Sacrococcygeal teratoma differential diagnosis

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]Associate Editor(s)-in-Chief: Mirdula Sharma, MBBS [2]

Overview

Sacrococcygeal teratoma must be differentiated from endodermal sinus tumor, ependymoma, fibromatosis, ganglioneuroma, giant cell tumor of the sacrum, leiomyoma, meningomyelocele, ovarian teratoma, neuroblastoma, retrorectal hamartoma, intracanalicular epidermoid tumor, rhabdomyosarcoma, paraganglioma, dermal sinus stalk ascending towards the conus modullaris, and hydromelia.[1]

Differenting Sacrococcygeal Teratoma from other Diseases


Diseases Clinical manifestations Para-clinical findings Gold standard Additional findings
Physical examination
Imaging
Vertebra column defect Protrusions, Dimples, Hair patch in the spine Motor and sensory abnormalities X-ray

(PA and Lateral view)

M.R.I.
Sacrococcygeal teratoma +/- ++ +/- Ultrasound
Spina bifida ++ ++ +/- Incomplete union of the posterior elements of vertebral levels MRI -
Terminal myelocystocele +/- Protrusions and dimples +/- Incomplete union of the posterior elements of vertebral levels MRI
Spine segmental dysgenesis + - +/- Defects in the segments of the spine and spinal cord
  • Spinal cord at the level of the abnormality is thinned or even indiscernible
  • a bulky, low-lying cord segment may be present caudad to the focal abnormality in most cases
MRI
  • The spinal column distal to the abnormality may be partially bifid
Caudal regression syndrome (sacral agenesis) + +/- +/- Agenesis of the sacrum and lumbar spine
  • Lumbosacral vertebral body dysgenesis/hypogenesis
  • The level of atresia/dysgenesis is usually below L1 and often limited to sacrum
MRI Associated with other developmental malformations (orthopedic, neurological, genito-urinary, gastrointestinal…)
VACTERL association + +/- +/- Vertebral body dysgenesis/hypogenesis - MRI, Ct scan, X ray VACTERL stands for:
  • Vertebral defects
  • Anal atresia
  • Cardiac defects
  • Tracheo-Esophageal fistula
  • Renal anomalies
  • Limb abnormalities
Arnold-chiari malformation + + + None MRI
Syringomyelia + + + MRI
  • Impaired ambulation and loss of penile erection when syrinx involves lumbosacral area
Scoliosis +/- +/- +/-
  • Abnormality that may be causing the deformity
  • Spinal cord abnormalities may be seen
MRI
Leg length discrepancy - - - None Orthoroentogram
  • Repeat standing x-rays with the patient standing on a block to account for the discrepancy demonstrates correction of the postural abnormality.

References

  1. 1.0 1.1 Myers LB, Bulich LA. Anesthesia for Fetal Intervention and Surgery. PMPH-USA; 2005.
  2. Calloni SF, Huisman TA, Poretti A, Soares BP (2017). "Back pain and scoliosis in children: When to image, what to consider". Neuroradiol J. 30 (5): 393–404. doi:10.1177/1971400917697503. PMC 5602330. PMID 28786774.
  3. Azar, F., Canale, S., Beaty, J. & Campbell, W. (2017). Campbell's operative orthopaedics. Philadelphia, PA: Elsevier. Page: 1898-2028.
  4. Meyer SH, Morris GF, Pretorius DH, James HE (March 1998). "Terminal myelocystocele: important differential diagnosis in the prenatal assessment of spina bifida". J Ultrasound Med. 17 (3): 193–7. PMID 9514174.
  5. Scott RM, Wolpert SM, Bartoshesky LE, Zimbler S, Karlin L (April 1988). "Segmental spinal dysgenesis". Neurosurgery. 22 (4): 739–44. PMID 3374785.
  6. Kremser E, Mitchell GM (February 1971). "Treatment of primary dysmenorrhea with a combined type oral contraceptive--a double blind study". J Am Coll Health Assoc. 19 (3): 195–6. PMID 4925436.
  7. Benedetti-Valentino F J, De Feo V, Pistolese GR, Fiorani P (September 1966). "[Nephroptosis and fibromuscular hyperplasia of the tunica media of the renal arteries]". Minerva Cardioangiol (in Italian). 14 (9): 528–34. PMID 5991006. Vancouver style error: name (help)
  8. Naccarato R, Sturniolo GC, Martin A, D'Odorico A, Montino C (March 1988). "[Irritable bowel syndrome]". G Clin Med (in Italian). 69 (3): 163–8. PMID 3169446.
  9. Sacrococcygel Teratoma. Radiopedia (2015) http://radiopaedia.org/articles/sacrococcygeal-teratoma Accessed on December 15, 2015
  10. Danzer E, Hubbard AM, Hedrick HL, Johnson MP, Wilson RD, Howell LJ, Flake AW, Adzick NS (2006). "Diagnosis and characterization of fetal sacrococcygeal teratoma with prenatal MRI". AJR Am J Roentgenol. 187 (4): W350–6. doi:10.2214/AJR.05.0152. PMID 16985105.

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