Yamaguchi Y, Tsukimori K, Hojo S, Nakanami N, Nozaki M, Masumoto K, Taguchi T, Wake N
Department of Gynecology and Obstetrics, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.
Ultrasound Obstet Gynecol. 2006 Oct;28(5):720-2. doi: 10.1002/uog.3821.
Sacrococcygeal teratoma (SCT) is the most common congenital tumor, with affected fetuses having a high risk of perinatal complications and death. We report a case of a fetus with an SCT that developed acute anemia due to spontaneous rupture of the tumor in utero. The fetus was referred at 25 weeks' gestation for evaluation of a large solid and cystic mass in the sacral region. There were no signs of hydrops or placentomegaly. At 33 weeks' gestation, loss of variability in the fetal heart rate pattern was recorded. Doppler ultrasonography showed increased middle cerebral artery peak systolic velocity, suggesting fetal anemia. Markedly bloody amniotic fluid, with 82% hemoglobin F, was observed on amniocentesis, suggesting rupture of the SCT with active fetal bleeding. An emergency Cesarean section was performed. At delivery, the tumor was bleeding actively and the neonatal hemoglobin concentration was 3.1 g/dL. There were no findings of hemorrhage or necrosis within the tumor. The neonate received a blood transfusion, and surgical resection of the tumor was carried out on the first day after delivery. Postoperatively, the baby did well. We suggest that fetal SCTs run the risk of inducing acute fetal anemia due to intrauterine hemorrhage of the tumor, a finding which could lead to an earlier and more appropriate management of this condition.
骶尾部畸胎瘤（SCT）是最常见的先天性肿瘤，患病胎儿发生围产期并发症和死亡的风险很高。我们报告一例患有SCT的胎儿，该胎儿因肿瘤在子宫内自发破裂而出现急性贫血。该胎儿在妊娠25周时因骶骨区域一个巨大的实性和囊性肿块而被转诊评估。没有水肿或胎盘肿大的迹象。在妊娠33周时，记录到胎儿心率模式变异性丧失。多普勒超声显示大脑中动脉收缩期峰值速度增加，提示胎儿贫血。羊膜穿刺术观察到明显血性羊水，其中血红蛋白F为82%，提示SCT破裂伴胎儿活动性出血。遂行急诊剖宫产。分娩时，肿瘤正在大量出血，新生儿血红蛋白浓度为3.1 g/dL。肿瘤内未发现出血或坏死。新生儿接受了输血，并在出生后第一天进行了肿瘤手术切除。术后，婴儿情况良好。我们认为，胎儿SCT有因肿瘤宫内出血而导致急性胎儿贫血的风险，这一发现可能有助于对该疾病进行更早、更恰当的处理。
