>> 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.
>> 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.
>> 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.
>> A SACROCOCCYGEAL TERATOMA, WE CALL THEM AN SCT,
IS A TERATOMA THAT ARISES FROM THE TAILBONE,
FROM THE SACROCOCCYGEAL AREA, FROM THE COCCYX.
>> 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.
>> AND THERE ARE FOUR TYPES.
TYPE I IS PREDOMINANTLY ON THE OUTSIDE OF THE BABY.
>> SO IT GROWS OUT OF THE FETUS, RATHER THAN INTO THE FETUS.
>> TYPE II IS MOSTLY EXTERNAL, BUT A SMALL INTERNAL COMPONENT
THAT COMES UP THROUGH THE PELVIC RING.
>> TYPE IIS CAN MANIFEST MORE PROBLEMS WITH COMPRESSION
OF PELVIC STRUCTURES LIKE URINARY OUTPUT, THE URETHRA,
THE BOWEL, ET CETERA.
>> 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.
>> AN IN THAT CIRCUMSTANCE, THE TUMORS CAN CAUSE COMPLICATIONS
RELATED TO COMPRESSION OF INTRA-ABDOMINAL STRUCTURES.
>> 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.
>> BECAUSE THEY AREN'T DETECTED EARLY, TYPE IVS 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.
>> 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.
>> 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.
>> CERVICAL TERATOMAS CAN BE CYSTIC, SOLID,
OR A COMBINATION OR BOTH.
MANY ARE A COMBINATION OF BOTH, ACTUALLY.
>> THE MOST COMMON PROBLEM THAT CERVICAL TERATOMAS CAUSE IS
DISTORTION OF THE AIRWAY OR COMPRESSION OF THE TRACHEA
AND AIRWAY IN THE NECK.
>> SO THAT AFTER DELIVERY THERE'S NO WAY FOR THE BABY
TO BREATHE.
>> 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.
>> A MEDIASTINAL TERATOMA IS A FANCY EXPRESSION FOR A TERATOMA
IN THE MIDLINE IN THE CHEST.
>> 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.
>> THE MAIN PROBLEM WITH MEDIASTINAL TERATOMAS IS JUST
SPACE OCCUPYING, TAKING UP SPACE IN THE TINY FETAL CHEST.
>> 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.