Vergnes P, Horovitz J, Mauge B, Lamireau T, Colombani J F, Billeau C, Demarquez J L, Pontailler J R, Bondonny J M
Service de Chirurgie Pédiatrique, Hôpital des Enfants, Bordeaux.
J Gynecol Obstet Biol Reprod (Paris). 1991;20(5):633-42.
The authors report eight cases of antenatal diagnosis of sacro-coccygeal teratoma (SCT) in five girls and three boys in whom the diagnosis was made between the 19th and 34th week of amenorrhea (mean = 27 weeks). The ultrasound pictures taken antenatally of the SCT assist in the discovery of a mass that is usually heterogenous, attached to the distal end of the sacrum, and the discovery is usually made fortuitously or because the height of the uterus is too great. A different series of antenatal diagnoses for SCT have made it possible to work out certain criteria of seriousness to be able to predict intra-uterine death: the presence of anasarca or of hydramnios, the discovery of the lesion before the 30th week of amenorrhoea, the relative weight of the teratoma as against the weight of the fetus being above 50%. We think from our experience that it is important to add the scale of the antenatal growth of the teratoma. A rapid growth of the SCT will lead to a tumour mass which is great as compared to the size of the fetus. Similarly in certain cases the vascular bed will increase in size, and intratumour haemorrhages can occur and give rise to fetal heart failure and also to fetal anaemia, hypoproteinaemia and the appearance of anasarca or of hydramnios. The child dies in utero or immediately after birth because of prematurity from the haemorrhagic state or from cardiac insufficiency. Furthermore accelerated growth of the tumour is nearly always in the immature tumour cells and that means that the child, if it is born alive, should be followed up for a long time because there is a risk of it becoming locally malignant. In practice the monitoring of SCT and the antenatal discovery of the condition should be carried out very seriously in order, in some cases, if it is viable to produce a living child in conditions where the rapid growth of tumour would make it likely that the child would die in utero.
作者报告了8例骶尾部畸胎瘤（SCT）的产前诊断病例，其中5名女孩和3名男孩，诊断时间在闭经第19至34周之间（平均27周）。产前拍摄的SCT超声图像有助于发现通常为异质性、附着于骶骨远端的肿块，这种发现通常是偶然的，或者是因为子宫高度过高。一系列不同的SCT产前诊断使得制定某些严重程度标准成为可能，以便能够预测宫内死亡：是否存在全身水肿或羊水过多、在闭经第30周之前发现病变、畸胎瘤相对于胎儿体重的相对重量超过50%。根据我们的经验，我们认为增加畸胎瘤产前生长的规模很重要。SCT的快速生长会导致肿瘤肿块相对于胎儿大小而言很大。同样，在某些情况下，血管床会增大，肿瘤内会发生出血，导致胎儿心力衰竭，还会导致胎儿贫血、低蛋白血症以及全身水肿或羊水过多的出现。由于出血状态导致的早产或心脏功能不全，胎儿会在子宫内死亡或出生后立即死亡。此外，肿瘤的加速生长几乎总是发生在未成熟的肿瘤细胞中，这意味着如果孩子存活出生，应该进行长期随访，因为存在局部恶变的风险。实际上，对SCT的监测和该疾病的产前发现应该非常认真地进行，以便在某些情况下，如果可行的话，在肿瘤快速生长可能导致胎儿在子宫内死亡的情况下生出活婴。
