Presacral tumor: a review of forty-five cases

Forty-five patients with primary presacral tumors underwent their treatment at Division of Colon Rectal Surgery, Chang Gung Memorial Hospital, from 1978 to 1992. These 45 patients, 20 male and 25 female, ranged from 15 to 76 years of age (mean, 41.1 years). Congenital tumors (47 per cent) were the most frequent histologic type, followed by miscellaneous tumors (36 per cent). Forty-eight per cent of patients had malignant tumors. All benign congenital cysts were in females. These tumors presented a variety of symptoms and signs. Diagnosis could be made by digital examination in 43 (96 per cent) of the patients. Computed tomographic scan was the most important diagnostic tool in determining the extent and degree of tumor invasion. The positive rate was 100 per cent in 21 patients. As for operative methods, abdominal approach was selected in 24 patients, transacral in 13 patients, abdominal/sacral combined in 6 patients, and biopsy only in two patients. Postoperative complications occurred in 16 patients (36 per cent), but there were no operative deaths. Of the tumors that underwent resection, 23 had total resection (18 benign and 5 malignant) and 22 incomplete (5 benign and 17 malignant). Benign tumors had a good chance with resection of the lesion (P < 0.05). For patients with malignant tumors, the 5-year survival rate was 40.7 per cent. Whenever possible, total resection could offer better results for presacral tumor, whether the lesions were benign or malignant.

[Malignant neonatal tumors]

Malignant neonatal tumors are rare (2% of childhood cancers, 1-2 cases/30,000 births). However, specificities in diagnosis and therapy must be underlined at this period of life; furthermore, the possibilities of antenatal sonographic diagnosis are improving and it may contribute to increase their incidence. Topographic analysis allows etiologic investigations since these tumors have the same diagnostic features as compared with older children, except Pepper's syndrome and leukemias. Therapeutic management depends on a rather good prognosis and fragility of such newborn. Indeed, surgical excision is the main step of treatment. Radiotherapy must be avoided whenever possible. Chemotherapy may be indicated (metastatic or unresectable tumors, omission or delay of irradiation in brain tumors) and has to be elaborated cautiously, according to the peculiar physiology of the neonate. Whatever the therapeutic strategy is, neonatal homeostasis must be well balanced, which implies a multidisciplinary specialized team. Respecting these conditions will help to cure more than the present 50% and better for future well being of such children.

Survey of congenital tumors in perinatal necropsies

In an audit of 17,417 necropsies from 1939 to 1989 at the Royal Women's Hospital, Melbourne, Victoria, 46 congenital tumors comprising 24 teratomas, 8 vascular tumors, 6 neuroblastomas, three rhabdomyomas, two mesoblastic nephromas, one thyroid adenoma, one hepatic adenoma and one cerebellar medulloblastoma were found. The teratomas were generally large tumors and, because of their size and location, incompatible with extrauterine life. Ten teratomas were associated with polyhydramnios, three with obstructed labour, five of the fetuses were hydropic and four had malformations at sites distant to the tumor. Twenty teratomas occurred in stillbirths, half of whom were macerated. The vascular tumors were associated with polyhydramnios in three cases and hydrops fetalis in two. The neuroblastomas were all incidental findings. Four were intra-adrenal, one was an adrenal tumor which had metastasized to the liver and the remaining case was a small paravertebral lesion. Two of the three rhabdomyomas were multiple and one of these occurred in a case of tuberous sclerosis. One of the mesoblastic nephromas occurred in a hydropic fetus who had the Arnold-Chiari malformation. The thyroid and hepatic adenomas were small incidental lesions. The cerebellar medulloblastoma had led to marked hydrocephalus. Congenital tumors have different incidence, presentation and behaviour than those in childhood or adult life. The association of congenital tumors with congenital malformations and hydrops fetalis should always be remembered.

Juvenile hyaline fibromatosis: a report of two severe cases

Two unrelated children with a severe form of juvenile hyaline fibromatosis are described. In addition to painful flexion contractures of all of the large joints, oral and skin lesions, and typical radiologic appearance of osteolytic defects, both girls had marked growth retardation and recurrent infections. Both children died in early infancy of overwhelming infection.

Prenatal diagnosis of fetal tumors by ultrasonography

Fetal tumors lead to serious illness or even death in the fetal or neonatal period. Problems vary from severe hydrops to underdevelopment of fetal organs. In some instances a tumor may cause mechanical obstruction during the birth process. Polyhydramnios frequently develops. Adequate prenatal diagnosis is of utmost importance. Timely detection of the fetal tumor prevents traumatic birth and postnatal care and treatment can be scheduled. This report is a review of the relevant recent literature and the tumors detected in our ultrasound unit between 1982 and 1988. The ultrasonographic appearance, clinical course, and differential diagnosis of the tumors are discussed.

[Neonatal tumors]

We review the cases of congenital and neonatal tumors treated at the Children's Hospital La Fe, Valencia. A total of 25 cases of neonatal benign tumors and 27 cases of malignant tumors were diagnosed. The most frequent benign tumor was solid teratoma (12 cases). The most frequent malignant tumor was neuroblastoma (14 cases). Variations in histology, clinical evolution and therapy in relation to age are described. The results obtained are compared with those previously published.

Maternal exposure to spermicides in relation to certain birth defects

Several studies have found no increase in the overall frequency of birth defects in association with the use of spermicides, but the possibility of an increase in specific defects remains. We evaluated this possibility in a large case-control study. Infants with certain malformations (265 with Down's syndrome, 396 with hypospadias, 146 with limb reduction defects, 116 with neoplasms, and 215 with neural-tube defects) were compared with 3442 control infants with a wide variety of other defects. Exposure to spermicides was assessed for three periods: use during the periconceptional period (one month before through one month after the last menstrual period), use during the first trimester (the first four lunar months of pregnancy), and any use during the lifetime. For the five groups of cases and for each interval, the odds ratios were close to 1.0 (range, 0.7 to 1.3); the upper 95 percent confidence bounds were 2.2 or lower. Risks did not increase with the duration of exposure. When each of the active ingredients in currently available spermicides was considered separately, no differences in odds ratios were apparent between the types of spermicides. With the possible exception of a subgroup of cases (limb reduction defects of unknown cause), these results suggest that risks for the five specific birth defects evaluated are not increased by exposure to spermicides.

Diagnosing congenital malformation in utero: ultrasound

The value of antenatal ultrasound in the detection of fetal defects is discussed in this article. The ways in which ultrasound diagnoses are made are reviewed as well as several of the most important anomalies that may be detected with this diagnostic tool.

[Sonographic diagnosis of severe fetal malformations]

The present paper reports on results of ultrasonographic examination in the identification of severe congenital malformations in the period between 1975 and 1982. The incidence of severe congenital malformations in relation to the total number of births during this period was 159 out of 11,372 (1.4%). In 144 cases with severe malformations at least one antenatal ultrasonographic examination had been performed. According to their topographic location, 42% of these were head/neural tube defects, 38% trunk/organ defects, only 2% were severe defects of the extremities and 18% were rare fetal malformations. As a result of previous ultrasonographic examinations at specialists' practices 60% of the cases were referred to the authors' clinic for further clarification with a correct diagnosis or a suspected fetal malformation. Of all the sonographically demonstrable structural defects of the fetus, 81% of all severe fetal defects seen at the authors' clinic during the period in question were identified correctly. If the observation period is divided into the years 1975 to 1979 and 1980 to 1982, there is a striking rate of increase in the number of antenatal ultrasonographic diagnoses which were correct, from 71% in the first period to 86% between 1980 and 1982. Most of the false-negative ultrasonographic findings were congenital cardiac abnormalities, since up to that point no special fetal echocardiographic examinations had been performed. In the entire period covered by the investigation there was only one false-positive finding ("Potter's syndrome"). Forty-six per cent of the ultrasonographically demonstrated severe fetal malformations were diagnosed before the end of the 24th week of pregnancy, and 54% after the end of the 24th week of pregnancy. Only in 60 out of 141 cases (43%) with severe fetal malformations was the quantity of amniotic fluid found to be normal; 26% of the cases had hydramnios and 31% oligohydramnios. Pathologic movement behaviour had been registered ultrasonographically in 43% of the cases with severe fetal malformations; biometric dimensions of the biparietal cranial diameter and the transverse diameter of the thorax (greater than 10th percentile to 90th percentile, according to the percentile growth curves of Schmidt, 1982) corresponding to gestational age had only been measured in 30% and 50%, respectively, of the cases with fetal malformations. During the entire period covered by the investigation, from 1975 to 1982, only 16 children born at term (between the 38th and 42nd weeks) had severe malformations which had not already been diagnosed.(ABSTRACT TRUNCATED AT 400 WORDS)

Perinatal (congenital and neonatal) neoplasms: a report of 110 cases

One hundred ten congenital and neonatal tumors encompassing a 25-year period are described and compared with similar published cases. Forty percent are classified as histologically malignant, and 65% of neonates with malignancies died. The types, frequency, and clinical features of neoplasms encountered in the perinatal period are markedly different from those observed in older children and adolescents. Their biological behavior and response to therapy are also dissimilar. Leukemia was responsible for the largest number of deaths followed by neuroblastoma and brain tumors.

Congenital subungual nevus

A 4-month-old infant with a congenital, darkly pigmented, macular lesion involving the subungual and periungual areas of the right ring finger is described. The lesion was excised when the infant was 6 months old in order to rule out a congenital pigmented nevus as well as a congenital acrolentiginous melanoma. Histopathologic examination revealed a compound nevus. Nevi in this location are very rare in Caucasians at any age and should probably be excised to rule out malignant melanoma.

Cancer in neonates: the experience at the Children's Hospital of Philadelphia

Among 22 neonates treated at the Children's Cancer Research Center of Philadelphia, 11 had neuroblastoma, which in two cases was widely metastatic. There were three infants with teratoma, three with sarcoma, three with leukemia, one with Wilms' tumor, and one with parotid carcinoma. Nine of eleven patients (82%) are long-term survivors following complete surgical excision of tumor, whereas only one of eight (13%) has survived following incomplete surgical excision. All three neonates with leukemia died. The overall two-year actuarial survival is 45% (10/22). The problems associated with treating neonates with chemotherapy, radiation therapy, or both are especially difficult because of the immaturity of the organs and structures. Surgical excision alone has been the treatment of choice for solid tumors. Chemotherapy or radiation therapy, when indicated, require careful monitoring for both acute toxicities and potential long-term morbidities.

Pathogenesis of congenital tumors and malformations of the sacrococcygeal region

Skin-covered lesions in the sacrococcygeal region include an unusual array of congenital tumors and malformations. Excluding the easily recognized meningomyelocele, there are over 50 other conditions that occur, many of which seem to be important in linking the disciplines of teratology and oncology. While it is impossible to precisely determine the manner in which these arise, there is suggestive evidence that early structures incorporated within the caudal cell mass of the embryonic tail may play an important role. The present paper reviews the basis for this speculation from both the literature and a series of 136 cases.

Dystocia, consumptive coagulopathy, and cardiac failure as complications of a congenital benign mesenchymoma

A congenital benign mesenchymoma which arose in the right foot resulted in dystocia. Shortly after birth, high-output cardiac failure developed secondary to abnormal shunting in the extensive irregular vasculature. Consumptive coagulopathy also occurred, believed to be the result of widely dilated abnormal vessels and extensive necrosis secondary to the trauma of the dystocia. These problems disappeared after resection of the tumor; there has been no recurrence after 2 years.

[Congenital malignant neoplasms]

In order to determine the proportion of congenital neoplasias, a study of 1 076 malignant neoplasias was carried out at the Pathology Department of the Hospital Infantil de Mexico. As unquestionably congenital malignant neoplasias were considered those detected since birth and as possibly congenital, those identified during the first year of life of the patient. As a whole, in this series of neoplasias, approximately one case was found of the sum of the congenital group and the possibly congenital, to 4.5 of the total series. However the proportion of the group of congenital malignant neoplasias and that of possibly congenital varied for each type of neoplasias in particular. Excluding malignant neoplasias of hematopoietic tissues, retinoblastoma, nephroblastoma and neuroblastoma were the malignant neoplasias most frequently found.

Neonatal oncology

All known tumor types have been reported in the neonate. A numerical listing and discussion are beyond the scope of this review. Wells and Fraumeni give some insight into common congenital malignant neoplasms. Table 2 lists the percentage of neonatal deaths caused by type-specific cancers. Retinoblastoma is probably the most common malignant tumor in the neonate. About seven per cent of these tumors have been apparent at birth. This tumor is not discussed in either article because it is not lethal until muypes in neonatal and pediatric patients. Some congenital malformations in the in the neonate are recognized as being frankly benign (cysts), potentially malignant (teratomas), and frankly malignant (neuroblastoma). A high percentage of teratomas are benign in the newborn period. Leukemia in the newborn appears to be more aggressive yet neuroblastoma has a better prognosis. More studies are needed to help us define why the neonate does better with some tumors and worse with others. Surface cell markers on neonatal leukemia, B and T cell function studies, and other immunologic surveillance studies are needed. Study of neonatal oncology may add to our knowledge of carcinogenesis and oncogenesis in the future.