1
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Johnston WR, Hwang R, Mattei P. Impact of microscopic deposits of yolk sac tumor on recurrence of mature sacrococcygeal teratoma. J Surg Oncol 2024. [PMID: 39016163 DOI: 10.1002/jso.27771] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2024] [Accepted: 06/25/2024] [Indexed: 07/18/2024]
Abstract
INTRODUCTION Sacrococcygeal teratomas (SCT) with malignant histology frequently recur and are treated aggressively, but risk factors and surveillance protocols are less established for mature tumors. In particular, prior studies have not investigated whether microscopic deposits of yolk sac tumor (YST) in otherwise mature teratomas lead to higher recurrence rates. METHODS We reviewed patients with mature SCTs resected at our institution from 2011 to 2021 and analyzed tumor characteristics, treatment, and outcomes. RESULTS We identified 56 patients with mature SCT, of which 9 (16%) demonstrated microscopic YST. Following surgery, 7/56 (13%) patients developed local recurrence at a mean of 1.2 ± 0.7 years, while no patients developed metastases. Recurrence was more likely in patients with microscopic YST [5/9 (56%) vs. 2/47 (4%), p = 0.021] and positive margins [6/24 (35%) vs. 1/32 (3.1%), p = 0.030]. A solid tumor component tended to increase recurrence risk as well [6/29 (21%) vs. 1/27 (4%), p = 0.053]. Five patients demonstrated malignant recurrence and were all detected by a rising alpha-fetoprotein (AFP), while two patients demonstrated recurrence of mature teratoma and were detected on surveillance magnetic resonance imaging (MRI). CONCLUSIONS Microscopic foci of YST may increase recurrence risk for patients with mature SCT. Such patients might benefit from closer postoperative surveillance with serial AFP measurements and MRI.
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Affiliation(s)
- William R Johnston
- Division of General, Thoracic, and Fetal Surgery, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
- Department of General Surgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Rosa Hwang
- Division of General, Thoracic, and Fetal Surgery, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Peter Mattei
- Division of General, Thoracic, and Fetal Surgery, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
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2
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Gil LA, Knaus ME, Stanek JR, Srivatsa S, Patterson KN, Wood RJ, Minneci PC, Ranalli MA, Aldrink JH. Variability in Surveillance Strategies Following Resection of Sacrococcygeal Teratoma. J Surg Res 2024; 295:423-430. [PMID: 38070256 DOI: 10.1016/j.jss.2023.11.040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Revised: 10/17/2023] [Accepted: 11/12/2023] [Indexed: 02/25/2024]
Abstract
INTRODUCTION Surveillance following sacrococcygeal teratoma (SCT) resection varies. The purpose of this study was to describe the clinical characteristics and outcomes of patients undergoing SCT resection and examine current institutional practices to detect recurrence. METHODS A single-institution retrospective review of children who underwent resection of an SCT from January 1, 2010 to December 31, 2020 was performed. Data were summarized and surveillance strategies compared between histopathologic subtypes using nonparametric methods. RESULTS Thirty six patients (75.0% female) underwent SCT removal at a median age of 8 d. Histopathology revealed 27 mature teratomas (75.0%), eight immature teratomas (22.2%), and one malignant germ cell tumor (2.8%). Median postoperative follow-up was 3.17 y (interquartile range [IQR]: 2.31-4.38 y). Patients had a median of 2.32 clinic visits per year (IQR: 2.00-2.70), alpha-fetoprotein levels were obtained at a median of 2.01 times per year (IQR: 0-1.66), and surveillance imaging was performed at a median of 2.31 times per year (IQR: 0-2.84). Patients with immature teratomas had alpha-fetoprotein laboratories obtained more frequently than patients with mature teratomas (3.10 times/year versus 0.93 times/year, P = 0.001). There was no significant difference in the number of imaging studies obtained between groups. Two patients (5.6%) developed recurrence, which were identified on magnetic resonance imaging at 191 and 104 d postresection, respectively. CONCLUSIONS Postoperative surveillance practices varied widely. Recurrence was noted in a single malignant case in the first year following resection. Multi-institutional studies are needed to determine the optimal surveillance strategy to detect recurrence of SCT.
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Affiliation(s)
- Lindsay A Gil
- Center for Surgical Outcomes Research, Abigail Wexner Research Institute, Nationwide Children's Hospital, Columbus, Ohio; Department of Pediatric Surgery, Nationwide Children's Hospital, The Ohio State University College of Medicine, Columbus, Ohio
| | - Maria E Knaus
- Center for Surgical Outcomes Research, Abigail Wexner Research Institute, Nationwide Children's Hospital, Columbus, Ohio; Department of Pediatric Surgery, Nationwide Children's Hospital, The Ohio State University College of Medicine, Columbus, Ohio
| | - Joseph R Stanek
- Department of Pediatric Hematology/Oncology, Nationwide Children's Hospital, Columbus, Ohio
| | - Shachi Srivatsa
- Center for Surgical Outcomes Research, Abigail Wexner Research Institute, Nationwide Children's Hospital, Columbus, Ohio; Department of Pediatric Surgery, Nationwide Children's Hospital, The Ohio State University College of Medicine, Columbus, Ohio
| | - Kelli N Patterson
- Center for Surgical Outcomes Research, Abigail Wexner Research Institute, Nationwide Children's Hospital, Columbus, Ohio; Department of Pediatric Surgery, Nationwide Children's Hospital, The Ohio State University College of Medicine, Columbus, Ohio
| | - Richard J Wood
- Department of Pediatric Surgery, Nationwide Children's Hospital, The Ohio State University College of Medicine, Columbus, Ohio; Department of Pediatric Colorectal and Pelvic Reconstructive Surgery, Nationwide Children's Hospital, Columbus, Ohio
| | - Peter C Minneci
- Center for Surgical Outcomes Research, Abigail Wexner Research Institute, Nationwide Children's Hospital, Columbus, Ohio; Department of Pediatric Surgery, Nationwide Children's Hospital, The Ohio State University College of Medicine, Columbus, Ohio
| | - Mark A Ranalli
- Department of Pediatric Hematology/Oncology, Nationwide Children's Hospital, Columbus, Ohio
| | - Jennifer H Aldrink
- Department of Pediatric Surgery, Nationwide Children's Hospital, The Ohio State University College of Medicine, Columbus, Ohio.
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Li S, Peng J, Zhang Y, Liu D, Li L, Nai M. Subsequent ovarian yolk sac tumor after operation of ovarian mature teratoma: a case report and review of the literature. Front Oncol 2024; 13:1327724. [PMID: 38298441 PMCID: PMC10828046 DOI: 10.3389/fonc.2023.1327724] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Accepted: 12/29/2023] [Indexed: 02/02/2024] Open
Abstract
Ovarian mature teratoma represents a benign ovarian tumor, while ovarian yolk sac tumor (YST, endodermal sinus tumor) is a rare malignant tumor predominantly affecting young women, often associated with a grim prognosis post-metastasis. Both ovarian mature teratoma and ovarian YST are germ cell tumors. There are few studies on the correlation between ovarian YST and mature teratoma. Recurrence or malignant transformation may occur following the surgical intervention for ovarian mature teratoma. However, the occurrence of YST subsequent to such procedures is notably rare. In this investigation, we reported a case involving a 24-year-old unmarried woman with both mature ovarian teratoma and YST within a brief 1-year interval. Regular reexamination protocols facilitated the early-stage detection of YST. The patient underwent surgical treatment, chemotherapy, and measures to preserve ovarian function, resulting in a favorable prognosis. Our primary purpose is to distill clinical insights from the diagnostic and therapeutic journey of this patient. Our purpose is to enhance medical professionals' awareness that YST may be secondary to mature teratoma. Additionally, we underscore the critical importance of routine postoperative surveillance for ovarian mature teratoma, emphasizing its pivotal role in early malignant tumor detection-a factor paramount to the prognosis of patients.
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Affiliation(s)
- Shuqing Li
- The Department of Obstetrics and Gynecology, The Third Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Juan Peng
- The Department of Obstetrics and Gynecology, The Third Affiliated Hospital of Zhengzhou University, Zhengzhou, China
- Zhengzhou Key Laboratory of Endometrial Disease Prevention and Treatment, Zhengzhou Science and Technology Bureau, Zhengzhou, China
| | - Yajun Zhang
- The Department of Obstetrics and Gynecology, The Third Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Dongxia Liu
- The Department of Obstetrics and Gynecology, The Third Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Lei Li
- The Department of Obstetrics and Gynecology, The Third Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Manman Nai
- The Department of Obstetrics and Gynecology, The Third Affiliated Hospital of Zhengzhou University, Zhengzhou, China
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Rescorla F, Dicken B, Billmire D, Weil B, Stark R, Madenci A, Ramaraj A. Critical elements of pediatrics sacrococcygeal germ cell tumor surgery. Semin Pediatr Surg 2023; 32:151344. [PMID: 38039830 DOI: 10.1016/j.sempedsurg.2023.151344] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2023]
Abstract
Sacrococcygeal teratoma is the most common extragonadal germ cell tumor in the pediatric population, and accounts for approximately 70% of all teratomas in childhood.1,2 They present in two distinct phases, with most cases seen in neonates with large predominately exophytic tumors, often detected in utero on prenatal sonography or at birth. A smaller cohort presents in older infants and children with primarily hidden tumors in the pelvis which have a much higher rate of malignancy. The primary surgical objective is complete tumor resection without compromise to critical structures or function. Herein we outline the critical elements of tumor resection and management of sacrococcygeal germ cell tumors with a focus on the technical aspects of this tumor across a range of presentations.
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Affiliation(s)
| | - Bryan Dicken
- Stollery Children's Hospital, Edmonton, AB T6G-2B7, USA
| | | | - Brent Weil
- Boston Children's Hospital, Boston, MA 02115, USA
| | - Rebecca Stark
- Seattle Children's Hospital and the University of Washington, Seattle, WA 98105, USA
| | - Arin Madenci
- Seattle Children's Hospital and the University of Washington, Seattle, WA 98105, USA
| | - Akila Ramaraj
- University of Connecticut Health, Farmington, CT 06030, USA
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5
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Mosleh MM, Heo TG, Shin HB, Sohn MJ. Sacrococcygeal teratomas: a case-based review from the perspective of individual multidisciplinary experts. Childs Nerv Syst 2023; 39:57-64. [PMID: 36422695 DOI: 10.1007/s00381-022-05768-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Accepted: 11/16/2022] [Indexed: 11/27/2022]
Abstract
PURPOSE Sacrococcygeal teratoma (SCT) is a rare congenital tumor originating from a variant of extragonadal germ cell neoplasm. Herein, we present three cases of neonatal SCTs undergoing surgical resection and reconstruction. We also review the literature to discuss the importance of proper perinatal management and timely surgical intervention depending on the tumor type and maturity to prevent malignant transformation and recurrence and ensure functional outcomes. METHODS AND RESULTS Three cases of SCT were retrospectively analyzed. All infants underwent complete surgical resection of the SCT and coccygectomy during their neonatal/infancy period, followed by pelvic floor and buttock reconstruction while minimizing buttock contour deformity and undesirable skin scar. Two of the cases were histopathologically diagnosed as predominantly cystic mature teratomas of Altman types I and IV, and the third was a mature teratoma of Altman type II. There were no complications or tumor recurrence during the average follow-up period of 5.3 years. CONCLUSIONS This case-based review highlights the role of multidisciplinary team approaches, including prenatal monitoring, oncologic resection, and adequate reconstruction according to the type of tumor and anomaly. Optimal perinatal evaluation allows promising oncologic and functional outcomes in terms of timely intervention to eliminate tumor recurrence and malignant transformation. Complete oncologic surgical resection of SCTs should also include proper functional preservation strategies, such as the reconstruction of the pelvic floor, cosmetic buttock contouring, and preservation of bladder and bowel sphincter function.
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Affiliation(s)
- Mohammad Mohsen Mosleh
- Department of Neurosurgery and Neuroscience & Radiosurgery Hybrid Research Center, College of Medicine, Inje University Ilsan Paik Hospital, 170 Juhwa-ro, Ilsanseo-Gu, Goyang, Gyeonggi Province, 10380, Korea
| | - Tae Gil Heo
- Department of General Surgery, College of Medicine, Inje University Ilsan Paik Hospital, 170 Juhwa-ro, Ilsanseo-Gu, Goyang, Gyeonggi Province, 10380, Korea
| | - Hyun Beak Shin
- Division of Pediatric Surgery, Department of Surgery, Jeonbuk National University Medical School, 20, Geonjiro, Deokjin-Gu, Jeonju, Jeollabuk-do, 54907, Korea
| | - Moon-Jun Sohn
- Department of Neurosurgery and Neuroscience & Radiosurgery Hybrid Research Center, College of Medicine, Inje University Ilsan Paik Hospital, 170 Juhwa-ro, Ilsanseo-Gu, Goyang, Gyeonggi Province, 10380, Korea.
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AbouZeid AA, Radwan AB, Elghandour MM, Guirguis NN, Bersy MA. Vertical wound closure following sacrococcygeal teratoma excision: an approachable aesthetic solution. ANNALS OF PEDIATRIC SURGERY 2022. [DOI: 10.1186/s43159-022-00223-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Abstract
Background
Sacrococcygeal teratoma is a rare tumour, usually presenting in the neonatal period. The benign nature of most tumours and the high survival rates would emphasise on the importance of both cosmetic and functional outcomes.
We report on our extended experience with more cases concentrating on the aesthetic outcome of vertical wound closure following excision of large irregular sacrococcygeal tumours.
The study included primary cases of sacrococcygeal teratoma who were referred to our surgical team for excision. Cases of presacral tumours associated with anorectal anomalies and sacral bony defects (Currarino triad) were excluded. In all cases, we planned for a vertical midline wound closure after tumour excision. The aesthetic outcomes are evaluated concerning the vertical midline scar, buttock’s contour, and position of the anus.
Results
In addition to twelve previously reported cases (during the period 2011 through 2016), we included another ten new consecutive cases operated during the period 2017 through 2021. Collectively, the study included 22 cases of sacrococcygeal teratoma that underwent vertical perineal wound closure after excision of the tumour. In 13 cases (those with relatively small or medium-sized tumours), the perineal wound was perfectly closed in the midline (well-hidden vertical scar in the natal cleft). For the rest of the cases (9 cases with large and/or irregular sacrococcygeal tumours), some modification was applied on the vertical linear mid-line skin closure to accommodate for skin redundancy and irregularity at the lower end of the wound, usually ending with an ‘inverted-Y’ skin closure
Conclusion
Vertical wound closure was always feasible after excision of sacrococcygeal teratomas. Even with large and irregular tumours, the vertical scar was perfectly or partially hidden within the natal cleft. Usually, there was adequate buttock development with minimal disturbance to the normal anal location within the perineum.
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7
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Zhu J, Chen H, Chen T, Zhen Z, Wang J, Sun F, Lu S, Huang J, Zhang Y, Sun X. Multimodal Treatment of Children With Sacrococcygeal Yolk Sac Tumor: Retrospective Analysis of Clinicopathology Characteristics and Relapse-free Survival. J Pediatr Hematol Oncol 2021; 43:e848-e853. [PMID: 33512871 PMCID: PMC8327933 DOI: 10.1097/mph.0000000000002068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2020] [Accepted: 12/06/2020] [Indexed: 11/19/2022]
Abstract
The aim of the study was to explore the clinicopathologic characteristics of sacrococcygeal yolk sac tumor (SYST) associated with relapse and the role of sensitivity to neoadjuvant chemotherapy in predicting outcome. The authors investigated prognostic factors of age, stage, initial tumor size, pathologic response to neoadjuvant chemotherapy, and alfa fetoprotein. A total of 26 patients with SYST were enrolled. Neoadjuvant chemotherapy was administered to 20 cases. Six patients underwent resection as initial therapy. Recurrence occurred in 12 patients. Nine patients with specimens exhibiting no malignant component after chemotherapy did not experience recurrence. By contrast, relapses occurred in 7 of 11 patients with viable residual tumor after neoadjuvant chemotherapy. All relapsed patients still achieved partial remission or complete remission after salvage therapy. Five-year relapse-free survival and overall survival rates were 55.2% and 100%, respectively (median follow-up, 59.5 mo; range, 16 to 155). Patients with complete necrosis after neoadjuvant chemotherapy had a better outcome compared with children with viable residual tumor. Relapse-free survival of pediatric SYSTs in this cohort were still low and warrants the multidisciplinary effort.
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Affiliation(s)
- Jia Zhu
- Department of Pediatric Oncology, Sun Yat-sen University Cancer Center
- Key Laboratory of Oncology in South China
- Collaborative Innovation Center for Cancer Medicine
| | - Huadong Chen
- Department of Pediatric Surgery, The First Affiliated Hospital of Sun Yat-Sen University, Zhongshan Er Lu, Guangzhou, China
| | - Tingting Chen
- Department of Pediatric Oncology, Sun Yat-sen University Cancer Center
- Key Laboratory of Oncology in South China
- Collaborative Innovation Center for Cancer Medicine
| | - Zijun Zhen
- Department of Pediatric Oncology, Sun Yat-sen University Cancer Center
- Key Laboratory of Oncology in South China
- Collaborative Innovation Center for Cancer Medicine
| | - Juan Wang
- Department of Pediatric Oncology, Sun Yat-sen University Cancer Center
- Key Laboratory of Oncology in South China
- Collaborative Innovation Center for Cancer Medicine
| | - Feifei Sun
- Department of Pediatric Oncology, Sun Yat-sen University Cancer Center
- Key Laboratory of Oncology in South China
- Collaborative Innovation Center for Cancer Medicine
| | - Suying Lu
- Department of Pediatric Oncology, Sun Yat-sen University Cancer Center
- Key Laboratory of Oncology in South China
- Collaborative Innovation Center for Cancer Medicine
| | - Junting Huang
- Department of Pediatric Oncology, Sun Yat-sen University Cancer Center
- Key Laboratory of Oncology in South China
- Collaborative Innovation Center for Cancer Medicine
| | - Yizhuo Zhang
- Department of Pediatric Oncology, Sun Yat-sen University Cancer Center
- Key Laboratory of Oncology in South China
- Collaborative Innovation Center for Cancer Medicine
| | - Xiaofei Sun
- Department of Pediatric Oncology, Sun Yat-sen University Cancer Center
- Key Laboratory of Oncology in South China
- Collaborative Innovation Center for Cancer Medicine
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Sharma R, Khera S, Sinha A, Yadav T. Pure yolk sac tumor of sacrococcygeal region. Autops Case Rep 2021; 11:e2021287. [PMID: 34249791 PMCID: PMC8214897 DOI: 10.4322/acr.2021.287] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2021] [Accepted: 04/11/2021] [Indexed: 11/23/2022]
Abstract
The sacrococcygeal region is the most common site for the extragonadal germ cell tumors comprising seminomatous and non-seminomatous tumors. Seminomatous tumors are seminomas, and non-seminomatous tumors comprise mainly teratoma (mature and immature), yolk sac tumor (YST), embryonal carcinoma (EC), and choriocarcinoma. These tumors occur in newborns, infants, and adolescents. Other common sites for extragonadal germ cell tumors are the brain and mediastinum, although they may occur anywhere in the body. These tumors may occur in mixed as well as pure form. So, sectioning from different areas should be done before labeling them as pure germ cell tumors. YST, in its pure form, is rare and therefore should not be missed as it is chemosensitive. The patient should be thoroughly assessed clinically. Imaging also becomes necessary while evaluating swelling in the sacrococcygeal region and can aid in differentials. When the clinical and imaging suspicion of either Sacrococcygeal teratoma or other germ cell tumor is high, serum biomarkers as alfa-fetoprotein should be requested. The serum levels are necessary and should be done preoperatively, postoperatively, and during the course of chemotherapy as follow-up. However, the final diagnosis rests on the histopathological diagnosis. We report one such case of pure YST in the sacrococcygeal region in a 9-month-old female child. The imaging suggested sacrococcygeal teratoma type 4, and high alfa-fetoprotein levels were determined postoperatively.
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Affiliation(s)
- Rashim Sharma
- All India Institute of Medical Sciences, Department of Pathology and Lab Medicine, Jodhpur, Rajasthan, India
| | - Sudeep Khera
- All India Institute of Medical Sciences, Department of Pathology and Lab Medicine, Jodhpur, Rajasthan, India
| | - Arvind Sinha
- All India Institute of Medical Sciences, Department of Pediatric Surgery, Jodhpur, Rajasthan, India
| | - Taruna Yadav
- All India Institute of Medical Sciences, Diagnostic and Interventional Radiology, Jodhpur, Rajasthan, India
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Kanburoglu MK, Okumus M. Case 2: Intergluteal Sulcus Flattening in a Newborn. Neoreviews 2021; 22:e263-e265. [PMID: 33795402 DOI: 10.1542/neo.22-4-e263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Affiliation(s)
- Mehmet Kenan Kanburoglu
- Division of Neonatology, Department of Pediatrics, Recep Tayyip Erdogan University, Medical School, Rize, Turkey
| | - Mustafa Okumus
- Department of Pediatric Surgery, Yeni Yüzyıl University, Faculty of Medicine, Istanbul, Turkey
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10
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Chen SH, Du CJ, Lai JY, Chang TY, Yang CP, Hung IJ, Jaing TH, Ming YC, Hsueh C. Malignant sacrococcygeal germ cell tumors in children in Taiwan: A retrospective single-center case series. Medicine (Baltimore) 2021; 100:e24323. [PMID: 33530223 PMCID: PMC7850750 DOI: 10.1097/md.0000000000024323] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Accepted: 12/21/2020] [Indexed: 01/05/2023] Open
Abstract
Although the incidence of malignant sacrococcygeal germ cell tumors (MSGCTs) is high in the East Asian countries, information about MSGCTs from this region is limited. This report aimed to analyze the data of children with MSGCTs in a single medical center in Taiwan.Patients aged 18 years or younger with primary MSGCTs or malignant recurrence of a sacrococcygeal teratoma who underwent surgery during the neonatal period between January 1999 and December 2016 were identified from the Linkou Chang Gung Cancer Center registry. The clinical features, laboratory data, and treatment outcomes were reviewed.Fifteen children (1 man and 15 women) with MSGCTs were identified. Sacrococcygeal tumors were present at birth in 7 patients. All patients presented with a bulging mass at the buttock region and they had normal alpha-fetoprotein levels at the time of diagnosis. They underwent primary excision of the tumor. Immature teratoma was histologically diagnosed in 5 neonates, and mature teratoma in 2. Only 1 patient with grade 3 immature teratoma received adjuvant chemotherapy. Two patients with mature teratoma developed malignant recurrence 1.6 and 2.1 years later, respectively. Eight patients were diagnosed with MSGCTs after the neonatal period. The common presenting symptoms included buttock asymmetry (37.5%), abdominal distension (25%), and constipation (12.5%). Seven patients had elevated alpha-fetoprotein levels for their age. They were administered neoadjuvant chemotherapy followed by tumor excision if a residual tumor was present. The histology of the excised tumor included mature teratoma (66.7%) and necrosis (33.3%). One patient with a normal alpha-fetoprotein level underwent primary tumor excision followed by adjuvant chemotherapy. Grade 2 immature teratoma with embryonal carcinoma was diagnosed histologically. Among the 15 patients with MSGCTs, 3 had a recurrence (at age of 2.1, 0.5, and 2.4 years, respectively) and 1 died (at age of 6.1 years) of disease progression. The 5-year overall and event-free survival rates were 90% and 80%, respectively.Children with MSGCTs had good overall prognoses in this case series. For those with sacrococcygeal mature teratoma or low-grade immature teratoma in the neonatal period, we recommend close follow-up for at least 3 years after surgery to detect malignant recurrence.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Chuen Hsueh
- Department of Pathology, Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Taoyuan, Taiwan
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11
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Carr S, Safavi A, Skarsgard ED. Case Reports: Management Challenges in Pediatric Germ Cell Tumors. Front Pediatr 2021; 9:659083. [PMID: 33937155 PMCID: PMC8081829 DOI: 10.3389/fped.2021.659083] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Accepted: 03/09/2021] [Indexed: 11/24/2022] Open
Abstract
Germ cell tumors in infants are most frequently extragonadal, benign, and amenable to surgical resection. An unusual feature of germ cell tumors is the potential coexistence of malignant with benign disease which makes it possible for patients with incompletely resected tumors to experience either a benign or malignant recurrence. A challenge to postoperative surveillance is the interpretation of serum alpha fetoprotein, a marker of malignancy, that is physiologically elevated during the first year of life. A rare subset of germ cell tumors occur in the retroperitoneum. Although the vast majority are benign, these tumors are often large and distort normal anatomy, and may demonstrate local invasiveness that increases risk of resection. The intent of these reports is to caution readers about these unusual features of germ cell tumors of infancy.
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Affiliation(s)
- Sophie Carr
- Department of Surgery, BC Children's Hospital, University of British Columbia, Vancouver, BC, Canada.,Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Arash Safavi
- Department of Child Health and Surgery, University of Arizona College of Medicine, Phoenix, AZ, United States
| | - Erik D Skarsgard
- Department of Surgery, BC Children's Hospital, University of British Columbia, Vancouver, BC, Canada
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12
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Lack of genetic homozygosity in prepubertal teratomas: divergent pathogenesis distinct from that of teratomas in adolescents. J Transl Med 2020; 100:1447-1454. [PMID: 32694569 DOI: 10.1038/s41374-020-0468-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2020] [Revised: 07/06/2020] [Accepted: 07/06/2020] [Indexed: 11/08/2022] Open
Abstract
In adults, both immature and mature ovarian teratomas show frequent genetic homozygosity consistent with tumorigenesis involving germ cells after meiosis I. Investigation into genetic zygosity of various teratomas in children has been limited. Thirteen sacrococcygeal, 12 ovarian, and 3 testicular teratomas in children 18 years or younger were retrieved from our departmental archives and histologically reviewed. Tumor and paired normal tissues were microdissected and subjected to short tandem repeat (STR) genotyping. DNA genotyping was informative in 12 sacrococcygeal teratomas, 8 ovarian teratomas, and 3 testicular teratomas. Sacrococcygeal teratomas included seven mature teratomas, four immature teratomas, and one mixed germ cell tumor with patient age ranging from 0 days to 3 years. All but two patients were female. Ovarian teratomas included five mature and three immature teratomas with patient age ranging from 2 to 18 years. Testicular teratomas included two mature teratomas and one immature teratoma with patient age ranging from 3 months to 3 years. All sacrococcygeal, testicular, and ovarian teratomas in patients younger than 4 years showed no evidence of genetic homozygosity by STR genotyping. In contrast, all four ovarian teratomas in patients older than 9 years showed either partial or complete homozygosity. In conclusion, unlike adolescent and adult ovarian teratomas, prepubertal sacrococcygeal and gonadal teratomas lack genetic homozygosity, supporting the hypothesis that teratomas before puberty develop at an early stage of germ cell development different from that of teratomas in adolescents and adults.
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Kops AL, Hulsker CC, Fiocco M, Zsiros J, Mavinkurve-Groothuis AMC, Looijenga LH, van der Steeg AF, Wijnen MH. Malignant recurrence after mature Sacrococcygeal teratoma: A meta-analysis and review of the literature. Crit Rev Oncol Hematol 2020; 156:103140. [PMID: 33142194 DOI: 10.1016/j.critrevonc.2020.103140] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2020] [Revised: 10/07/2020] [Accepted: 10/15/2020] [Indexed: 01/29/2023] Open
Abstract
BACKGROUND AND AIMS Sacrococcygeal teratoma (SCT) is a rare extragonadal germ cell tumour mostly diagnosed during infancy and early childhood. Neonatal SCTs are mostly mature, but can also contain immature and/or malignant components. Recurrence of an SCT alters prognosis, especially when it is malignant, of which its mechanism is not yet fully understood. This study is a review and meta-analysis of the literature on malignant recurrences after an initially mature SCT. METHODS A literature search was performed to identify studies describing children with SCT and presenting specific information on histology of the initial tumour as well as the recurrence. Random effect models for mature recurrence and malignant recurrence after an initially mature SCT were employed to pool study-specific percentages in order to estimate an overall percentage and its associated 95 % confidence intervals (CI). Inverse variance method, which gives more weight to larger studies, was used to pool outcomes for the different studies. RESULTS A total of 22 articles, comprising 1516 patients with SCT, were included in the meta-analysis. The pooled proportions of mature and malignant recurrences after mature SCT were 3 % (95 % CI 1-4 %) and 5% (95 % CI 3-6 %), respectively. Fifty-seven (56 %) of a total of 102 recurrences after resection of an initially mature SCT were malignant, mostly yolk sac tumour (YST). Many recurrences occurred within 1-6 years, however some occurred as long as 20 years after initial diagnosis. CONCLUSIONS A substantial number of recurrences of mature SCT present as a malignant tumour. Overlooking malignant components on initial pathological evaluation and the progression of mature SCT cells to malignant cells may play a role. Treatment of mature SCTs with resection alone requires thorough follow-up of at least 6 years. Future research is needed to determine whether SCTs with malignant microfoci should be treated or followed-up differently from mature or immature SCTs. In addition, the value of serum biomarkers in follow-up after SCT needs to be further evaluated.
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Affiliation(s)
- Aranka L Kops
- Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands
| | | | - Marta Fiocco
- Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands
| | - József Zsiros
- Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands
| | | | | | | | - Marc Hw Wijnen
- Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands
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14
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van Heurn LJ, Knipscheer MM, Derikx JPM, van Heurn LWE. Diagnostic accuracy of serum alpha-fetoprotein levels in diagnosing recurrent sacrococcygeal teratoma: A systematic review. J Pediatr Surg 2020; 55:1732-1739. [PMID: 32376010 DOI: 10.1016/j.jpedsurg.2020.03.014] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2019] [Revised: 03/12/2020] [Accepted: 03/12/2020] [Indexed: 01/03/2023]
Abstract
BACKGROUND The incidence of children developing recurrent sacrococcygeal teratoma (SCT) is 2-35%. Serum alpha-fetoprotein (AFP) is often used as a tumor marker for (malignant) recurrences of SCT and could potentially be used during routine follow-up after SCT resection. However, the diagnostic accuracy of serum AFP levels during follow-up has not been well established. Therefore, we aimed to systematically review the diagnostic accuracy of serum AFP levels in recurrent SCT. METHODS We queried Search Premier, COCHRANE Library, EMCARE, EMBASE, PubMed, ScienceDirect and Web of Science databases to identify studies regarding patients with SCT with follow-up using serum AFP levels postoperative. We estimated sensitivity and specificity of serum AFP levels. RESULTS Fifteen studies (613 patients, 121 recurrences) were included and these mainly described serum AFP levels in patients with recurrent SCT (n = 111); 83 (75%) patients with recurrent SCT had elevated serum AFP levels. A subgroup analysis of articles that measured serum AFP levels in all patients (n = 6, 136 patients, 14 recurrences) showed a sensitivity and specificity of 79% and 95%, respectively. The sensitivity of AFP levels to detect malignant recurrence was 96%. CONCLUSION Diagnostic accuracy of serum AFP levels to detect recurrent SCT seems promising, though sensitivity could be overestimated since serum AFP levels are mainly described in patients with elevated AFP levels or at recurrent SCT. Furthermore, serum AFP levels could be helpful to detect malignant recurrences. TYPE OF STUDY Systematic review of level 2-4 studies. LEVEL OF EVIDENCE Level 2-4 (mostly level 2).
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Affiliation(s)
- L J van Heurn
- Emma Children's Hospital, Amsterdam UMC, University of Amsterdam & Vrije Universiteit Amsterdam, Department of P(a)ediatric Surgery, Amsterdam, The Netherlands.
| | - M M Knipscheer
- Emma Children's Hospital, Amsterdam UMC, University of Amsterdam & Vrije Universiteit Amsterdam, Department of P(a)ediatric Surgery, Amsterdam, The Netherlands
| | - J P M Derikx
- Emma Children's Hospital, Amsterdam UMC, University of Amsterdam & Vrije Universiteit Amsterdam, Department of P(a)ediatric Surgery, Amsterdam, The Netherlands
| | - L W E van Heurn
- Emma Children's Hospital, Amsterdam UMC, University of Amsterdam & Vrije Universiteit Amsterdam, Department of P(a)ediatric Surgery, Amsterdam, The Netherlands
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Tamura D, Maeda D, Sato T, Sugawara T, Shirasawa H, Shimizu D, Sato N, Goto A, Terada Y. An extragonadal yolk sac tumor presumed to be of postmeiotic germ cell origin by genetic zygosity analysis via single nucleotide polymorphism array. Genes Chromosomes Cancer 2019; 59:209-213. [DOI: 10.1002/gcc.22817] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2019] [Accepted: 10/15/2019] [Indexed: 01/19/2023] Open
Affiliation(s)
- Daisuke Tamura
- Department of Obstetrics and Gynecology, Graduate School of MedicineAkita University Akita Japan
- Department of GynecologyAkita Red Cross Hospital Akita Japan
| | - Daichi Maeda
- Department of Clinical Genomics, Graduate School of MedicineOsaka University Osaka Japan
| | - Toshiharu Sato
- Department of Obstetrics and Gynecology, Graduate School of MedicineAkita University Akita Japan
| | - Tae Sugawara
- Department of Obstetrics and Gynecology, Graduate School of MedicineAkita University Akita Japan
| | - Hiromitsu Shirasawa
- Department of Obstetrics and Gynecology, Graduate School of MedicineAkita University Akita Japan
| | - Dai Shimizu
- Department of Obstetrics and Gynecology, Graduate School of MedicineAkita University Akita Japan
| | - Naoki Sato
- Department of Obstetrics and Gynecology, Graduate School of MedicineAkita University Akita Japan
| | - Akiteru Goto
- Department of Cellular and Organ Pathology, Graduate School of MedicineAkita University Akita Japan
| | - Yukihiro Terada
- Department of Obstetrics and Gynecology, Graduate School of MedicineAkita University Akita Japan
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16
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Halleran DR, Vilanova-Sanchez A, Reck CA, Maloof T, Weaver L, Stanek J, Levitt MA, Wood RJ, Aldrink JH. Presacral masses and sacrococcygeal teratomas in patients with and without anorectal malformations: A single institution comparative study. J Pediatr Surg 2019; 54:1372-1378. [PMID: 30630596 DOI: 10.1016/j.jpedsurg.2018.11.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2018] [Revised: 10/31/2018] [Accepted: 11/27/2018] [Indexed: 11/26/2022]
Abstract
BACKGROUND Despite variability at presentation, presacral masses in patients with and without anorectal malformations (ARM) appear histologically similar. The purpose of this study was to identify differences in oncologic outcomes between these two groups. METHODS A retrospective review was performed utilizing our institutional cancer and colorectal and pelvic reconstruction databases for patients with presacral masses and sacrococcygeal teratomas between 1990 and 2017. Data captured included age at surgical resection, type of ARM, tumor location within the pelvis, tumor histopathology, tumor size, adjuvant chemotherapy, recurrence, and follow-up. RESULTS Forty-six patients comprised our cohort, of whom 12 had an ARM. The median age was older at resection for those with an ARM (1.4 years; range 1 day to 29.4 years) compared to those without an ARM (9 days; range 0 days to 6.9 years) (p = 0.01). The mean tumor size was 2.5 cm in patients with an ARM compared to 6.0 cm in patients without an ARM (p = 0.036). All patients with ARM had exclusively intrapelvic tumors, and histopathology included mature teratoma (8), yolk sac tumor (1), lipoma (1), and unknown (2). Tumor location for patients with sacral and presacral masses without ARM included exclusively extrapelvic (10), primarily extrapelvic with large intrapelvic component (7), primarily intrapelvic with extrapelvic component (1), exclusively intrapelvic (8), and unknown (8). Histopathology for patients with presacral masses without ARM included mature teratoma (20), immature teratoma (7), yolk sac tumor (3), ganglioneuroma (1), neuroblastoma (1), benign epithelial cyst (1), and unknown (1). Tumor recurrence rate was similar between patients with ARM (n = 3, 25%) and those without an ARM (n = 5, 15%) (p = 0.41). The 5-year event free survival was 65% (95% CI: 25%-87%) in the group with ARM and 81% (95% CI: 60%-92%) in the group without ARM (p = 0.44). CONCLUSION Sacral and presacral masses in patients with ARM are resected at a later age and are more likely to be intrapelvic. They appear histologically similar and have similar rates of recurrence and malignancy when compared to patients without ARM. LEVEL OF EVIDENCE III TYPE OF STUDY: Retrospective comparative study.
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Affiliation(s)
- Devin R Halleran
- Center for Colorectal and Pelvic Reconstruction, Nationwide Children's Hospital, Columbus, OH
| | | | - Carlos A Reck
- Center for Colorectal and Pelvic Reconstruction, Nationwide Children's Hospital, Columbus, OH
| | - Tassiana Maloof
- Center for Colorectal and Pelvic Reconstruction, Nationwide Children's Hospital, Columbus, OH
| | - Laura Weaver
- Center for Colorectal and Pelvic Reconstruction, Nationwide Children's Hospital, Columbus, OH
| | - Joseph Stanek
- Department of Biostatistics, Division of Hematology/Oncology/Bone Marrow Transplantation, Nationwide Children's Hospital, Columbus, OH
| | - Marc A Levitt
- Center for Colorectal and Pelvic Reconstruction, Nationwide Children's Hospital, Columbus, OH
| | - Richard J Wood
- Center for Colorectal and Pelvic Reconstruction, Nationwide Children's Hospital, Columbus, OH
| | - Jennifer H Aldrink
- Department of Surgery, Division of Pediatric Surgery, Nationwide Children's Hospital, The Ohio State University College of Medicine, Columbus, OH.
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Rahadiani N, Krisnuhoni E, Stephanie M, Handjari DR. Extragonadal yolk sac tumor following congenital buccal mature cystic teratoma. J Oral Maxillofac Pathol 2019; 23:49-53. [PMID: 30967724 PMCID: PMC6421921 DOI: 10.4103/jomfp.jomfp_127_18] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Yolk sac tumor (YST) and teratoma both categorized as germ cell tumor (GCT). YST shows preferential differentiation toward yolk sac structures, while teratoma consists of tissues that originate from at least two embryonic germinal layers. Extragonadal location of YST is rare, whereas extragonadal teratoma is majority presented in nasopharynx area. Mature teratoma tends to be benign although some malignant transformation can occur. Recurrence of teratoma was reported mostly in the case of immature teratoma. YST occurrence after removal of mature teratoma is never reported. It is extremely rare for a second GCT to occur at the same site and with a different histological type. We herein report a case of a female infant presented with YST following a congenital buccal mature teratoma.
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Affiliation(s)
- Nur Rahadiani
- Department of Anatomical Pathology, Faculty of Medicine, Universitas Indonesia, Cipto Mangunkusumo Hospital, Jakarta, Indonesia
| | - Ening Krisnuhoni
- Department of Anatomical Pathology, Faculty of Medicine, Universitas Indonesia, Cipto Mangunkusumo Hospital, Jakarta, Indonesia
| | - Marini Stephanie
- Department of Anatomical Pathology, Faculty of Medicine, Universitas Indonesia, Cipto Mangunkusumo Hospital, Jakarta, Indonesia
| | - Diah Rini Handjari
- Department of Anatomical Pathology, Faculty of Medicine, Universitas Indonesia, Cipto Mangunkusumo Hospital, Jakarta, Indonesia
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Ferraro S, Panzeri A, Braga F, Panteghini M. Serum α-fetoprotein in pediatric oncology: not a children’s tale. ACTA ACUST UNITED AC 2018; 57:783-797. [DOI: 10.1515/cclm-2018-0803] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2018] [Accepted: 09/11/2018] [Indexed: 12/16/2022]
Abstract
Abstract
Background
Measurement of α-fetoprotein (AFP) concentrations in the serum of infants is useful for the management of testicular germ cell tumors, hepatoblastoma and hepatocellular carcinoma. Here, we provide a critical review of the available information about pediatric reference intervals (RI), focusing on their utility in interpreting AFP as an aid for cancer diagnosis.
Content
Evidence sources in the available literature were critically appraised. Out of 3873 retrieved papers, 24 were finally selected and carefully inspected, and six of them overcame exclusion criteria (i.e. methodological limitations in the study design, statistical gaps, drawbacks in traceability of the AFP assay to higher order materials and/or biased reporting of AFP results). Preterm and term infants up to the 3rd month of life exhibited the highest average AFP concentrations, but the attempt of defining RI by data pooling and partitioning for age intervals was impeded by the wide variability of data. The inability of defining robust RI in the first months of life made difficult, if not impossible, using upper reference limits for ruling out malignancies with a single AFP result. Evaluating the behavior of AFP concentrations 5 days from the baseline result, if this exceeds risk thresholds partitioned for age, according to the formula Xt=X0*2−t/HL (where: t=days elapsed for AFP retest; HL=AFP half-life according to age; X0=AFP baseline concentration, and Xt=predicted AFP concentration at day 5), could give a better information.
Summary
Novel studies defining AFP RI in infants based on robust methodology are warranted to improve the interpretation of AFP results in pediatric oncology. In the meantime, algorithms based on both serum AFP absolute concentrations and HL may aid in cancer diagnosis.
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Affiliation(s)
- Simona Ferraro
- UOC Patologia Clinica, Ospedale “Luigi Sacco” , Via GB Grassi 74 , Milan 20157 , Italy
- Department of Biomedical and Clinical Sciences ‘Luigi Sacco’ , University of Milan, and Clinical Pathology Unit, ASST Fatebenefratelli-Sacco , Milan , Italy
| | - Andrea Panzeri
- Department of Biomedical and Clinical Sciences ‘Luigi Sacco’ , University of Milan, and Clinical Pathology Unit, ASST Fatebenefratelli-Sacco , Milan , Italy
| | - Federica Braga
- Department of Biomedical and Clinical Sciences ‘Luigi Sacco’ , University of Milan, and Clinical Pathology Unit, ASST Fatebenefratelli-Sacco , Milan , Italy
| | - Mauro Panteghini
- Department of Biomedical and Clinical Sciences ‘Luigi Sacco’ , University of Milan, and Clinical Pathology Unit, ASST Fatebenefratelli-Sacco , Milan , Italy
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Phi JH, Wang KC, Kim SK. Intracranial Germ Cell Tumor in the Molecular Era. J Korean Neurosurg Soc 2018; 61:333-342. [PMID: 29742886 PMCID: PMC5957323 DOI: 10.3340/jkns.2018.0056] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2018] [Revised: 04/02/2018] [Accepted: 04/16/2018] [Indexed: 12/15/2022] Open
Abstract
Intracranial germ cell tumors (iGCTs) are a heterogeneous group of tumors with peculiar characteristics clearly distinguished from other brain tumors of neuroepithelial origin. Diverse histology, similarity to gonadal GCT, predilection to one sex, and geographic difference in incidence all present enigmas and fascinating challenges. The treatment of iGCT has advanced for germinoma to date; thus, clinical attention has shifted from survival to long-term quality of life. However, for non-germinomatous GCT, current protocols provide only modest improvement and more innovative therapies are needed. Recently, next-generation sequencing studies have revealed the genomic landscape of iGCT. Novel mutations in the KIT-RAS-MAPK and AKT-MTOR pathways were identified. More importantly, methylation profiling revealed a new method to assess the pathogenesis of iGCT. Molecular research will unleash new knowledge on the origin of iGCT and solve the many mysteries that have lingered on this peculiar neoplasm for a long time.
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Affiliation(s)
- Ji Hoon Phi
- Division of Pediatric Neurosurgery, Seoul National University Children's Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Kyu-Chang Wang
- Division of Pediatric Neurosurgery, Seoul National University Children's Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Seung-Ki Kim
- Division of Pediatric Neurosurgery, Seoul National University Children's Hospital, Seoul National University College of Medicine, Seoul, Korea
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20
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Kremer MEB, Wellens LM, Derikx JPM, van Baren R, Heij HA, Wijnen MHWA, Wijnen RMH, van der Zee DC, van Heurn LWE. Hemorrhage is the most common cause of neonatal mortality in patients with sacrococcygeal teratoma. J Pediatr Surg 2016; 51:1826-1829. [PMID: 27502009 DOI: 10.1016/j.jpedsurg.2016.07.005] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2016] [Revised: 07/10/2016] [Accepted: 07/14/2016] [Indexed: 11/17/2022]
Abstract
BACKGROUND A small percentage of neonates with sacrococcygeal teratoma die shortly after birth from hemorrhagic complications. The incidence of and risk factors associated with hemorrhagic mortality are unknown. In this multicenter study we determined the incidence of early death in neonates born with SCT and evaluated potential risk factors for hemorrhagic mortality. METHODS 235 children with SCT treated from 1970 to 2010 in the Netherlands were retrospectively included. The following candidate risk factors for hemorrhagic mortality were examined: sex, prematurity, Altman type, tumor volume, tumor histology, necessity of emergency operation and time of diagnosis. RESULTS Eighteen patients (7.7%) died at a median age of 163.5days (range 1.7-973days). Nine patients died of a malignancy. Nine others (3.8%) died postnatally (age 1-27days), six even within two days after birth. In seven of these nine patients death was related to tumor-hemorrhage and/or circulatory failure. Risk factors for hemorrhagic mortality were prematurity, tumor volume>1000cm3 and performance of an emergency operation. CONCLUSIONS Hemorrhagic mortality of neonates with SCT is relatively high (3.8%) representing almost 70% of the overall mortality in the neonatal period. High-output cardiac failure, internal tumor hemorrhage and perioperative bleeding were the most common causes of early death and were all strongly associated with larger tumor sizes. LEVEL-OF-EVIDENCE RATING II (Retrospective study).
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Affiliation(s)
- Marijke E B Kremer
- Department of Surgery-Maastricht University Medical Centre, Maastricht, the Netherlands
| | - Lianne M Wellens
- Department of Surgery-Maastricht University Medical Centre, Maastricht, the Netherlands
| | - Joep P M Derikx
- Department of Surgery-Maastricht University Medical Centre, Maastricht, the Netherlands
| | - Robertine van Baren
- Department of Paediatric Surgery-University Medical Centre Groningen, Groningen, the Netherlands
| | - Hugo A Heij
- Department of Paediatric Surgery-Surgical Centre of Amsterdam (Emma Children's Hospital AMC and VU Medical Centre), Amsterdam, the Netherlands
| | - Marc H W A Wijnen
- Department of Paediatric Surgery-Radboud University Medical Centre, Nijmegen, the Netherlands
| | - René M H Wijnen
- Department of Paediatric Surgery-Erasmus Medical Centre-Sophia Children's Hospital, Rotterdam, the Netherlands
| | - David C van der Zee
- Department of Paediatric Surgery-Wilhelmina Children's Hospital, University Medical Centre Utrecht, Utrecht, the Netherlands
| | - L W Ernest van Heurn
- Department of Surgery-Maastricht University Medical Centre, Maastricht, the Netherlands.
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21
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Emerson RE, Kao CS, Eble JN, Grignon DJ, Wang M, Zhang S, Wang X, Fan R, Masterson TA, Roth LM, Cheng L. Evidence of a dual histogenetic pathway of sacrococcygeal teratomas. Histopathology 2016; 70:290-300. [DOI: 10.1111/his.13062] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2016] [Accepted: 08/12/2016] [Indexed: 12/19/2022]
Affiliation(s)
- Robert E Emerson
- Department of Pathology and Laboratory Medicine; Indiana University School of Medicine; Indianapolis IN USA
| | - Chia-Sui Kao
- Department of Pathology; Stanford University Medical Center; Stanford CA USA
| | - John N Eble
- Department of Pathology and Laboratory Medicine; Indiana University School of Medicine; Indianapolis IN USA
| | - David J Grignon
- Department of Pathology and Laboratory Medicine; Indiana University School of Medicine; Indianapolis IN USA
| | - Mingsheng Wang
- Department of Pathology and Laboratory Medicine; Indiana University School of Medicine; Indianapolis IN USA
| | - Shaobo Zhang
- Department of Pathology and Laboratory Medicine; Indiana University School of Medicine; Indianapolis IN USA
| | - Xiaoyan Wang
- Department of Pathology and Laboratory Medicine; Indiana University School of Medicine; Indianapolis IN USA
| | - Rong Fan
- Department of Pathology and Laboratory Medicine; Indiana University School of Medicine; Indianapolis IN USA
| | - Timothy A Masterson
- Department of Urology; Indiana University School of Medicine; Indianapolis IN USA
| | - Lawrence M Roth
- Department of Pathology and Laboratory Medicine; Indiana University School of Medicine; Indianapolis IN USA
| | - Liang Cheng
- Department of Pathology and Laboratory Medicine; Indiana University School of Medicine; Indianapolis IN USA
- Department of Urology; Indiana University School of Medicine; Indianapolis IN USA
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22
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Kremer MEB, Derikx JPM, Peeters A, Ter Kuile MM, van Baren R, Heij HA, Wijnen MHWA, Wijnen RMH, van der Zee DC, van Heurn LWE. Sexual function after treatment for sacrococcygeal teratoma during childhood. J Pediatr Surg 2016; 51:534-40. [PMID: 26460155 DOI: 10.1016/j.jpedsurg.2015.09.013] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2015] [Revised: 08/29/2015] [Accepted: 09/13/2015] [Indexed: 11/19/2022]
Abstract
BACKGROUND Children treated for sacrococcygeal teratoma (SCT) may suffer from sexual dysfunction later in life because of the extended pelvic surgery performed, however, structured evaluations have not been performed yet. METHODS The Female Sexual Function Index (FSFI), the International Index of Erectile Function (IIEF) and the Body Image Questionnaire (BIQ) were sent to patients (≥18years) treated for SCT in the Dutch pediatric surgical centers after 1970. RESULTS Forty-five of 76 patients returned the questionnaires; 28 women (median age 27.3years, range 18.3-41.0) and seven men (median age 22.0years, range 19.1-36.5) were eligible for analysis. The FSFI and IIEF results were compared to healthy controls. Female patients scored significantly lower on the desire (p=0.014), arousal (p=0.013) and lubrication domain (p=0.019). FSFI total-scores of female patients were significantly lower compared to controls [median 30.5 (IQR 28.6-31.4) vs. median 32.4 (IQR 30.6-33.45) p≤0.001] but were above the threshold value for sexual dysfunction. Males reported normal erectile function and penetration ability with normal ejaculation. Females had significant lower BIQ results compared to males; BIQ-cosmesis scores were moderately correlated to the FSFI-desire score (r=-0.37, p=0.028). CONCLUSION SCT resection in girls may result in diminished sexual function at adult age with worse self-perceived body image. The possibility of sexual complaints should be integrated in the surveillance strategies for these patients.
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Affiliation(s)
- Marijke E B Kremer
- Department of Surgery, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Joep P M Derikx
- Department of Surgery, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Andrea Peeters
- Department of Clinical Epidemiology and Medical Technology Assessment, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Moniek M Ter Kuile
- Department of Psychosomatic Gynecology and Sexology, Leiden University Medical Center, Leiden, the Netherlands
| | - Robertine van Baren
- Department of Pediatric Surgery, University Medical Center Groningen, Groningen, the Netherlands
| | - Hugo A Heij
- Pediatric Surgical Center of Amsterdam (Emma Children's Hospital AMC and VU Medical Center), Amsterdam, the Netherlands
| | - Marc H W A Wijnen
- Department of Pediatric, Radboud University Medical Center, Nijmegen, the Netherlands
| | - René M H Wijnen
- Department of Pediatric Surgery, Erasmus Medical Center-Sophia Children's Hospital, Rotterdam, the Netherlands
| | - David C van der Zee
- Department of Pediatric Surgery, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, the Netherlands
| | - L W Ernest van Heurn
- Department of Surgery, Maastricht University Medical Center, Maastricht, the Netherlands.
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Kremer MEB, Derikx JPM, Kremer LCM, van Baren R, Heij HA, Wijnen MHWA, Wijnen RMH, van der Zee DC, van Heurn LWE. Evaluation of chemotherapeutic sequelae and quality of life in survivors of malignant sacrococcygeal teratoma. Pediatr Surg Int 2016; 32:261-8. [PMID: 26667016 DOI: 10.1007/s00383-015-3842-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/17/2015] [Indexed: 11/24/2022]
Abstract
PURPOSE The impact of chemotherapeutic sequelae on long-term quality of life (QoL) for survivors of malignant sacrococcygeal teratoma (SCT) is unknown. The incidence of chemotherapeutic toxicity in patients treated for malignant SCT and possible effects on the QoL were analyzed. METHODS Retrospective chart review of patients ≥18 years treated for SCT in the Netherlands was performed. Present QoL was evaluated using the SF-36 questionnaire. The results of survivors of malignant SCT were compared to those of patients treated for benign SCT. RESULTS Fifty-one of 76 traceable patients consented to participate. The results of 47 (92.2 %), 9 men and 38 women (median age 25.4 years, range 18.3-41.2), were analyzed. Eleven had been treated for malignancy; 63.6 % suffered from at least one chemotherapeutic sequel with hearing loss as the most common one. Results for both groups were similar on all but one SF-36 subcategory; those treated for malignant tumor scored significantly lower on the subcategory physical functioning (p = 0.02). CONCLUSION Despite the high incidence of chemotherapeutic sequelae among survivors of malignant SCT, their QoL does not differ from that of those treated for benign SCT. Even though their physical functioning is restricted, daily activities and psychosocial functioning of survivors of malignant SCT are not restricted.
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Affiliation(s)
- Marijke E B Kremer
- Department of Pediatric Surgery, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Joep P M Derikx
- Department of Pediatric Surgery, Maastricht University Medical Center, Maastricht, The Netherlands.,Paediatric Surgical Center of Amsterdam Emma Children's Hospital AMC and VU University Medical Center, P.O. Box 22660, 1100 DD, Amsterdam, The Netherlands
| | - Leontien C M Kremer
- Department of Pediatric Oncology, Emma Children's Hospital, University Medical Center Amsterdam, Amsterdam, The Netherlands
| | - Robertine van Baren
- Department of Pediatric Surgery, University Medical Center Groningen, Groningen, The Netherlands
| | - Hugo A Heij
- Pediatric Surgical Center of Amsterdam (Emma Children's Hospital University Medical Center and VU Medical Center Amsterdam), Amsterdam, The Netherlands
| | - Marc H W A Wijnen
- Department of Pediatric Surgery, University Medical Center Nijmegen, Nijmegen, The Netherlands
| | - René M H Wijnen
- Department of Pediatric Surgery, Sophia Children's Hospital, Erasmus University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - David C van der Zee
- Department of Pediatric Surgery, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, The Netherlands
| | - L W Ernest van Heurn
- Department of Pediatric Surgery, Maastricht University Medical Center, Maastricht, The Netherlands. .,Paediatric Surgical Center of Amsterdam Emma Children's Hospital AMC and VU University Medical Center, P.O. Box 22660, 1100 DD, Amsterdam, The Netherlands.
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Li Y, Zheng Y, Lin J, Xu G, Cai A, Chen R, Wu M. Radiological-pathological correlation of yolk sac tumor in 20 patients. Acta Radiol 2016; 57:98-106. [PMID: 25492969 DOI: 10.1177/0284185114561916] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2014] [Accepted: 11/07/2014] [Indexed: 02/05/2023]
Abstract
BACKGROUND Yolk sac tumor (YST) is a rare tumor. Familiarity of its radiological characteristics may permit preoperative diagnosis and improve surgical management of patients. However, a detailed description of the imaging features of YST with pathological correlation in particular is scarce. PURPOSE To investigate computed tomography (CT) findings of YSTs with pathological correlation. MATERIAL AND METHODS CT images of 20 patients with pathologically proven YST were retrospectively reviewed. The location, size, margin, internal architecture, and pattern and degree enhancement of the lesion were evaluated. Radiological findings were correlated with pathological results. RESULTS The locations of 20 tumors were distributed between the testis (n = 3), ovary (n = 6), sacrococcygeal area (n = 6), rectum (n = 1), and mediastinum (n = 4). The median age was 13 years. On CT images, all tumors were seen as oval (n = 14) or irregular (n = 6), well-defined (n = 16) or ill-defined (n = 4) masses with a mean size of 9.7 cm. The lesions were solid cystic (n = 10), entirely solid (n = 6), or predominantly cystic (n = 4). Intratumoral hemorrhage, calcification, and fatty tissue were seen in nine, three, and two tumors, respectively. Discontinuity of the tumor wall was seen in eight tumors. After contrast media administration, most tumors showed heterogeneous moderate to marked enhancement (n = 7) or heterogeneous marked enhancement (n = 9). Enlarged intratumoral vessels were seen in 17 tumors. CONCLUSION YST usually appears as a large solid-cystic mass with intratumoral hemorrhage, capsular tear, marked heterogeneous enhancement, and enlarged intratumoral vessels on CT images. Intratumoral calcification and fatty tissue, although rare, may indicate a mixed YST containing teratoma component.
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Affiliation(s)
- YangKang Li
- Department of Radiology, Cancer Hospital, Shantou University Medical College, Shantou, PR China
| | - Yu Zheng
- Department of Clinical Pharmacology, Cancer Hospital, Shantou University Medical College, Shantou, PR China
| | - JianBang Lin
- Department of Radiology, Cancer Hospital, Shantou University Medical College, Shantou, PR China
| | - GuiXiao Xu
- State Key Laboratory of Oncology in South China, Department of Diagnostic Imaging and Intervening Center, Cancer Center of Sun Yat-sen University, Guangzhou, PR China
| | - AiQun Cai
- Department of Radiology, Cancer Hospital, Shantou University Medical College, Shantou, PR China
| | - RuoWei Chen
- Department of Diagnostic Imaging, the Second affiliated Hospital of Shantou University Medical College, Shantou, PR China
| | - MingYao Wu
- Department of Pathology, Shantou University Medical College, Shantou, PR China
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Dirix M, van Becelaere T, Berkenbosch L, van Baren R, Wijnen RM, Wijnen MH, van der Zee DC, Heij HA, Derikx JPM, van Heurn LWE. Malignant transformation in sacrococcygeal teratoma and in presacral teratoma associated with Currarino syndrome: a comparative study. J Pediatr Surg 2015; 50:462-4. [PMID: 25746708 DOI: 10.1016/j.jpedsurg.2014.07.014] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2014] [Revised: 07/14/2014] [Accepted: 07/25/2014] [Indexed: 10/24/2022]
Abstract
BACKGROUND/PURPOSE The risk of malignant transformation of sacrococcygeal teratoma (SCT) and of presacral teratoma in Currarino syndrome (CS) may differ despite the similar position and appearance. METHODS Malignant transformation and teratoma recurrence were assessed in a national retrospective comparative analysis of 205 SCT and 16 CS patients treated in one of the six pediatric surgical centers in the Netherlands between January 1981 and December 2010. RESULTS The malignancy free survival of patients with SCT was lower than for patients with a presacral teratoma associated with CS (80% and 58% after one and two years in SCT versus 100% after two years in CS, p=0.017) CONCLUSIONS: In SCT, malignancy and recurrence risk are high. Therefore, early and complete resection is mandatory. Our data show that the risk of malignant transformation of a presacral teratoma in CS is small.
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Affiliation(s)
- Marc Dirix
- Department of Pediatric Surgery, Maastricht University Medical Centre, The Netherlands
| | - Tine van Becelaere
- Department of Pediatric Surgery, Maastricht University Medical Centre, The Netherlands
| | - Lizanne Berkenbosch
- Department of Pediatric Surgery, Maastricht University Medical Centre, The Netherlands
| | - Robertine van Baren
- Department of Pediatric Surgery, University Medical Centre Groningen, The Netherlands
| | - Rene M Wijnen
- Department of Pediatric Surgery, Erasmus Medical Centre-Sophia Children's Hospital, Rotterdam, The Netherlands
| | - Marc H Wijnen
- Department of Pediatric Surgery, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - David C van der Zee
- Department of Pediatric Surgery, Wilhelmina Children's Hospital, University Medical Centre, Utrecht, The Netherlands
| | - Hugo A Heij
- Pediatric Surgical Centre of Amsterdam (Emma Children's Hospital AMC/VU University Medical Centre), The Netherlands
| | - Joep P M Derikx
- Department of Pediatric Surgery, Maastricht University Medical Centre, The Netherlands
| | - L W Ernest van Heurn
- Department of Pediatric Surgery, Maastricht University Medical Centre, The Netherlands.
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