The human tail associated with intraspinal lipoma: case report

A case of a tail in a 9-month-old baby is reported. Computed tomography and magnetic resonance imaging clearly demonstrated the presence of spina bifida and lipoma continuous from the tail to the spinal canal. A few medical-historical aspects are discussed. The human tail may be related to spinal dysraphism and requires detailed neuroimaging investigation and microsurgery.

[Sacrococcygeal teratoma in obstetrics]

MATERIALS/METHODS

5 fetuses with prenatally diagnosed sacrococcygeal teratoma at the Department of Prenatal Diagnosis and Therapy during a 30-month period. Modified splint technique according to Duzin, following a Pfannenstiel's incision in 4 cases.

RESULTS

4 infants with uninjured tumor could be transferred to pediatric surgery for treatment.

CONCLUSIONS

The modified splint technique according to Duzin can be applied particularly in the case of a big tumor.

Prenatal diagnosis and perinatal management of fetal sacrococcygeal teratoma

Sacrococcygeal teratoma is the most common fetal neoplasm, with an incidence of 1 in 40,000 births. Fetuses with this malformation are at risk for significant perinatal morbidity and mortality. We identified nine fetuses with sacrococcygeal teratomas that were diagnosed antenatally and managed at the University of North Carolina Hospitals over a 7-year period. We retrospectively reviewed the charts of mothers and infants and recorded data concerning perinatal and surgical management. Six infants survived the neonatal period. All infants diagnosed after 20 weeks' gestation survived. Fetal hydrops developed in three fetuses, all of whom died. Inadequate ventilation secondary to prematurity was a contributing factor in each lethal case. Diagnosis at an early gestational age, development of fetal hydrops, and premature delivery predicted a poor prognosis. When possible, we recommend that delivery be delayed to allow for fetal development. Stabilization of the infant should be attempted before resection of the teratoma.

Prenatal diagnosis and perinatal management of fetal sacrococcygeal teratoma

Sacrococcygeal teratoma is the most common fetal neoplasm, with an incidence of 1 in 40,000 births. Fetuses with this malformation are at risk for significant perinatal morbidity and mortality. We identified nine fetuses with sacrococcygeal teratomas that were diagnosed antenatally and managed at the University of North Carolina Hospitals over a 7-year period. We retrospectively reviewed the charts of mothers and infants and recorded data concerning perinatal and surgical management. Six infants survived the neonatal period. All infants diagnosed after 20 weeks' gestation survived. Fetal hydrops developed in three fetuses, all of whom died. Inadequate ventilation secondary to prematurity was a contributing factor in each lethal case. Diagnosis at an early gestational age, development of fetal hydrops, and premature delivery predicted a poor prognosis. When possible, we recommend that delivery be delayed to allow for fetal development. Stabilization of the infant should be attempted before resection of the teratoma.

Adult sacrococcygeal teratomas

We report a rare case of a benign adult sacrococcygeal teratoma discovered during pregnancy. The cystic mass was confirmed on CT scan and magnetic resonance imaging. In the fifth postpartum month, three cysts (1, 2.5, and 6 cm) were excised. Pathologically, the specimens contained differentiated tissue from all three germ layers, including endocrine tissue within the ectopic exocrine pancreas.

MR imaging of congenital anomalies of the pediatric spine

Congenital anomalies of the pediatric spine are ideally evaluated with MR imaging. The wide spectrum of pathology in this category of disease is dramatically displaced for both diagnosis and treatment planning for the neurosurgeon. An understanding of embryology and knowledge of the clinical presentation combined with the MR imaging findings allows the radiologist to play a key role in the evaluation of these complex anomalies.

A case of incomplete Currarino triad with malignant transformation

A case of an incomplete Currarino triad is reported. The baby underwent an emergency laparotomy due to a life-threatening intestinal obstruction caused by severe rectal stenosis. During the posterosagittal anorectoplasty (PSARP), a presacral teratoma was identified and resected. The tumor recurred three times; she initially responded to chemotherapy, but nonetheless died at the age of 4 years. In cases with evidence of anorectal stenosis, a presacral mass should be suspected. PSARP is the best choice of treatment for both the anorectal anomaly and excision of the presacral mass. The presacral region should be followed up closely for recurrence of the tumor.

[Significance of prenatal diagnosis in interdisciplinary treatment of sacrococcygeal teratoma]

The perinatal treatment of 23 infants with sacrococcygeal teratomas was recorded prospectively from 1990 to 1997, during which period 14 children (teratomas 6.9-18 cm) could be followed throughout the whole pregnancy at our own perinatal department. There were three prenatal deaths (21 h-27 week of gestation) and two peripartal deaths (1 hydrops and 1 ruptured teratoma). Prenatal Doppler sonography allows appropriate selection of high-risk fetuses. The vital prognostic sign was developing fetal hydrops with associated umbilical vein pulsations, increased aortal flow and an increasing pulsatility index in der venous duct.

[Perinatal and perianesthetic management of the sacrococcygeal teratoma in a neonate]

We report perinatal and perianesthetic management of a female infant with sacrococcygeal teratoma who underwent fetal bladder puncture and postnatal tumor resection. At 33 weeks' gestation, fetal ultrasonography revealed an intrapelvic mass, oligohydramnios and the dilatation of the bladder. At 34 weeks' gestation, bladder puncture was performed in utero to relieve urinary obstruction by the mass. And it served to reserve the renal function but caused remarkable ascites at birth due to urine leakage to the peritoneum through the puncture site. After the delivery by cesarean section, the patient underwent the tumor extirpation at 2 days of life. The operation and anesthesia proceeded uneventfully. In previous reports, several mortalities due to exsanguinating hemorrhage during surgery have been reported. In addition, sacrococcygeal teratoma is occasionally accompanied by coagulopathy and high output cardiac failure caused by arteriovenous fistulae. Therefore it is important for good patient outcomes to evaluate preoperatively the risks mentioned above.

Prenatal diagnosis and perinatal management of fetal sacrococcygeal teratoma

Sacrococcygeal teratoma is the most common fetal neoplasm, with an incidence of 1 in 40,000 births. Fetuses with this malformation are at risk for significant perinatal morbidity and mortality. We identified nine fetuses with sacrococcygeal teratomas that were diagnosed antenatally and managed at the University of North Carolina Hospitals over a 7-year period. We reviewed retrospectively the charts of mothers and infants and recorded data concerning perinatal and surgical management. Six infants survived the neonatal period. All infants diagnosed after 20 weeks' gestation survived. Fetal hydrops developed in three fetuses, all of whom died. Inadequate ventilation secondary to prematurity was a contributing factor in each lethal case. Diagnosis at an early gestational age, development of fetal hydrops, and premature delivery predicted a poor prognosis. When possible, we recommend that delivery be delayed to allow for fetal development. Stabilization of the infant should be attempted before resection of the teratoma.

Spinal canal involvement in infantile myofibromatosis: case report and review of the literature

PURPOSE

An unusual case of infantile myofibromatosis with spinal canal involvement is reported and the literature is reviewed.

PATIENT AND METHODS

A female neonate had bladder and bowel dysfunction and paresis of the lower extremities.

RESULTS

Intrapelvic and paravertebral masses with extension into the spinal canal were detected by imaging studies. In addition, radiologic examination showed multiple metaphyseal radiolucent lesions of the long bones and pathologic fracture of the left femur. The histopathologic diagnosis of the paravertebral tumor and bone lesions was infantile myofibromatosis. Surgical resection of the paravertebral and intrapelvic masses was performed to improve her neurologic impairments. Paresis of the lower limbs gradually improved, whereas bladder and bowel dysfunction remained unchanged.

CONCLUSIONS

Only six cases of infantile myofibromatosis associated with spinal canal involvement have been reported. Three patients with flaccid paresis of extremities and respiratory distress died in the newborn period. The other three patients showed improvement of the paresis. The prognosis of infantile myofibromatosis without visceral complication is generally good, but neurologic impairment may occur at birth if the spinal cord is compressed.

A case of congenital intraspinal neuroblastoma

A case of congenital intraspinal neuroblastoma with paraplegia in a newborn is described, and a review of previously reported cases is presented. Calcification within the spinal canal and abdominal mass was noted. At age 75 days, the patient underwent a resection of almost the entire retroperitonial tumor. A magnetic resonance scan showed hepatic metastasis, and chemotherapy was changed to a more intensive regimen. The liver metastasis disappeared; however, neurological signs persisted. A literature review of 38 cases showed 26 patients had a laminectomy and 12 patients did not. Treatment with or without laminectomy was associated with a poor prognosis for neurological recovery, suggesting cord compression must occur antenatally, and irreversible damage occurs before birth. Congenital intraspinal neuroblastoma has a relatively good prognosis (survival rate, 91.9%), although complete neurological recovery is highly unusual. Based on these findings, the authors conclude that a laminectomy is not indicated for those patients.

[Delivery following surgically treated sacrococcygeal teratoma in the mother]

The delivery of a 23 para I who was born herself with a sacrococcygeal teratoma of the type II is reported. After the extirpation of the tumor and of the coccyx an anomaly of the pelvis is found in the sense of a pygopagic pelvis (stretching and bending of the sacrum towards the dorsum). This anomaly and the scars in the way of a maternal soft tissue dystocia seem to be the reasons for the insufficient progression of labour. The delivery had to be done by caesarean section. A historical review concerning the surgery of sacrococcygeal teratomas is given.

[Prenatal diagnosis of an intraspinal lipoma. A case report]

This report describes a prenatal diagnosis of intraspinal lipoma. This pathology, not well known by obstetricians, forms a part of neural tube defects. Echographic aspect, embryologic origin, differential diagnosis, neurosurgical prognosis and treatment are reviewed and discussed.

Oncoproteins and tumor suppressor proteins in congenital sacrococcygeal teratomas

Congenital sacrococcygeal teratoma (SCT) is the most common germ cell tumor of infancy and childhood with a female preponderance. Most SCTs are diagnosed at birth, are benign, and consist of fully differentiated, mature tissues. Tumorigenesis of SCTs remains poorly understood. Almost nothing is known about possible oncogene activation or tumor suppressor inactivation in these rare tumors. We describe the presence of various oncoproteins and tumor suppressor proteins in eight cases of congenital SCT. The following oncogenes were examined: ras family (c-H-, c-N-, and c-K-ras), early genes (fos, jun), and tumor suppressor genes (p53 and nm23-H-I). There was no relationship between the intensity of expression of these oncoproteins and tumor suppressor genes and the following parameters: tumor size, age, and survival of the patients. We did not observe any difference, however, between the expression of the examined oncogenes and tumor suppressor genes nm23 and p53 in immature and mature teratomas. Our findings suggest that the ras family of oncogenes, fos and jun oncogenes, and nm23 and p53 tumor suppressor genes are present in congenital SCT, indicating a possible role in genesis and development of these tumors.

Resection of a massive sacrococcygeal teratoma using hypothermic hypoperfusion: a novel use of extracorporeal membrane oxygenation

A 33-week-gestation infant with a massive sacrococcygeal teratoma weighted 4,000 g, but the actual weight of the infant was approximately 1,500 g. With the potential for massive blood loss and impaired lung compliance during resection, some type of cardiopulmonary support was necessary. Resection was undertaken with the assistance of venoarterial extracorporeal membrane oxygenation (ECMO) and hypothermic hypoperfusion. Immediately after removal of the tumor, which weighted 2,420 g, the infant was decannulated from ECMO, and the carotid artery was primarily reconstructed end-to-end. The amount of intraoperative blood loss was 550 mL Postoperatively, the child weighted 1,580 g. Follow-up head ultrasound results were normal, and the patient has done well. This is the first reported case in which ECMO with hypothermic hypoperfusion was used for resection of a massive tumor. This experience shows that ECMO is both useful and safe as a means of temporary cardiopulmonary support for resection of massive tumors in infants.

[The MRI in pre- and postnatal diagnosis of congenital sacrococcygeal teratoma]

INTRODUCTION

The main tasks of imaging methods on the evaluation of relatively rare and potentially malignant connatal sacrococcygeal teratomas (SCT) are to depict the extent, structure and relationship to surrounding systems.

METHODS

Two cases with SCT were studied with pre- and postnatal MRI and findings were compared with the ultrasound and clinical data.

RESULTS

Before delivery, MRI permits depiction of the size and structure of teratomas and the integrity of the serum. After delivery, evaluation of the rectum, urinary tract and levator muscles is important to facilitate surgical reconstruction.

[Sacrococcygeal teratomas. Apropos of a case of teratoma weighing 4200 g]

We report a clinical case of a large sacro-coccygeal teratoma diagnosed antenatally by ultra-sound at 35 weeks gestation. A review of the literature shows that their outcome depends upon the size of the tumor, its degree of maturity, whether its location is pelvic or not, the presence of any associated malformations, prematurity, atraumatic delivery and upon prompt and complete removal of the tumor.

Human tail associated with lipomeningocele--case report

A 3-month-old boy presented with a tail associated with lipomeningocele. Computed tomography and magnetic resonance imaging clearly demonstrated the presence of spina bifida and lipoma continuous from the tail to the thickened conus medullaris. The human tail may be related to spinal dysraphism and requires detailed neuroimaging investigation, and possibly microsurgery to prevent the tethered cord syndrome.

Effect of surgical repair on the neurologic function in infants with lipomeningocele

Eighteen children under the age of 1 year underwent surgery for lipomeningocele at our institution between 1983 and 1991. All the patients had neurologic exams and urodynamic studies (UDS) including a cystometrogram and electromyography of the external urethral sphincter pre- and postoperatively. The surgical procedure performed included an untethering of the spinal cord, laser debulking of the lipoma and placement of a dural graft. All the infants presented with a lesion on their back. Two of 10 infants with a normal neurological exam had abnormal UDS preoperatively. Early surgery normalized abnormal preoperative UDS in 5 of 6 (83%) infants with abnormal UDS. Moreover, 3 of 8 (38%) infants with an abnormal neurological exam preoperatively improved after surgery and none worsened. These observations suggest that abnormal urinary tract function in infants with lipomeningocele may be reversible with early prophylactic surgery.

Tailgut remnant--or teratoma?

The tailgut is the distalmost portion of the embryonic gut, located caudal to the cloacal membrane. Up to the sixth week of development, it is in close proximity to the distal end of the notochord and the neural tube. It completely regresses by the seventh week, but some caudal duplication-like cysts have been attributed to its remnants. We report a full-term male born with a large heterogeneous sacral mass. Severe bony abnormalities of the coccyx, sacrum and lower lumbar vertebrae were present, but the infant was neurologically intact. At surgery, the upper cystic structures within the mass were found to communicate with the dura, while the solid component, whose surface resembled intestinal mucosal folds, was closely related to the perirectal tissues. The mass was completely resected and the dura oversewn. Since this complex mass contained all three cell lines in an aberrant location, it satisfies the definition of a sacrococcygeal teratoma. However, its unique architecture suggests a malformative, rather than tumoral origin. The macroscopic appearance of this lesion reflects the embryonic relationship between the tailgut, the neural tube and the notochord.

Fetal sacrococcygeal teratoma

The fetus with sacrococcygeal teratoma (SCT) is at high risk for prenatal and perinatal complications. The natural history and pathophysiology of fetal SCT is different than that of postnatally diagnosed SCT, and has only recently been defined. Survival of fetuses with SCT is dependent on anticipation and recognition of pathophysiologic events, and optimal obstetric and surgical management. In a subset of fetuses with SCT, fetal resection of tumor may offer the only hope for survival.