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Published in Under the Rainbow on May 01, 2014
A peacefully sleeping Marissa gets a kiss from mom Tambra Posey.
A peacefully sleeping Marissa gets a kiss from mom Tambra Posey.

Safe Arrival

At just 24 weeks into her pregnancy, Tambra Posey went in for what she thought was a routine screening. Instead, she was told her growing baby girl had a growing tumor.

Dr. Barry Berch, right, assistant professor of pediatric surgery, and Dr. James Bofill, professor of maternal fetal medicine, examine Marissa in the neonatal intensive care unit, where she stayed for seven weeks after her birth.
Dr. Barry Berch, right, assistant professor of pediatric surgery, and Dr. James Bofill, professor of maternal fetal medicine, examine Marissa in the neonatal intensive care unit, where she stayed for seven weeks after her birth.

Posey scoured the internet for information on the diagnosis – sacrococcygeal teratoma (SCT).

The facts didn’t faze her.

SCTs are one of the most common tumors in newborns, occurring in 1 in 35,000 to 40,000 live births.

SCTs develop from the fetus’ tailbone and can grow to tremendous sizes.

SCTs are a serious fetal condition and can cause heart failure in the fetus.

The images did.

“I was fine until I saw pictures and I started crying,” Posey acknowledged.

And anyone would. The pictures are gruesome and frightening; large masses distorting tiny bodies.

“I didn’t know what was in store. How big would it get? Would they have to take her early? Would it hurt her heart?”

She would find some answers and some peace of mind from team members at the University Center for Maternal and Fetal Care – a group of obstetric and pediatric specialists who collaborate to get moms and babies through complex pregnancies. The maternal-fetal medicine team sees an average of one SCT every two years.

“We practice high-risk obstetrics,” said Dr. James Bofill, professor of maternal fetal medicine. “So we watch the mom, but we also do a good deal of prenatal diagnosis to make sure that the baby appears normal in its growth and development.”

A sacrococcygeal teratoma
A sacrococcygeal teratoma

The team assured Posey that her baby girl had developed normally to that point, in spite of the SCT.

Like many fetal anomalies, the closer a baby is to full-term at birth, the better. With a wait-and-see approach, attention turned to the baby’s heart.

“What made this difficult is that this was a rapidly growing tumor,” Bofill said. “It was growing so quickly that it was stealing blood from the baby and the placenta and becoming a bigger burden day-by-day.”

Although Posey said everyone on the team made things as easy as possible for her, she admits to questioning what she had done to cause this.

Team members assured her there was nothing she could’ve done any differently.

The truth is that no one knows what causes these errant cells to miss their marching orders to become muscle or bone or skin and develop into these tumors instead.

“I felt like they were watching us really closely,” Posey said. “They just kept telling me, ‘You’re okay, she’s okay.’”

Dr. Barry Berch, assistant professor of pediatric surgery, who met with Posey to discuss the process for removing the tumor, believes putting a mom at ease and 

berch_bofill_headshots

answering the inevitable questions are part of the process.

“This can be scary and I think having multiple specialists telling her it’s going to be okay just provides some peace of mind,” Berch said.

Several weeks passed uneventfully until two days before Christmas when Posey went in for a 30-week checkup feeling like she was going into labor.

Marissa swaddled in her crib in the neonatal intensive care unit.
Marissa swaddled in her crib in the neonatal intensive care unit.

Her doctor put a fetal heart monitor on her and realized that the baby’s heartbeat was dropping periodically. He sent her straight to UMMC.

“We got here and they said, ‘You’re having this baby today.’”

A few hours later Marissa Re-Ane arrived safely in this world via emergency cesarean section, ten weeks before her March 5 due date. She weighed four pounds and 13 ounces. The tumor accounted for more than a third of her total weight.

One week later, Berch surgically removed the tumor and part of Marissa’s tailbone – a precautionary move to prevent regrowth. She stayed in the neonatal intensive care unit for seven weeks and her scar is healing well according to Berch.

“SCTs of this variety are rare and it is very satisfying to get a mother and baby treated successfully,” Berch said.

A battle had been won but the war was not over.

There was one unanswered question remaining; one thing that Posey would not find out until Marissa was born and the mass was removed.

Would it be cancerous?

According to Bofill, only about five percent of SCTs have a malignant component and unfortunately, Marissa’s was one of the five percent.

The usual course of treatment at this point is intense chemotherapy to kill whatever cancer cells remained in Marissa’s tiny body.

“…with Marissa’s preterm status and size, we as a group chose not to give chemotherapy at this time since the tumor was completely resected,” said Dr. Sharon McDonald, assistant professor of pediatric hematology-oncology.

McDonald watched as Marissa’s high alpha-fetal protein levels – a key indicator of relapse – dropped into the normal range.

She is considered in remission from cancer.

But with a recurrence rate of about 20 percent, Marissa will be followed by the Children’s Cancer Center at Batson Children’s Hospital for the next couple of years where she will undergo routine imaging to make sure the tumor does not begin growing again and her alpha-fetal protein levels will continue to be monitored.

“They keep telling me she’s doing good,” Posey said.

To look at her now, swaddled in a blanket sucking peacefully on a pacifier, one would never know what it took to get her to this point or if struggles may lie ahead.