby, the doctor may recommend prenatal intervention.

There are two types of prenatal interventions:

• Open fetal surgery: The mother's uterus is opened, the baby is taken out of the uterus, and, while the fetus is still attached to and sustained by the mother's placenta, the tumor is removed. The fetus is then returned to the mother's uterus to be carried as close to term as possible. Open fetal surgery can cause preterm labor and early delivery, so mothers are monitored closely after surgery.

• Radio-frequency ablation: During this procedure, a needle is placed into the mother's uterus and into the tumor. Radio frequency waves are sent through the needle to destroy the blood vessels that lead to the tumor. Without blood flow to the tumor, it does not grow and the risk of heart failure goes down. After delivery of the baby, the mass is completely removed in the operating room, and reconstruction is performed if needed.

What happens after delivery to babies who underwent fetal surgery?

Some reconstructive surgery to properly close the perineum may be needed. Fetal skin is remarkably resilient and may heal on its own without any scarring.

Depending on the development of the tumor's cells, no further treatment may be needed, or your child's physician may determine that chemotherapy may be necessary.

A comprehensive level of care

The Fetal Care and Surgery Center (MFCC) of Boston Children's Hospital is making a significant difference in the outcomes for families facing challenges to the health of their fetus or newborn.

Pushing beyond the pages of yesterday's textbooks, we are rewriting what is possible in fetal medicine delivering hope — and healthy babies — through groundbreaking advancements and a commitment to the best in pediatric care.