Rare case of exomphalos complicated with umbilical cord teratoma in a fetus with trisomy 13

Umbilical cord cysts: Classification, diagnosis, prognosis, and pregnancy recommendations

Umbilical cord cysts (UCCs)-cysts located in the umbilical cord that are derived from an abnormal embryonic development process-are typically an incidental discovery during prenatal ultrasound. It can be described as either a pseudocyst or a true UCC, which results from focal edema or degeneration of Wharton jelly or the remnants of embryonic development, respectively. Due to the relative rarity of the UCC, the clinical guidance of UCCs is not yet available. Herein, the aim of this paper is to discuss the classification, diagnosis, prognosis, and clinical management of UCCs through a literature review, in order to improve the understanding of UCCs among clinical obstetricians and pediatricians.

Umbilical Cord Teratoma - A Short Case Report

Background: Teratomas can occur in the umbilical cord, and may or may not be associated with other congenital abnormalities. Case report: This 35-year-old primigravida gave birth 37-38 weeks to a 3290-g normal female. The umbilical cord, at 10 cm from the abdominal insertion, had an 8 cm mature teratoma. Work-up revealed no other abnormalities. Discussion: Mature teratomas may occur in the umbilical cord, and may or may not have additional clinical sequalae.

Umbilical Cord Teratoma Presenting as Ruptured Omphalocele

Congenital mature teratomas of the umbilical cord are extremely rare. We report on a girl who presented with a ruptured omphalocele and a 7 cm mass connected to the umbilicus, which we resected on the first day of life. Histology revealed mature umbilical cord teratoma . On the 29th day of life, a secondary laparotomy was necessary to address the associated intestinal malformations (megaduodenum, stenotic small bowel with duplication and malrotation). After a prolonged hospital stay, we discharged the patient in age-appropriate conditions. Antenatal diagnosis of an umbilical cord tumor can be challenging in the presence of an omphalocele. Given the high prevalence of associated malformations, the finding of umbilical cord teratoma should be followed by a detailed and comprehensive neonatal workup for additional abnormalities.

Clinically Relevant Prenatal Ultrasound Diagnosis of Umbilical Cord Pathology

Umbilical cord abnormalities are not rare, and are often associated with structural or chromosomal abnormalities, fetal intrauterine growth restriction, and poor pregnancy outcomes; the latter can be a result of prematurity, placentation deficiency or, implicitly, an increased index of cesarean delivery due to the presence of fetal distress, higher admission to neonatal intensive care, and increased prenatal mortality rates. Even if the incidence of velamentous insertion, vasa praevia and umbilical knots is low, these pathologies increase the fetal morbidity and mortality prenatally and intrapartum. There is a vast heterogeneity among societies’ guidelines regarding the umbilical cord examination. We consider the mandatory introduction of placental cord insertion examination in the first and second trimester to practice guidelines for fetal ultrasound scans. Moreover, during the mid-trimester scan, we recommend a transvaginal ultrasound and color Doppler assessment of the internal cervical os for low-lying placentas, marginal or velamentous cord insertion, and the evaluation of umbilical cord entanglement between the insertion sites whenever it is incidentally found. Based on the pathological description and the neonatal outcome reported for each entity, we conclude our descriptive review by establishing a new, clinically relevant classification of these umbilical cord anomalies.

Placenta Teratoma or Acardiac Fetus Amorphous: A Case Study by DNA Genotyping

To date, 40 cases of placental teratoma and 21 cases of umbilical cord teratoma have been reported in the literature. Such entities are purportedly described as originating from ectopically derived totipotential germ cells forming 1 or more of 3 germ layers, similar to teratomas arising in other sites. These entities have been described as distinct from acardiac twins based on the absence of both an axial skeleton and/or separate umbilical cord attachment. We present a case that would be compatible with placental teratoma according to these criteria. However, DNA genotyping analysis of the "teratoma" and its corresponding normal placental tissue revealed an identical genetic profile at all microsatellite polymorphic loci with exception of one locus demonstrating loss of heterozygosity involving 1 of 2 "teratoma" samples tested. Our finding established that the "teratoma" in fact represented a monozygotic acardiac (amorphous) twin with aberrant division of embryogenesis as a continuum of the monozygotic twinning phenomenon. In summary, this is the first case study of so-called placental teratoma by DNA genotyping investigation. We conclude that the diagnostic term "placental teratoma" should be discouraged unless evidence of monozygotic twining can be ruled out by molecular genotyping.

A fetus with an immature umbilical cord teratoma associated with exomphalos: case report and review of the literature

Objective: To describe the antenatal and pathological features of an immature umbilical cord teratoma associated with exomphalos, and to review the literature on this subject. Case presentation: An abdominal wall defect, suspected to be an exomphalos, was identified during routine ultrasound examination performed at 13 weeks of gestation. The pregnancy was terminated. Fetopathological examination revealed an immature umbilical cord teratoma associated with exomphalos. Chromosomal microarray analysis was normal. Conclusions: Umbilical cord teratomas, albeit very rare, should be emphasized as a possible differential diagnosis when abdominal wall defects are detected. Since cord teratomas may lead to adverse fetal or neonatal outcomes, close follow-up of the fetus is recommended.

Case Report: A Rare Case of a Combination of Omphalocele With Umbilical Teratoma

Omphalocele is a congenital malformation of the abdominal wall, which occurs with a frequency of 1-5,000 newborns. The prognosis of treatment often depends on the presence of concomitant malformations. The most common contents of the hernia with omphalocele are the intestinal loops, liver, spleen. However, all organs of the abdominal cavity can be part of the hernial sac with large sizes of omphalocele. Teratoma is a germ cell tumor made up of several different types of tissue, such as hair, muscle, teeth, or bone. They are a type of germ cell tumor and divided into two types: mature and immature. In this article, we describe a rare case of a combination of an omphalocele with a mature teratoma and report the successful single step surgical treatment. On the first day after birth, a simultaneous operation-Removal of teratoma with abdominoplasty was performed. The postoperative period was uneventful, and the child was discharged for recovery.

Umbilical Cord Teratomas Associated With Congenital Malformations

CONTEXT.—

Congenital mature teratomas of the umbilical cord are extremely rare and pose a challenge in prenatal diagnosis. Mature teratomas are defined as tumors composed of mature tissues derived from more than 1 germ cell layer. The tumor often shows solid and cystic components, which adds to the difficulty of prenatal diagnosis. Although benign, mature teratomas of the umbilical cord are commonly associated with congenital malformations of the fetus with variable severity and rarely, with chromosomal abnormalities.

OBJECTIVE.—

To review the clinical, radiologic, gross, and histologic features of umbilical cord teratoma; its differential diagnosis; and to emphasize the increased risk of associated congenital malformations.

DATA SOURCES.—

Umbilical cord teratoma cases published in the literature.

CONCLUSIONS.—

Umbilical cord teratomas are difficult to diagnose by imaging studies alone and require histopathologic examination for diagnosis. Given the increased risk of associated anomalies and malformations, the finding of umbilical cord teratoma should trigger a detailed and comprehensive evaluation of the neonate for additional abnormalities.

Sacrococcygeal Teratoma associated with Trisomy 13

Sacrococcygeal teratoma (SCT) is rarely associated with syndromes. We report a female newborn with a prenatal diagnosis of small sacrococcygeal teratoma and postnatally diagnosed as having trisomy 13. The sacrococcygeal teratoma was excised. It was reported as mature teratoma. The child succumbed to sepsis postoperatively.

Sacrococcygeal teratoma in a female newborn with clinical features of trisomy 13: a case report from Central Africa

Introduction

The objective of this report is to describe the first patient presenting clinical features of trisomy 13 in association with a sacrococcygeal teratoma.

Case presentation

We present the case of a Congolese female infant born with bilateral cleft lip and palate, hypotelorism, microcephaly, and capillary hemangioma on her face. She presented with a large sacrococcygeal mass (15.0 cm ×12.0 cm ×5.0 cm) with a cystic consistency and a positive transillumination.

Conclusion

This observation suggests that overexpression of certain genes on chromosome 13 may lead to tumor formation from remnant cells of Hensen’s node.

Comprehensive imaging review of abnormalities of the umbilical cord

A complete fetal ultrasonographic (US) study includes assessment of the umbilical cord for possible abnormalities. Knowledge of the normal appearance of the umbilical cord is necessary for the radiologist to correctly diagnose pathologic conditions. Umbilical cord abnormalities can be related to cord coiling, length, and thickness; the placental insertion site; in utero distortion; vascular abnormalities; and primary tumors or masses. These conditions may be associated with other fetal anomalies and aneuploidies, and their discovery should prompt a thorough fetal US examination. Further workup and planning for a safe fetal delivery may include fetal echocardiography and karyotype analysis. Doppler US is a critical tool for assessment and diagnosis of vascular cord abnormalities. US also can be used for follow-up serial imaging evaluation of conditions that could result in fetal demise. Recent studies suggest that three- or four-dimensional Doppler US of the fetal umbilical cord and abdominal vasculature allows more accurate diagnosis of vascular abnormalities. Doppler US also is invaluable in assessment of fetal growth restriction since hemodynamic changes in the placenta or fetus would appear as a spectral pattern of increased resistance to forward flow in the fetal umbilical artery. Early detection of umbilical cord abnormalities and close follow-up can reduce the risk of morbidity and mortality and assist in decision making.

Immature teratoma at umbilicus region presenting as exomphalos: A case report with review of literature

Umbilical cord neoplasms are rare. Teratomas, which are accepted as the only true neoplasms at this site, are exceptional. These tumors are polymorphic in their presentation and are often associated with other abnormalities, with exomphalos being the most common abnormality. Histologically these tumors show mature tissues from all the three-germ layers. Immature elements as seen in our case are rare. Germ cells which have gone astray during embryonic development are thought to be the cells of origin of these tumors.

Intracranial teratoma in children: the role of chromosome 21 trisomy

Teratomas are very rare intracranial tumors and cytogenetic information on this group remains rare. We report a case of a mature teratoma with abnormal +21 trisomy in tumor karyotype ocurring in a non-Down syndrome(DS) infant. Additionally, the evidence for the contribution of chromosome 21 trisomy in this neoplasia are briefly reviewed. The 6-month-old male baby presented with a posterior fossa tumor. Histological evaluation of tumor specimen showed a mature teratoma composed of fully differentiated ectodermal, mesodermal and endodermal components. Although somatic karyotyping of the index case was normal, composite tumor karyotype depicted 47,XY,+21[6]/46,XY[6]. Besides previous reports of children with DS and intracranial teratomas, this is the first report to describe the occurrence of an isolated chromosome 21 trisomy within the tumor of a non-DS child. The participation of chromosome 21 in this rare pediatric tumor, either somatic or restricted to tumor specimen,may deserve special interest and further investigation.

Prenatal diagnosis of fetal umbilical cord teratoma

Umbilical cord teratomas are rare tumoral lesions of umbilical cord which have challenging antenatal diagnosis. The cord teratomas contain tissue from all three germ layers and have both cystic and solid components. This ultrasonographic appearance may help the clinician to clarify the correct diagnosis. We report a case of cord teratoma diagnosed prenatally by ultrasonography and magnetic resonance imaging. Since cord teratomas may lead to adverse fetal outcomes, close follow-up of the fetus is recommended.

[Giant teratoma of the umbilical cord associated with foetal malformations: a morphological and cytogenetic study]

We report on an unusually large teratoma of the umbilical cord associated with multiple fetal anomalies. At 18 WG, an umbilical cord tumour was discovered by ultrasonography in a 38 year-old woman. A 2680 g female neonate (46, XX) was delivered at 37 WG by caesarean section. During surgery for exomphalos, a complete bowel malrotation, ischemic jejunal stenoses and bowel duplication were discovered. The tumor (2515 g) was a teratoma supplied by collaterals of the umbilical vein. Proliferative index calculated by flow cytometry was less than 10%. Tumor karyotype revealed several numerical anomalies with no structural abnormalities using multi-FISH analysis. Immunostaining for CEA and AFP were observed in endodermic derivatives of the duplication and associated with transient high levels of AFP in the blood. To our knowledge, it is the first case to be reported in the literature where karyotype, multi-FISH and FCM studies were available.