Coccyx teratoma

The Coccyx teratoma is a prenatal tumor on the coccyx that is usually benign and associated with a malevolent development of the primitive streak. The tumor can be recognized prenatally and treated if necessary. Above all, prenatal treatment stabilizes the embryo's circulation.

What is a tailbone teratoma?

Germ cell tumors are tumors that originate in the germ cells. In women, the tumors are usually benign. The males are more often affected by malignant forms. The coccyx teratoma is the most common manifestation of germ cell tumor in infancy. The teratoma is located in the context of a coccyx tumor in the area of ​​the coccyx and corresponds to a malformation tumor of the spine.

Part of the tumor infiltrates the fetal pelvis from the spine. Teratoma literally means “monster tumor”. Often, coccyx teratomas are already large at birth and can be seen with the naked eye, matching this name. Although these are mostly benign tumors, the risk of degeneration should not be underestimated. Large coccyx teratomas are already visible prenatally in fine ultrasound. Depending on the degree of blood flow, a previously benign coccyx tumor can have serious or fatal consequences.

causes

The coccyx teratoma is a malformation tumor. As this term implies, the overgrowth is caused by a malformation during embryonic development. The malformation affects the developmental phase of the primitive stripe. The primitive streak actually regresses during gastrulation. Patients with coccyx teratoma suffer from incomplete regression of the primitive streak.

In a coccyx teratoma, the remnants of the strip develop into a tumor at the rear end of the embryonic spine. The resulting tumor often causes the individual cotyledons to unfold incorrectly. This connection can interfere with the development of all possible tissues, organs and limbs of the embryo. Coccyx teratomas with particularly high blood flow, for example, can result in heart failure and cause the unborn child to die.

Symptoms, ailments & signs

The tailbone teratoma can manifest as a mature tumor the size of a child's head. In milder cases, the teratoma is not necessarily noticeable immediately after birth, but only manifests itself as a slight swelling in the area of ​​the coccyx. The teratoma can have little or a lot of blood. If the coccyx teratomas are very well supplied with blood, the newborn often suffers from functional impairments of the heart.

Pelvic enteratomas often compress the bladder or bowel and cause associated symptoms. For example, particularly large, compressive teratomas can also cause pain. If the spinal canal is infiltrated, there may be movement restrictions, which are usually due to the severe pain.

In some cases, the pregnant woman will also have symptoms during pregnancy. For example, mirror syndrome during pregnancy can be traced back to a tailbone teratoma in the unborn child. Abdominal pain, shortness of breath and massive edema formation were observed in part as a reflection of the fetal disease in the pregnant woman.

Diagnosis & course of disease

The diagnosis of a large coccyx teratoma is usually made prenatally using fine ultrasound. If the teratoma is not a prominent size, the doctor makes the diagnosis postnatal. Usually he develops an initial suspicion of the widespread tumor through tactile findings. In addition to blood tests, he uses radiological procedures for diagnostics. Alpha-fetoprotein is primarily determined in the child's blood.

Imaging such as sonography is used to accurately depict the coccyx area. In addition to the location, the size of the growth is determined via the imaging. Magnetic resonance tomography is the method of choice for detailed diagnostics. The MRI also helps the doctor to plan the treatment steps. The prognosis for patients with coccyx teratomas depends primarily on the malignancy and the degree of their blood flow. A prenatal diagnosis time has a positive effect on the prognosis.

Complications

In most cases, the coccyx teratoma does not have any particular complications or discomfort. The tumor is usually benign so that metastases do not develop. The coccyx teratoma does not have to cause symptoms in every case. In many people, the symptom is discovered by chance, although it can show up as a swelling in the tailbone.

The swelling is often not associated with pain. Due to the increased blood flow, however, it can lead to heart problems, which can lead to a serious course, especially in newborns. Movement restrictions can also occur in this area and may have a negative impact on the child's development. Furthermore, the patients often suffer from abdominal pain or shortness of breath, so that the coccyx teratoma must definitely be removed.

As a rule, there are no particular complications associated with the removal and treatment of this tumor. After that, however, chemotherapy is necessary, which is associated with side effects. Furthermore, the person concerned is dependent on regular examinations in order to avoid further tumors. Successful treatment of the coccyx teratoma does not result in a reduced life expectancy for the patient.

When should you go to the doctor?

In the case of a coccyx teratoma, a visit to a doctor is always necessary. Since it cannot heal itself and the symptoms worsen in most cases if left untreated, the disease must always be treated by a doctor. Only through an early examination and subsequent treatment can further complications be prevented.

A doctor should be consulted in the case of a coccyx teratoma if the patient has severe mobility restrictions. In most cases, those affected can no longer cope with their everyday lives on their own and are dependent on the help and support of their friends and family. Severe leg pain or severe shortness of breath can also indicate a tailbone teratoma. If these complaints persist and, above all, for no particular reason, a doctor should be consulted.

In most cases, severe and persistent tiredness or fatigue also indicates a coccyx teratoma and should also be examined by a health professional. Usually the tailbone teratoma can be diagnosed by a pediatrician or a general practitioner. Further treatment is then based on the exact symptoms and their severity.

Therapy & Treatment

If the diagnosis of the coccyx teratoma is made before birth, prenatal fetal surgery can be used. From the 20th to the 32nd week of pregnancy, fetal surgical interventions can, for example, reduce the blood flow to the teratoma and thus improve the unborn child's circulatory situation. After the birth, an excision of the tumor should be sought as soon as possible.

In the case of a prenatal diagnosis, therapy planning is carried out by an interdisciplinary team of paediatricians, gynecologists, pediatric surgeons and anesthetists with links to perinatal centers. The due date is usually determined on an interdisciplinary basis so that all the necessary preparations can be made for the best possible treatment. The child's circulatory situation should be stable for excision.

For this reason, the postnatal diagnosis worsens the prognosis, since in this case no more fetal surgical circulatory stabilizing measures can be taken. During excision, removal of the coccyx is indicated in most cases in order to eliminate the tumor as completely as possible. After the excision, the doctors decide whether chemotherapy is necessary in each individual case.

After the teratoma has been removed and treated, the children have to attend regular checkups. Oncology and hematology doctors permanently care for patients in the outpatient department of a children's clinic. In the event of a relapse, the doctors recognize the recurring tumor in the early stages and can intervene in good time.

prevention

The coccyx teratoma is a malformation during embryonic development. So far, however, it remains unclear which factors are decisive for this undesirable development. Therefore, the teratoma has so far not been successfully prevented. Nevertheless, the fine ultrasound can be viewed as a kind of preventive measure, since teratomas in the child can be recognized by imaging and pretreated prenatally.

Aftercare

Follow-up care for a coccyx teratoma depends on the shape of the teratoma and the type of treatment chosen. The sooner the teratoma, including part of the coccyx, is surgically removed, the faster the necessary medical follow-up can be established. Ideally, the coccyx teratoma shows up before or immediately at birth.

After surgery and an analysis of the tissue, it must be determined whether further therapy is necessary. This can consist of chemotherapy, for example, which in turn entails various follow-up examinations and treatments.

If it has been determined that nothing remains of the teratoma and that there are no more malignant tumor cells to worry about, aftercare includes wound care and an examination of all parts of the body adjacent to the coccyx. This checks whether the coccyx teratoma has affected the bladder or the intestine, for example. If necessary, surgery or therapy is carried out here.

If, on the other hand, the coccyx teratoma appears in the first months or years of life, malignancy is much more likely. The follow-up care that takes place after the treatment of such a coccyx teratoma is similar to that after cancer therapy. Accordingly, the medical follow-up here is associated with a large number of examinations, including the blood and imaging procedures.

You can do that yourself

In the best case scenario, a coccyx teratoma can be diagnosed and removed before the child is born. The mother should watch out for warning signs and inform the gynecologist of any symptoms.

If the tumor is too large, it will be removed immediately after the baby is born. It is the mother's job to watch the child carefully. If the surgical scar opens or the child shows other signs of pain or discomfort, the emergency medical service or the ambulance service should be called. Usually, however, a coccyx teratoma is relatively symptom-free. If it is recognized and removed early, the child will not experience any further symptoms.

However, a tumor disease in the child can be a serious psychological burden for the parents and especially the mother. Affected parents should consult a therapist if they feel stressed or overwhelmed by the situation. The responsible gynecologist or surgeon can also put you in touch with a therapist or psychologist. The child may need to take pain relievers or anti-inflammatories. Parents should seek support from a specialist doctor or other parents.