The Children's Hospital of Philadelphia
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What Families and Physicians Should Know About Teratomas — Types of Teratomas

N. Scott Adzick, MD: We can have teratomas in various sites in the body, usually based on the midline. Some are cystic, contain large fluid filled spaces. Some are solid and highly vascular, the blood supply to them is very rich. And there is some that are a mixture of cystic and solid components.

Alan W. Flake, MD: Cystic teratomas are almost like balloons. They have a very thin outer rim and they contain a large amount of fluid inside the cyst. And the cyst can be single, or they can be multiple cysts that are separated by membranes. A solid teratoma, on the other hand, is like any tissue; it's firm, comprised of either spongy or solid components, and all of that contains blood vessels that run throughout the tumor.

Lori J. Howell, RN: There are those that occur in the neck. There are those that occur in the chest. And then there are those that occur in the sacral area right off the butt.

N. Scott Adzick, MD: A sacrococcygeal teratoma, we call them an SCT, is a teratoma that arises from the tailbone, from the sacrococcygeal area, from the coccyx.

Alan W. Flake, MD: It's an area called "Hensen's node," named after pathologist, and it contains a cluster of pluripotent stem cells, so stem cells that can turn into any tissue of the body.

N. Scott Adzick, MD: -- and there are four types. type I is predominantly on the outside of the baby.

Alan W. Flake, MD: So it grows out of the fetus, rather than into the fetus.

N. Scott Adzick, MD: Type II is mostly external, but a small internal component that comes up through the pelvic ring.

Alan W. Flake, MD: Type IIs can manifest more problems with compression of pelvic structures like urinary output, the urethra, the bowel, et cetera.

N. Scott Adzick, MD: Type III is principally internal through the pelvic ring and can get quite large in the abdomen but still a small external component, so you can see it.

Alan W. Flake, MD: And in that circumstance, the tumors can cause complications related to compression of intra-abdominal structures.

N. Scott Adzick, MD: And type IV is the mysterious one because that's all on the inside and, in a newborn baby who has this, you might not even notice it, of course.

Alan W. Flake, MD: Because they aren't detected early, type IV's often evolve into malignancies before they're noticed in children. It's one of the advantages of prenatal diagnosis is that if you can recognize a type IV before birth, you can remove it early on and perhaps prevent the malignancy.

N. Scott Adzick, MD: It is better as a whole to have a largely external sacrococcygeal teratoma. Once there's an internal component, bad things can occur. The urinary tract can get blocked, the tumor can grow up into the spinal canal and, most importantly, one cannot treat by fetal surgery those fetuses who have a large teratoma with a large internal component because one can't resect the internal component safely before birth.

Alan W. Flake, MD: A cervical teratoma is a teratoma that forms in the neck. And teratomas in the neck are like other teratomas in that they contain all types of tissue.

N. Scott Adzick, MD: Cervical teratomas can be cystic, solid, or a combination or both. Many are a combination of both, actually.

Alan W. Flake, MD: The most common problem that cervical teratomas cause is distortion of the airway or compression of the trachea and airway in the neck.

Mark P. Johnson, MD: So that after delivery there's no way for the baby to breathe.

Alan W. Flake, MD: And that's the reason that we need to follow them closely and ultimately deliver them by an EXIT procedure to establish an airway in the fetus.

N. Scott Adzick, MD: A mediastinal teratoma is a fancy expression for a teratoma in the midline in the chest.

Alan W. Flake, MD: The mediastinum is the compartment between the lungs that surrounds the heart. And the typical mediastinal teratoma forms in the upper mediastinum, above the heart, in front of the trachea and airways.

N. Scott Adzick, MD: The main problem with mediastinal teratomas is just space occupying, taking up space in the tiny fetal chest.

Alan W. Flake, MD: So the heart can be squished downward against the diaphragms, the lungs can be pushed to the side, and the airway can be flattened behind the tumor.