Unusual presentations of genital tract tuberculosis

Three cases of genital tract tuberculosis (GTB) are described. This disease is uncommon in developed countries. Patients may present with infertility, non-specific menstrual disturbance, pain or abdominal distention. The genital tract is usually infected by hematogenous spread from a distant focus, with the fallopian tubes most commonly involved. Diagnosis is often made retrospectively, and once confirmed medical management is the mainstay of treatment. Future fertility is doubtful in these patients.     

Thermocoagulation of fetal sacrococcygeal teratoma

Fetal sacrococcygeal teratoma can lead to a high output cardiac failure resulting in hydrops fetalis. One of the prenatal therapeutic options is to occlude the feeding vessels by radiofrequency ablation. We present a case of fetal sacrococcygeal teratoma diagnosed at 13 weeks of gestation. The tumour increased in size more than 100 fold over 5 weeks causing polyhydramnios and cardiac and placental enlargement. Thermocoagulation was performed at 18 weeks' gestation by passing an insulated electric wire through an 18 gauge needle placed close to the feeding vessels of the tumour at its neck. Blood supply to the tumour was successfully reduced. However, fetal death was diagnosed 2 days after the procedure. We speculate that it may be safer to limit the extent of coagulation in one attempt but to repeat the procedure at a later stage when necessary.     

Spontaneous rupture of fetal sacrococcygeal teratoma

With recent advances in technology, fetal sacrococcygeal teratoma is being diagnosed increasingly during the early prenatal period by ultrasound examination. In addition, early detection of tumor related complications such as polyhydramnios, congestive heart failure, hydrops, hemorrhage, urinary tract or bowel obstruction can be followed closely in utero. Active prenatal management can improve fetal perinatal outcome by allowing planned delivery for neonatal surgery [Chisholm, C.A. et al.: Am J Perinatol 1999;16:47-50] or in some cases, fetal intervention. Additionally, families can be counseled appropriately regarding the range of outcomes. We report a case of fetal sacrococcygeal teratoma Type I diagnosed at 20 weeks with a prominent vessel supplying the tumor mass. At 23 weeks, there was a sudden appearance of an additional lobular mass, consistent with intrauterine spontaneous ruptured of a sacrococcygeal teratoma mass.     

Sonographic demonstration of fetal sacrococcygeal teratoma

Six cases of sonographically diagnosed fetal sacrococcygeal teratoma (SCT) are presented and illustrate the variable features of fetal SCT. The sonographic findings assisted the parents and perinatal team in making decisions, and in two of the cases the children survived after elective Cesarean section and prompt neonatal resection of the tumors. None of the patients showed signs of malignant degeneration of the teratoma or metastases. Fetal SCT no longer should be considered a uniformly fatal condition. The literature on sacrococcygeal teratoma detected after birth indicates that the mortality rate is correlated with the degree of extension of the tumor. Therefore, the classification of sonographically diagnosed fetal SCT according to its size and position is important for decisions regarding pregnancy management.     

Prenatal resection of a fetal pericardial teratoma

OBJECTIVE: Pericardial teratomas are rare congenital tumors which invade the developing mediastinum, compressing the venous return to the heart, leading to hydrops. Tumors, with large cystic components, have been treated previously with in utero pericardiocentesis with some success. We present the first reported case of in utero open resection of a fetal pericardial teratoma. METHODS: A 31-year-old G1P0 woman was found to have a fetus with a pericardial teratoma. Hydrops developed at 24 weeks' gestation. After counseling, open fetal resection was performed via a fetal median sternotomy. RESULTS: Although the tumor was successfully removed, the hydrops did not resolve. In addition, over the course of 3 weeks, the mother developed maternal mirror syndrome which prompted an emergent cesarean section. Neonatal death ensued shortly after birth. CONCLUSIONS: The fetus with a pericardial teratoma complicated by hydrops is compromised. Treatment options include early delivery, aspiration of the pericardial effusion, and in utero operative resection.     

Diagnosis and management of fetal sacrococcygeal teratoma

Four cases of fetal sacrococcygeal teratomas were managed in Kuwait Maternity Hospital in the previous 2.5 years, making an incidence of 1 in 10,000 deliveries. Three were diagnosed antenatally and one unbooked case presented during labor with dystocia. Polyhydramnios and characteristic ultrasonic tumor echogenicity were documented. Two patients were delivered vaginally after partial excision of the tumor through hysterotomy. In all cases female infants were delivered. Tumor size dictated the mode of delivery being vaginal in cases with maximum tumor diameter less than 10 cm. A single infant survived after tumor excision done 48 h after delivery. All tumors were histopathologically benign. Routine antenatal ultrasonic examinations should allow early diagnosis of such cases to avoid unanticipated dystocia. In the absence of associated major anomalies amniocentesis may relieve maternal symptoms, when necessary, and postpone onset of premature labor, vaginal delivery should be allowed in cases with maximal tumor diameter less than 10 cm. This should be conducted in a center with experienced neonatal and pediatric surgical care.     

Radiofrequency ablation of human fetal sacrococcygeal teratoma

OBJECTIVE: Fetuses with solid, highly vascularized sacrococcygeal teratomas can die as a result of the vascular steal syndrome. This is the first report in which a percutaneous technique, radiofrequency ablation, was used to interrupt blood flow to a sacrococcygeal teratoma in 4 human fetuses. STUDY DESIGN: A radiofrequency ablation probe was percutaneously inserted into the fetal tumor under ultrasonographic guidance. In 2 fetuses a significant portion of the tumor mass was ablated, whereas in the other 2 fetuses only the major feeding vessels were targeted. RESULTS: Two infants were delivered at 28 and 31 weeks' gestation, respectively, and are doing well. In 2 other cases hemorrhage into the tumor led to an unfavorable fetal outcome. CONCLUSION: Ablation of a majority of the tumor tissue in sacrococcygeal teratoma is not necessary and proved fatal in two instances. Targeted ablation of the feeding tumor vessels diminishes blood flow sufficiently to reverse high-output fetal heart failure.     

Prenatal diagnosis of a fetal intracranial immature teratoma

Congenital intracranial teratoma is a rare disease. A fetus with a congenital intracranial teratoma presenting with a hydrocephalus at 27 weeks' gestation is presented. Prenatal ultrasonography and fetal magnetic resonance imaging demonstrated a huge, heterogeneous intracranial mass including the infra- and supratentorial region and polyhydramnios. At 28 weeks' gestation, a cesarean section was performed to avoid divisive operation during delivery. The infant died after 10 min from respiratory failure. Histological examination revealed the diagnosis of immature teratoma. Early detection of congenital intracranial tumors is crucial. The prognosis is poor with death usually occurring shortly after birth.     

Placental teratoma: differential diagnosis with fetal acardia

The acardiac fetus is a rare congenital malformation observed only in monozygotic twin pregnancies (1/35.000 pregnancies). Placental teratoma is extremely rare (less than 20 cases have been reported in the literature since 1925). A case of placental teratoma, misdiagnosed as fetus acardius amorphus, is presented with ultra-sound follow-up, delivery and outcome of the normal fetus. Pathological findings, histogenesis, differential diagnosis with the acardiac fetus and finally review of the literature will be discussed.     

Unusual presentations of ectopic pregnancy. A report of two cases

Extrauterine, or ectopic, pregnancy (EP) is located in the fallopian tube 95-97% of the time. EP occasionally continues to term, either in the abdomen or, more commonly, in the tube or ovary. Fistulae between the conceptus and the abdominal viscera or abdominal wall are most uncommon. Two rare clinical presentations of EP occurred at Good Shepherd Hospital. One was an advanced tubal pregnancy that formed a fistula with the abdominal wall and delivered spontaneously through the fistula, requiring surgical intervention. The second was an early tubal pregnancy that formed a fistula with the ileum, leading to severe rectal hemorrhage.     

Unusual clinical presentations of choriocarcinoma: A systematic review of case reports

Choriocarcinoma (CC) is a highly malignant tumor originating in the trophoblastic tissue. The clinical presentation of CC is so much varied that every case may be one of its kinds and thus can be a diagnostic challenge. Numerous case reports have been published in various journals regarding the unusual clinical presentations of this cancer. Therefore, we conducted a systematic review of all case reports in English language on gestational CC published in PubMed-indexed journals from 1998 to 2015. The main aim was to provide a summary and critical analysis of all the data and evidence published regarding the atypical clinical presentations of CC in recent years. In total, 121 case reports pertaining to unusual clinical manifestations of gestational CC were analyzed. The age of patients in whom cases were reported ranged from 17 to 67 years, and the time period between the index pregnancy and development of CC varied from 4 weeks to as long as 25 years. Cardiopulmonary complaints (20.66%) followed by gastrointestinal (18.43%) and central nervous system manifestations (17.67%) were found to be the most common. Through this review, the authors have made an attempt to discuss various manifestations with which a patient with gestational CC can present to clinician so that early diagnosis and timely management can be initiated, thus improving clinical prognosis.     

Prenatal diagnosis and perinatal management of fetal sacrococcygeal teratoma.

Sacrococcygeal teratoma is the most common fetal neoplasm, with an incidence of 1 in 40,000 births. Fetuses with this malformation are at risk for significant perinatal morbidity and mortality. We identified nine fetuses with sacrococcygeal teratomas that were diagnosed antenatally and managed at the University of North Carolina Hospitals over a 7-year period. We retrospectively reviewed the charts of mothers and infants and recorded data concerning perinatal and surgical management. Six infants survived the neonatal period. All infants diagnosed after 20 weeks' gestation survived. Fetal hydrops developed in three fetuses, all of whom died. Inadequate ventilation secondary to prematurity was a contributing factor in each lethal case. Diagnosis at an early gestational age, development of fetal hydrops, and premature delivery predicted a poor prognosis. When possible, we recommend that delivery be delayed to allow for fetal development. Stabilization of the infant should be attempted before resection of the teratoma.     

Prenatal diagnosis and perinatal management of fetal sacrococcygeal teratoma.

Sacrococcygeal teratoma is the most common fetal neoplasm, with an incidence of 1 in 40,000 births. Fetuses with this malformation are at risk for significant perinatal morbidity and mortality. We identified nine fetuses with sacrococcygeal teratomas that were diagnosed antenatally and managed at the University of North Carolina Hospitals over a 7-year period. We retrospectively reviewed the charts of mothers and infants and recorded data concerning perinatal and surgical management. Six infants survived the neonatal period. All infants diagnosed after 20 weeks' gestation survived. Fetal hydrops developed in three fetuses, all of whom died. Inadequate ventilation secondary to prematurity was a contributing factor in each lethal case. Diagnosis at an early gestational age, development of fetal hydrops, and premature delivery predicted a poor prognosis. When possible, we recommend that delivery be delayed to allow for fetal development. Stabilization of the infant should be attempted before resection of the teratoma.     

Giant hemangioma of the fetal neck, mimicking a teratoma

We present a case involving a giant hemangioma of the fetal neck, prenatal diagnosis of which was a teratoma. A 32-year-old pregnant woman was referred to our hospital at 31 weeks' gestation owing to a giant solid mass of the fetal neck and excessive amniotic fluid. The mass seemed to be occupying the neck almost entirely, extending to the nasopharyngeal cavity, the mandible, the surface of the left orbit and the left shoulder. Based on sonographic and magnetic resonance imaging (MRI) findings, diagnosis of a giant teratoma was made. Cesarean section was performed at 35.5 weeks' gestation, and a female infant weighing 2826 g was delivered. Purpurae were observed on the neck of the infant, and the tumor turned out to be a hemangioma. Postnatal MRI findings, in which the tumor's signal intensity differed from that of the prenatal findings, were quite compatible with the diagnosis of a typical hemangioma. Laser and corticosteroid treatment successfully decreased the volume of the mass. Although it may not always be possible to make a prenatal differential diagnosis between a hemangioma and a teratoma in the neck of the fetus, serial ultrasound and MRI examination are mandatory to evaluate the prognosis and to plan suitable treatment. Moreover, possible postnatal changes to the tumor characteristics have to be taken into consideration when evaluating the findings of prenatal diagnostic imaging.     

Successful management of fetal cervical teratoma using the EXIT procedure

Fetal cervical teratoma is a cause of polyhydramnios, premature labor, and newborn airway obstruction. Formation of a multispecialty team and use of the EXIT procedure is essential for survival of the neonate. Without a team, there is little hope for fetal survival; mortality will be 80–100%. Early diagnosis and planning are essential. Cervical teratomas can contribute to pulmonary insufficiency and chondromalacia because of a mass effect in utero and underdevelopment of the fetal lungs.