**3.4 Diagnostic tools**

Except for clinical examination, there are a variety of radiographic studies that can help. Plain X-Ray may show the presence of calcification within the tumor and anterior displacement of the rectum by the tumor. The sacrum may appear abnormal (such as hemivertebrae, agenesis).

Computer tomography (CT) or MRI of the pelvis with intravenous contrast material may reveal urinary tract displacement or obstruction and outlines the extent of the tumor more accurately. MRI is also a useful diagnosis of spinal cord extension of tumor (**Figure 3**).

A chest X-Ray or CT thoracic scan is obtaining to rule out the presence of pulmonary metastases.

Malignant SCT may have elevated tumor markers. The most commonly produced tumor marker is AFP (alpha-fetoprotein) because yolk sac components are the most common malignant elements. Other malignant elements may produce beta HCG (human chorionic gonadotropin). Serum AFP and beta HCG should be evaluated at the initial diagnostic work-up and assessed to monitor tumor relapse during the follow up period. The use of AFP as a tumor marker is well established and persistent, elevated level may indicate a residual tumor, recurrence or malignant degeneration. Because AFP is produced by fetal liver and fetal gastrointestinal tract,

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**Figure 3.**

**Figure 2.**

*Prenatal Diagnosis and Management of Sacrococcygeal Teratomas*

its level is normally elevated in the first 8 months of life and after that age it rapidly falls to normal adult level (10 ng/ml). The mean time required for AFP to normalize

*SCT type II in a newborn girl. Large mass visible in sacral region, with displacement of anal orifice.*

The differential diagnosis of SCT include rectal duplication, meningocele,

after SCT resection is about 9 months [7, 8].

*Type II SCT with intrapelvic component—MRI.*

lipoma, chordoma, epidermoid cyst, neuroblastoma.

*DOI: http://dx.doi.org/10.5772/intechopen.87987*

*Prenatal Diagnosis and Management of Sacrococcygeal Teratomas DOI: http://dx.doi.org/10.5772/intechopen.87987*

*Basic Principles and Practice in Surgery*

**3.3 Clinical presentation**

**Figure 1.**

obstruction of the bladder neck).

mal (such as hemivertebrae, agenesis).

extension of tumor (**Figure 3**).

pulmonary metastases.

**3.4 Diagnostic tools**

Most external tumors are asymptomatic, with the exception of the presence of a visible exophytic large mass at the sacral region with occasional surface ulceration and hemorrhage and with anus displaced anteriorly (**Figure 2**). Sometimes, rupture of the tumor may occur as a result of a difficult delivery. Pelvic tumors or tumors that extend into the abdominal cavity may present with compression of the rectum or recto-sigmoid and urinary tract obstruction (constipation, frequent stools,

*Currarino triad in a female patient with SCT—MRI. Red arrow points the SCT. The girl presented with* 

*imperforate anus, recto-vestibular fistula and SCT was misdiagnosed until MRI.*

Except for clinical examination, there are a variety of radiographic studies that can help. Plain X-Ray may show the presence of calcification within the tumor and anterior displacement of the rectum by the tumor. The sacrum may appear abnor-

Computer tomography (CT) or MRI of the pelvis with intravenous contrast material may reveal urinary tract displacement or obstruction and outlines the extent of the tumor more accurately. MRI is also a useful diagnosis of spinal cord

A chest X-Ray or CT thoracic scan is obtaining to rule out the presence of

Malignant SCT may have elevated tumor markers. The most commonly produced tumor marker is AFP (alpha-fetoprotein) because yolk sac components are the most common malignant elements. Other malignant elements may produce beta HCG (human chorionic gonadotropin). Serum AFP and beta HCG should be evaluated at the initial diagnostic work-up and assessed to monitor tumor relapse during the follow up period. The use of AFP as a tumor marker is well established and persistent, elevated level may indicate a residual tumor, recurrence or malignant degeneration. Because AFP is produced by fetal liver and fetal gastrointestinal tract,

**60**

**Figure 2.** *SCT type II in a newborn girl. Large mass visible in sacral region, with displacement of anal orifice.*

**Figure 3.** *Type II SCT with intrapelvic component—MRI.*

its level is normally elevated in the first 8 months of life and after that age it rapidly falls to normal adult level (10 ng/ml). The mean time required for AFP to normalize after SCT resection is about 9 months [7, 8].

The differential diagnosis of SCT include rectal duplication, meningocele, lipoma, chordoma, epidermoid cyst, neuroblastoma.
