The Children's Hospital of Philadelphia
www.chop.edu
What Families and Physicians Should Know About Teratomas — Diagnosing a Teratoma

Stefanie Kasperski: Yes, good morning; this is Stefanie Kasperski. I'm one of the coordinators here at the Center for Fetal Diagnosis and Treatment. I understand that you have some questions.

Lori J. Howell, RN: Before a family even arrives, we have reviewed their prenatal records and have set up a comprehensive evaluation that will occur in one day so that by the end of the day, they'll have the answers they need to make the best decision they can for their pregnancy.

Victoria Dougherty, parent of Josephine: You want answers, and you want answers right away so that you can start feeling like you have, you know, a handle on the situation.

N. Scott Adzick, MD: The diagnosis can be tricky, particularly in the early - to mid-gestation.

Alan W. Flake, MD: Misdiagnosis can occur with any fetal diagnosis and, because of that, when ever we're referred a patient, we always reevaluate that patient with our own imaging.

N. Scott Adzick, MD: -- which includes maternal fetal ultrasound, very detailed, looking at the characteristics of the teratoma and also to make certain that there is nothing else wrong, an ultra-fast fetal MRI, which is another way of getting anatomic information, and the third crucial test is a fetal echocardiogram, a look at the fetal heart just to look at fetal heart performance in particular.

Victoria Dougherty: It was actually strangely comforting and meditative going through the tests because you felt like this process was starting to happen and that at the end of the day you were going to know something.

N. Scott Adzick, MD: We think it's extremely important for the mother to have at least the ultrasound, the MRI and the echocardiogram done in one day, one after the next, meet with our genetic counselors, our advanced practice nurses, have some financial counseling, if need be, and then to meet with the team at the end of the day so we can review the findings and go through our recommendations.

Victoria Dougherty: No one was going to tell me, "Everything's going to be all right," because they couldn't tell me that. And no one was going to say, "This is how we think the teratoma's going to grow -- "Because they couldn't tell me that. They could say, "This is how we hope it's going to be, and we're going to keep monitoring it. And if it continues in this vein, this is what will probably happen." But, you know, at that point in time there were a lot of "ifs" and a lot of question marks.

Lori J. Howell, RN: A major focus of our program is to provide education of families.

Victoria Dougherty: My questions were answered, and I felt like we could move forward and start making decisions. And I also felt like I needed to hear a very sobering diagnosis, and I needed to hear what could happen.

Lori J. Howell, RN: It's very important to us that families leave here knowing what their diagnosis is and how best to take care of them the rest of the pregnancy.