Sacrococcygeal teratoma differential diagnosis: Difference between revisions

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__NOTOC__
__NOTOC__
{{Sacrococcygeal teratoma}}
[[Image:Home_logo1.png|right|250px|link=https://www.wikidoc.org/index.php/Sacrococcygeal_teratoma]]
{{CMG}}{{AE}}{{MGS}}
{{CMG}}{{AE}}{{MGS}}


==Overview==
==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.<ref = "dd">Myers LB, Bulich LA. Anesthesia for Fetal Intervention and Surgery. PMPH-USA; 2005.</ref>
'''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.<ref name="DD">Myers LB, Bulich LA. Anesthesia for Fetal Intervention and Surgery. PMPH-USA; 2005.</ref>
==Differenting Sacrococcygeal Teratoma from other Diseases==
==Differenting Sacrococcygeal Teratoma from other Diseases==
*[[Endodermal sinus tumor]] <ref = "dd">Myers LB, Bulich LA. Anesthesia for Fetal Intervention and Surgery. PMPH-USA; 2005.</ref>
*[[Endodermal sinus tumor]] <ref name="DD">Myers LB, Bulich LA. Anesthesia for Fetal Intervention and Surgery. PMPH-USA; 2005.</ref>
*[[Ependymoma]]
*[[Ependymoma]]
*[[Fibromatosis]]
*[[Fibromatosis]]
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*Dermal sinus stalk ascending towards the conus modullaris
*Dermal sinus stalk ascending towards the conus modullaris
*Hydromelia
*Hydromelia
*Sacrococcygeal teratoma must be differentiated from other diseases that causes [[vertebral column]] defects, spinal deformity and [[neurologic]] abnormalities or [[gait]] abnormalities, such as: Terminal myelocystocele, spine segmental [[dysgenesis]], [[Caudal regression syndrome]] ([[sacral agenesis]]), multiple [[vertebral]] segmentation disorder, [[VACTERL|VACTERL association,]] [[Arnold-Chiari malformation|arnold-chiari malformation]], [[syringomyelia]], [[Scoliosis]],  and [[leg length discrepancy]].<ref name="pmid28786774">{{cite journal| author=Calloni SF, Huisman TA, Poretti A, Soares BP| title=Back pain and scoliosis in children: When to image, what to consider. | journal=Neuroradiol J | year= 2017 | volume= 30 | issue= 5 | pages= 393-404 | pmid=28786774 | doi=10.1177/1971400917697503 | pmc=5602330 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=28786774  }} </ref><ref>Azar, F., Canale, S., Beaty, J. & Campbell, W. (2017). Campbell's operative orthopaedics. Philadelphia, PA: Elsevier. Page: 1898-2028.</ref><ref name="pmid9514174">{{cite journal |vauthors=Meyer SH, Morris GF, Pretorius DH, James HE |title=Terminal myelocystocele: important differential diagnosis in the prenatal assessment of spina bifida |journal=J Ultrasound Med |volume=17 |issue=3 |pages=193–7 |date=March 1998 |pmid=9514174 |doi= |url=}}</ref><ref name="pmid3374785">{{cite journal |vauthors=Scott RM, Wolpert SM, Bartoshesky LE, Zimbler S, Karlin L |title=Segmental spinal dysgenesis |journal=Neurosurgery |volume=22 |issue=4 |pages=739–44 |date=April 1988 |pmid=3374785 |doi= |url=}}</ref><ref name="pmid4925436">{{cite journal |vauthors=Kremser E, Mitchell GM |title=Treatment of primary dysmenorrhea with a combined type oral contraceptive--a double blind study |journal=J Am Coll Health Assoc |volume=19 |issue=3 |pages=195–6 |date=February 1971 |pmid=4925436 |doi= |url=}}</ref><ref name="pmid5991006">{{cite journal |vauthors=Benedetti-Valentino F J, De Feo V, Pistolese GR, Fiorani P |title=[Nephroptosis and fibromuscular hyperplasia of the tunica media of the renal arteries] |language=Italian |journal=Minerva Cardioangiol |volume=14 |issue=9 |pages=528–34 |date=September 1966 |pmid=5991006 |doi= |url=}}</ref><ref name="pmid3169446">{{cite journal |vauthors=Naccarato R, Sturniolo GC, Martin A, D'Odorico A, Montino C |title=[Irritable bowel syndrome] |language=Italian |journal=G Clin Med |volume=69 |issue=3 |pages=163–8 |date=March 1988 |pmid=3169446 |doi= |url=}}</ref>
{|
|- style="background: #4479BA; color: #FFFFFF; text-align: center;"
! rowspan="4" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Diseases
| colspan="3" |'''Clinical manifestations'''
! colspan="2" rowspan="2" |Para-clinical findings
| colspan="1" rowspan="4" style="background: #4479BA; color: #FFFFFF; text-align: center;" |'''Gold standard'''
! rowspan="4" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Additional findings
|-
! colspan="3" rowspan="2" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Physical examination
|-
! colspan="2" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Imaging
|-
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Vertebra column defect
! colspan="1" rowspan="1" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Protrusions, Dimples, Hair patch in the spine
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Motor and sensory abnormalities
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |X-ray
(PA and Lateral view)
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |M.R.I.
|-
|Sacrococcygeal teratoma
| +/-
| ++
| +/-
|
* Mass projecting from the lower [[Pelvis|pelvic]] region or within the [[Abdomen|abdomino]]-[[Pelvis|pelvic]] cavity<ref name="XRAY">Sacrococcygel Teratoma. Radiopedia (2015) http://radiopaedia.org/articles/sacrococcygeal-teratoma Accessed on December 15, 2015</ref>
* Mass may show [[calcification]]
|
* Characterizes the [[Pelvis|intrapelvic]] and [[Abdomen|abdominal]] extent of the [[tumor]]<ref name="mir">{{cite journal |vauthors=Danzer E, Hubbard AM, Hedrick HL, Johnson MP, Wilson RD, Howell LJ, Flake AW, Adzick NS |title=Diagnosis and characterization of fetal sacrococcygeal teratoma with prenatal MRI |journal=AJR Am J Roentgenol |volume=187 |issue=4 |pages=W350–6 |year=2006 |pmid=16985105 |doi=10.2214/AJR.05.0152 |url=}}</ref>
|[[Ultrasound]]
|
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Spina bifida]]
| style="background: #F5F5F5; padding: 5px;" | ++
| style="background: #F5F5F5; padding: 5px;" | ++
| style="background: #F5F5F5; padding: 5px;" | +/-
| style="background: #F5F5F5; padding: 5px;" |Incomplete union of the posterior elements of [[Vertebra|vertebral]] levels
| style="background: #F5F5F5; padding: 5px;" |
* Various degrees of failure of [[Neural tube defect|neural tube]] closure
* Posterior sac contains [[meninges]] and/or [[spinal cord]]
| style="background: #F5F5F5; padding: 5px;" |[[MRI]]
| style="background: #F5F5F5; padding: 5px;" | -
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |Terminal myelocystocele
| style="background: #F5F5F5; padding: 5px;" | +/-
| style="background: #F5F5F5; padding: 5px;" | Protrusions and dimples
| style="background: #F5F5F5; padding: 5px;" | +/-
| style="background: #F5F5F5; padding: 5px;" |Incomplete union of the posterior elements of [[Vertebra|vertebral]] levels
| style="background: #F5F5F5; padding: 5px;" |
* Various degrees of failure of [[Neural tube defect|neural tube]] closure
* Posterior sac contains [[meninges]] and/or [[spinal cord]]
| style="background: #F5F5F5; padding: 5px;" |[[MRI]]
| style="background: #F5F5F5; padding: 5px;" |
* Progression of lower extremity paralysis
* Common in patients with [[cloacal exstrophy]]
*
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |Spine segmental dysgenesis
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" | +/-
| style="background: #F5F5F5; padding: 5px;" |Defects in the segments of the spine and spinal cord
| style="background: #F5F5F5; padding: 5px;" |
* 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
| style="background: #F5F5F5; padding: 5px;" |[[MRI]]
| style="background: #F5F5F5; padding: 5px;" |
* The spinal column distal to the abnormality may be partially bifid
*
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Caudal regression syndrome]] ([[sacral agenesis]])
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" | +/-
| style="background: #F5F5F5; padding: 5px;" | +/-
| style="background: #F5F5F5; padding: 5px;" |Agenesis of the sacrum and lumbar spine
| style="background: #F5F5F5; padding: 5px;" |
* Lumbosacral vertebral body dysgenesis/hypogenesis
* The level of atresia/dysgenesis is usually below L1 and often limited to sacrum
| style="background: #F5F5F5; padding: 5px;" |[[MRI]]
| style="background: #F5F5F5; padding: 5px;" |Associated with other developmental malformations (orthopedic, neurological, genito-urinary, gastrointestinal…)
*
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[VACTERL|VACTERL association]]
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" | +/-
| style="background: #F5F5F5; padding: 5px;" | +/-
| style="background: #F5F5F5; padding: 5px;" |Vertebral body dysgenesis/hypogenesis
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" |[[MRI]], Ct scan, X ray
| style="background: #F5F5F5; padding: 5px;" |[[VACTERL association|VACTERL]] stands for:
* Vertebral defects
* [[Anal atresia]]
* Cardiac defects
* Tracheo-Esophageal fistula
* Renal anomalies
* Limb abnormalities
*
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Arnold-Chiari malformation|Arnold-chiari malformation]]
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" |None
| style="background: #F5F5F5; padding: 5px;" |
* [[Tethered spinal cord syndrome|Tethered spinal cord]]
* [[Brain herniation|Tonsillar herniation]]
| style="background: #F5F5F5; padding: 5px;" |[[MRI]]
| style="background: #F5F5F5; padding: 5px;" |
* [[Headache]]
* Absent [[gag reflex]]
*
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Syringomyelia]]
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" |
* [[Rib]] or [[Vertebra|vertebral]] abnormalities may be seen
| style="background: #F5F5F5; padding: 5px;" |
* Abnormality that may be causing the deformity
* Enlargement of the [[central canal]] of the [[spinal cord]]
| style="background: #F5F5F5; padding: 5px;" |[[MRI]]
| style="background: #F5F5F5; padding: 5px;" |
* Impaired ambulation and loss of penile erection when [[Syrinx (medicine)|syrinx]] involves lumbosacral area
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Scoliosis]]
| style="background: #F5F5F5; padding: 5px;" | +/-
| style="background: #F5F5F5; padding: 5px;" | +/-
| style="background: #F5F5F5; padding: 5px;" | +/-
| style="background: #F5F5F5; padding: 5px;" |
* [[Rib]] or [[Vertebra|vertebral]] abnormalities usually seen
| style="background: #F5F5F5; padding: 5px;" |
* Abnormality that may be causing the deformity
* [[Spinal cord]] abnormalities may be seen
| style="background: #F5F5F5; padding: 5px;" |[[MRI]]
| style="background: #F5F5F5; padding: 5px;" |
* [[Electromyography|EMG]] and [[Nerve conduction study|nerve conduction]] testing: evidence of [[Upper motor neuron|upper motor neuron lesions]].
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Leg length discrepancy]]
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" |
* Quantify the degree of [[Leg length discrepancy|leg-length discrepancy]].
| style="background: #F5F5F5; padding: 5px;" |None
| style="background: #F5F5F5; padding: 5px;" |Orthoroentogram
| style="background: #F5F5F5; padding: 5px;" |
* Repeat standing [[x-rays]] with the patient standing on a block to account for the discrepancy demonstrates correction of the [[Posture|postural]] abnormality.
|}


==References==
==References==
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[[es:Teratoma sacrococcígeo]]
[[fr:Tératome sacro-coccygien]]
[[it:Teratoma sacro-coccigeo]]
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Latest revision as of 21:28, 7 May 2019

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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