Developmental disorders

II./3.1.: Introduction

II./3.1.1.: General aspects

Most frequent solid tumor in newborns. Four times more frequent in females as in males. The choice of appropriate imaging method depends on the detection time (intrauterine) and the localisation. Any kind of method is applied by imaging, since many, matured tissue elements are contained, the visualised image corresponds to the signal which is characteristic to the certain tissue components of the teratoma developed due to the physical effect (sound, X-ray beam, radiowave). Possibility of sacral (sacrococcygeal) teratoma can be sometimes raised already in utero. It must be cleared if the mass does not cause the obstruction of birth canal, namely, per vias naturales (via natural way) delivery can be carried out, or caesarean section (sectio caesarea) must be performed. It can and must be defined by radiological methods (US, MRI).

II./3.1.2.: Topographic classification of sacral teratoma

Altman classification of the localisation and its grading according to the extension contributes to the intrauterine judgment of the tumor progress:

• I. Dominantly external sacrococcygeal teratoma covered by skin, which extends beyond the fetus, but might also have a tiny presacral component in certain cases.

• II. Dominantly extrafetal tumor with an intrapelvic part with presacral extension.

• III. Dominantly sacral tumor with small-scale extrafetal and abdominopelvic extension.

• IV. The tumor is located presacrally in the pelvis of the fetus, but does not exceed its borders.

II./3.1.3.: Matured teratoma (teratoma adultum seu maturum)

Accounts for more than half of all cases. According to the definition, the tumor contains matured tissues resultant from two or all the three germinal plates. Moreover, organ portions, organs: skin and its accessories (hair, glandulae); nerve elements; chorioid plexus; intestinal lumens; bronchial portions; glandulae such as pancreas, thyroid gland; partial or even whole teeth; bone tissue, rarely even whole bones (e.g. metacarpal bones). This benign tumor contains such tissues which were produced far away from their original anatomic location. Using imaging methods, these issues and organs show the same signal as the similar, „real” tissues on their original locations.

II./3.1.4.: Unmatured teratoma (teratoma embryonale seu immaturum)

Unmatured teratomas account for appr. ¼ of all cases. It is a mixture of primitive neuroepithelial cells and unmatured tissue portions of various grade. Namely, it is an embryonal elements containing potentially or obviously malignant tumor. Imaging methods (mainly referring to MRI) visualize the tissue (and not the histological!) characteristics.