Sacrococcygeal teratoma.

OBJECTIVE: Description of newborn with early prenatal diagnosis of sacrococcygeal teratomia. Desing: Case report. SETTING: Department of Obstetrics and Gynecology, 2nd Faculty of Medicine and Faculty Hospital Motol Prague. CASE REPORT: In this case report a term neonate with a massive sacrococcygeal teratoma was delivered by a cesarean section (approach by Geppert) with an intrapartal relieving punction of the tumor. It was a type II SCT with both pelvic end extracorporal component with a size of 60×35 centimeters. The tumor was completely resected during the first day of life and was followed by a normal function of lower extremities, normal bowel function and only transitional urinary tract symptoms. CONCLUSION: A sacrococcygeal teratoma (SCT) is the most common congenital tumor in newborns with reported incidence of 1:35000-40000 live births affecting more frequently females (4:1). This germinal tumor is either benign (mature) or malignant (immature), mature types are more common in neonates. A SCT is usually diagnosed by prenatal ultrasound, magnetic resonance is performed to characterize its size and content, type of tumor (type I-IV Altman classification) and relation to surrounding tissues. Preemptive early delivery by cesarean section is recommended when the tumor exceeds the diameter of 5 centimeters to avoid complications during vaginal delivery (rupture, bleeding etc.). The primary treatment of SCT is an early surgical resection with a complete resection of the coccyx („en bloc“ resection), malignant tumors are indicated for adjuvant chemotherapy. Long term complications can be urinary tract or bowel dysfunctions, lower extremity muscle weakness or paralysis and recurrence of the tumor with potential malignancy.

[Diagnostics of the retrocalcaneal bursitis: possibilities of the use of new anatomical data]. / Diagnostika retrokalkaneárních burzitíd: moznosti vyuzití nových anatomických poznatku.

The anatomy and histology of the normal retrocalcaneal bursa (RB) was studied on both embalmed and fresh cadaverous material. The bursa is a constant structure, its upper and posterior walls are completely covered with the unilayered synovial membrane. Its anterior wall represents the superior facet of the calcaneal tuberosity, the posterior one corresponds to the anterior surface of the insertional part of the Achilles tendon. The superior wall is formed by the adipose tissue of the inferior part of Kager's triangle, extending into the cavity of the bursa in a form of constant large and irregularly shaped synovial fold. The normal anatomical features as well as some pathological changes of the bursa and its neighbourhood were demonstrated on examples of some case reports, by use of the ultrasonography and magnetic resonance investigations. In healthy individuals the space of the bursa was not figured in the ultrasonographic investigations, but was well apparent in the MR images. The pathological changes of the bursa are detectable by using of both methods, but the MR images present substantially precise quality of depiction. The authors recommend the use of presented new anatomical data for the improvement in differential diagnostic of the wide spectrum of achillar enthesopathies.