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Kane GA, Mortell A, Gillick J, Thambipillai SP, Cascio S. The Irish Experience with Sacrococcygeal Teratomas: Are Type IV Lesions More Common than We Think? Eur J Pediatr Surg 2024; 34:458-463. [PMID: 37793425 DOI: 10.1055/a-2185-9018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/06/2023]
Abstract
INTRODUCTION Sacrococcygeal teratomas (SCTs) are rare tumors occurring in approximately 1 in 35,000 to 40,000 live births. The Altman classification is used to describe SCTs. There are four types, with type 1 predominantly external through to type IV which is a presacral, completely internal mass. As far as the authors are aware, this is the first study to focus on type IV SCT lesions. MATERIALS AND METHODS Using ICD-10-AM (The International Statistical Classification of Diseases and Related Health Problems, Tenth Revision, Australian Modification) codes, we identified all patients in the Republic of Ireland with a diagnosis of SCT from 2004 to 2020. The following information was obtained for each patient: gender, time of diagnosis, clinical presentation, method of diagnosis, Altman classification, biomarkers, age at operation, surgical technique, pathology, recurrence, and age at most recent follow-up. RESULTS There were 29 patients in total; 23 females (79%) and 6 males (21%). In total, 16 (55%) were diagnosed antenatally, 4 (14%) at less than 1 month, 4 (14%) less than 1 year, 3 (10%) age 2 to 4 years, and 2 (7%) were aged 5 to 12 years. In addition, 22 (76%) were mature teratomas, 2 (7%) immature teratomas, and 5 (17%) were malignant tumors. There were 6 (21%) type I lesions, 9 (30%) type II, 6 (21%) type III, and 8 (28%) type IV lesions. CONCLUSION In Altman's original 1974 study, type IV lesions were present in 10% of cases. As a result, this is the most frequently quoted figure. Type IV lesions were present in 28% of cases in our study. We propose that type IV lesions may be more common than the current literature suggests and consequently a higher index of suspicion of their presence should be entertained.
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Affiliation(s)
- Gavin Alan Kane
- Department of Paediatric Surgery, Our Lady's Hospital Crumlin, Cooley Rd, Crumlin, Dublin, Crumlin, Ireland
| | - Alan Mortell
- Department of Paediatric Surgery, Our Lady's Hospital Crumlin, Cooley Rd, Crumlin, Dublin, Crumlin, Ireland
| | - John Gillick
- Department of Paediatric Surgery, Our Lady's Hospital Crumlin, Cooley Rd, Crumlin, Dublin, Crumlin, Ireland
| | - Sri Paran Thambipillai
- Department of Paediatric Surgery, Our Lady's Hospital Crumlin, Cooley Rd, Crumlin, Dublin, Crumlin, Ireland
| | - Salvatore Cascio
- Department of Paediatric Surgery, Our Lady's Hospital Crumlin, Cooley Rd, Crumlin, Dublin, Crumlin, Ireland
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2
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van Heurn LJ, Kremer MEB, de Blaauw I, van Baren R, van Gemert WG, van Goudoever JB, Sloots CEJ, Witvliet MJ, Ernest van Heurn LW, Derikx JPM. The Diagnostic Accuracy of Serum Alpha-Fetoprotein Levels in Follow-up for Recurrence of Sacrococcygeal Teratoma; a Nationwide Review of SCT Cases in the Netherlands. J Pediatr Surg 2024; 59:1740-1745. [PMID: 38418277 DOI: 10.1016/j.jpedsurg.2024.01.048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2023] [Revised: 01/20/2024] [Accepted: 01/31/2024] [Indexed: 03/01/2024]
Abstract
BACKGROUND Serum alpha-fetoprotein (AFP) is often used as tumour marker for recurrent sacrococcygeal teratoma (SCT). We aimed to assess the normal dynamics of serum AFP levels after initial resection and diagnostic accuracy of serum AFP levels the follow-up for recurrence in SCT. METHODS This retrospective study included 57 patients treated for SCT in the six pediatric surgical centers in the Netherlands from 1980 to 2018. MAIN RESULTS 57 patients were included in the study of whom 19 children developed 20 recurrences at a median of 14.0 months after initial resection. No significant difference was found in serum AFP level dynamics between the recurrence and non-recurrence group after initial resection (p = 0.950). Serum AFP levels did not significantly increase before recurrence (p = 0.106) compared to serum AFP levels of children without recurrence at the same time. However, serum AFP levels did significantly increase in malignant recurrences (n = 7) (p = 0.03) compared to patients without recurrence. A cut-off value of 55 μg/L was found to be predictive for recurrent SCT with an Area Under the Curve (AUC) of 0.636 with sensitivity of 50% and specificity of 100%. CONCLUSION Dynamics of serum AFP levels are not different between patients with and without recurrence after initial resection of SCT. Serum AFP levels are not predictive for mature or immature recurrent SCT and normal AFP levels do not rule out recurrent SCT. However, serum AFP levels exceeding 55 μg/L can indicate recurrent SCT, especially malignant recurrences.
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Affiliation(s)
- Lieke J van Heurn
- Emma Children's Hospital, Amsterdam UMC, University of Amsterdam & Vrije Universiteit Amsterdam, Department of Pediatric Surgery, Amsterdam, the Netherlands.
| | - Marijke E B Kremer
- Department of Pediatric Surgery, University Medical Centre Maastricht, Maastricht, the Netherlands
| | - Ivo de Blaauw
- Department of Pediatric Surgery, Radboud University Medical Center, Amalia Children's Hospital, Nijmegen, the Netherlands
| | - Robertine van Baren
- Department of Surgery and Pediatric Surgery, University Medical Center Groningen, Groningen, the Netherlands
| | - Wim G van Gemert
- Department of Pediatric Surgery, University Medical Centre Maastricht, Maastricht, the Netherlands
| | - Johannes B van Goudoever
- Department of Pediatrics, Amsterdam UMC, University of Amsterdam, Vrije Universiteit, Emma Children 's Hospital, Amsterdam, the Netherlands
| | - Cornelius E J Sloots
- Department of Pediatric Surgery and Intensive Care, Erasmus MC-Sophia Children's Hospital, Rotterdam, the Netherlands
| | - Marieke J Witvliet
- Department of Pediatric Surgery, University of Utrecht, Wilhelmina Children's Hospital, UMC Utrecht, Utrecht, the Netherlands
| | - L W Ernest van Heurn
- Emma Children's Hospital, Amsterdam UMC, University of Amsterdam & Vrije Universiteit Amsterdam, Department of Pediatric Surgery, Amsterdam, the Netherlands
| | - Joep P M Derikx
- Emma Children's Hospital, Amsterdam UMC, University of Amsterdam & Vrije Universiteit Amsterdam, Department of Pediatric Surgery, Amsterdam, the Netherlands
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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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4
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Acharya A, Mahapatra AK, Panigrahi S, Deo RC, Senapati SB. Pulsatile giant sacrococcygeal teratoma appearing like 2nd head. Childs Nerv Syst 2024; 40:1953-1956. [PMID: 38372776 DOI: 10.1007/s00381-024-06324-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2024] [Accepted: 02/13/2024] [Indexed: 02/20/2024]
Abstract
Sacrococcygeal teratoma is a congenital tumor of early infancy. Eighty percent are present in the first month of life. It is considered to be an extragonadal germ cell tumor that can be diagnosed in utero. It is considered to be a rare tumor in infancy and childhood. Incidences in girls are more common as compared to boys. Association with other congenital abnormalities of the gastrointestinal system, cardiovascular system, and urological manifestations may be present. Association with spinal dysraphism may be present. A complete systemic evaluation needs to be done before any surgical intervention. We hereby present you a case of a 5-day-old male child, born from a non-consanguineous marriage, who presented to us with a large swelling at the coccygeal region. The mass had a variegated consistency with an ear-like appendage over it with associated hair, bones, and necrotic tissue in it. The patient was evaluated with imaging (MRI) which revealed a heterogeneously enhancing mass at the sacrococcygeal region with mild extension into the pre-sacral space suggesting sacrococcygeal teratoma. After a complete evaluation for congenital abnormal abnormalities of other sites, gross total excision of the mass was performed. The post-operative condition of the baby was uneventful. A biopsy of the mass revealed a mature cystic teratoma. The baby is under follow-up at present.
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Affiliation(s)
- Abhijit Acharya
- Dept of Neurosurgery, IMS & SUM Hospital, SOA University, Bhubaneswar, Odisha, India.
| | - A K Mahapatra
- Dept of Neurosurgery, IMS & SUM Hospital, SOA University, Bhubaneswar, Odisha, India
| | - Souvagya Panigrahi
- Dept of Neurosurgery, IMS & SUM Hospital, SOA University, Bhubaneswar, Odisha, India
| | - Ram Chandra Deo
- Dept of Neurosurgery, IMS & SUM Hospital, SOA University, Bhubaneswar, Odisha, India
| | - Satya Bhusan Senapati
- Dept of Neurosurgery, IMS & SUM Hospital, SOA University, Bhubaneswar, Odisha, India
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Behera G, Manekar A, Mahallik S, Sable M, Das K. Currarino syndrome with immature teratoma: A case report with review of literature. J Cancer Res Ther 2024; 20:1088-1091. [PMID: 39023623 DOI: 10.4103/jcrt.jcrt_1142_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Accepted: 05/06/2020] [Indexed: 07/20/2024]
Abstract
ABSTRACT Currarino syndrome (CS) is a rare congenital syndrome characterized by a triad of anorectal malformation, sacral deformity, and presacral mass. In about 50% of cases, it is caused by HLXB9 gene mutation in chromosome 7q36. A 13-month-male child presented with presacral discharging sinus with a history of surgery for anorectal malformation and perineal fistula at the time of birth. On detailed investigation, the child revealed to have anal atresia, hemisacrum, and presacral mass. Histopathology of presacral mass showed features of immature teratoma. The presacral mass in CS is mostly an anterior myelomeningocele or presacral teratoma. The development of immature teratoma in presacral mass is very rare. The histopathological identification of immature component of teratoma in the presacral mass of CS is important for risk stratification and further management. Suspicion of CS should be raised in any child presenting with partial phenotype of the triad.
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Affiliation(s)
- Gayatri Behera
- Department of Pathology and Lab Medicine, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
| | - Aaditya Manekar
- Department of Pediatric Surgery, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
| | - Santosh Mahallik
- Department of Pediatric Surgery, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
| | - Mukund Sable
- Department of Pathology and Lab Medicine, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
| | - Kanishka Das
- Department of Pediatric Surgery, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
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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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Varlas VN, Cloțea EM, Varlas RG, Pop A, Peneș O, Crețoiu D, Dima V, Bălănescu L. Immature Sacrococcygeal Teratoma: A Case Report and Extensive Review of the Literature. Diagnostics (Basel) 2024; 14:246. [PMID: 38337762 PMCID: PMC10854813 DOI: 10.3390/diagnostics14030246] [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: 11/07/2023] [Revised: 01/11/2024] [Accepted: 01/22/2024] [Indexed: 02/12/2024] Open
Abstract
Immature sacrococcygeal teratoma represents a histological form with rapid tumor growth, a risk of premature birth, an enhanced rate of complications, an increased risk of recurrence, and a higher mortality rate than the mature type. Thus, prenatal diagnosis of immature forms would significantly improve the prognosis of these cases. To this end, we performed an extensive literature review on the diagnosis, therapeutic management, and follow-up of immature teratomas. Regarding this medical conduct, we also presented our case. In conclusion, the early identification of immature sacrococcygeal teratomas with or without other associated structural abnormalities and their correct therapeutic approach are basic principles for a favorable evolution of these cases.
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Affiliation(s)
- Valentin Nicolae Varlas
- Faculty of Medicine, “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania; (V.N.V.); (L.B.)
- Department of Obstetrics and Gynecology, Filantropia Clinical Hospital, 011132 Bucharest, Romania
| | - Eliza Maria Cloțea
- Department of Obstetrics and Gynecology, Filantropia Clinical Hospital, 011132 Bucharest, Romania
| | - Roxana Georgiana Varlas
- Department of Obstetrics and Gynecology, Filantropia Clinical Hospital, 011132 Bucharest, Romania
| | - Anca Pop
- Faculty of Medicine, “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania; (V.N.V.); (L.B.)
- Department of Clinical Laboratory, Food Safety, “Carol Davila” University of Medicine and Pharmacy, 6 Traian Vuia Street, 020945 Bucharest, Romania
| | - Ovidiu Peneș
- Faculty of Medicine, “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania; (V.N.V.); (L.B.)
- Department of Intensive Care, University Clinical Hospital, “Carol Davila” University of Medicine and Pharmacy, 37 Dionisie Lupu St., 020021 Bucharest, Romania
| | - Dragoș Crețoiu
- Fetal Medicine Excellence Research Center, Alessandrescu-Rusescu National Institute for Mother and Child Health, 020395 Bucharest, Romania
- Department of Genetics, Carol Davila University of Medicine and Pharmacy, 8 Eroii Sanitari Blvd., 050474 Bucharest, Romania
| | - Vlad Dima
- Department of Neonatology, Filantropia Clinical Hospital, 011132 Bucharest, Romania
| | - Laura Bălănescu
- Faculty of Medicine, “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania; (V.N.V.); (L.B.)
- Department of Pediatric Surgery, Children Emergency Hospital “Grigore Alexandrescu”, 011743 Bucharest, Romania
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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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Ozdemir OMA, Turgut M, Demir GS, Uzunlu O, Ergin H. Holt-Oram Syndrome with Sacrococcygeal Teratoma - A Rare Association. SISLI ETFAL HASTANESI TIP BULTENI 2023; 57:563-566. [PMID: 38268646 PMCID: PMC10805053 DOI: 10.14744/semb.2022.02359] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Revised: 11/14/2022] [Accepted: 11/19/2022] [Indexed: 12/12/2022]
Abstract
Holt-Oram syndrome (HOS) is characterized by upper-limb defects and congenital heart malformation, and its prevalence is very rarely. Mature cystic teratoma is the most common tumor seen in neonates and its most common location is sacrococcygeal region. Diagnosis of a sacrococcygealteratoma should be confirmed by pathology. Surgical resection is the mainstay therapeutic approach of this tumor. Some malformations such as genitourinary system, musculoskeletal anomalies, neural defects, cardiovascular anomalies, and pulmonary disorders associated with this tumor have been reported. Herein, we reported a male neonate diagnosed with HOS associated with sacrococcygealteratoma. To our knowledge, it has been not reported a case with HOS associated with sacrococcygealteratoma. Patients with sacrococcygealteratomas (SCTs) may have multiple and extreme congenital abnormalities; therefore, patients with SCTs should be carefully evaluated clinically, laboratory, and radiologically and it should be also considered that HOS may accompany them.
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Affiliation(s)
- Ozmert Muhammet Ali Ozdemir
- Department of Pediatrics, Division of Neonatology, Pamukkale University Faculty of Medicine, Denizli, Türkiye
| | - Musa Turgut
- Department of Pediatrics, Division of Neonatology, Pamukkale University Faculty of Medicine, Denizli, Türkiye
| | - Gulay Sonmez Demir
- Department of Pediatrics, Division of Neonatology, Pamukkale University Faculty of Medicine, Denizli, Türkiye
| | - Osman Uzunlu
- Department of Pediatric Surgery, Pamukkale University Faculty of Medicine, Denizli, Türkiye
| | - Hacer Ergin
- Department of Pediatrics, Division of Neonatology, Pamukkale University Faculty of Medicine, Denizli, Türkiye
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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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11
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Elgendy A, AbouZeid AA, El-Debeiky M, Mostafa M, Takrouney MH, Abouheba M, Khairi A, Shehata S, Shehata SM. Management strategy and outcomes of sacrococcygeal teratoma - an Egyptian multicenter experience. World J Surg Oncol 2023; 21:294. [PMID: 37718391 PMCID: PMC10506197 DOI: 10.1186/s12957-023-03180-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Accepted: 09/09/2023] [Indexed: 09/19/2023] Open
Abstract
OBJECTIVES Nationwide criteria regarding patients with sacrococcygeal teratoma (SCT) are still lacking in Egypt. We aimed to present a multicenter study regarding the management and outcomes of this tumor to evaluate our national treatment strategy. METHODS A retrospective analysis including all patients with SCT who were managed at four major Egyptian centers between 2013 and 2023. Clinical data, surgical approaches, and short- and long-term outcomes were discussed. RESULTS The study included 95 patients (74 were females). Antenatal diagnosis was reported in 25% of patients. Seventy-one patients (74.7%) were classified as Altman type I/II. Surgery was performed via a perineal approach in 75 patients, whereas the remaining 20 underwent a combined abdominoperineal approach. Vertical elliptical incision with midline closure was conducted in 51.5% of patients, followed by classic or modified chevron incisions. Benign mature teratoma was detected in 82% of patients. At a median follow-up of 57 months, eight patients (8.5%) had relapsed. The 5-year overall survival (OS) and event-free survival (EFS) of all patients were 94% and 91%, respectively. In the after-care monitoring, 19 patients (20%) had urinary or bowel dysfunctions. Nine of them were managed using medications. Clean intermittent catheterization was practiced in another five patients. The remaining five underwent further surgical interventions. CONCLUSION Favorable outcomes were achieved in our country during the last decade. Diverse perineal incisions were performed for resection, and vertical elliptical with midline closure was the commonest. During follow-up, 20% of patients developed urological or bowel dysfunctions that required medical and surgical treatment modalities to improve their quality of life.
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Affiliation(s)
- Ahmed Elgendy
- Surgical Oncology Unit, Department of Surgery, Faculty of Medicine, Tanta University, Tanta, 31515, Egypt.
| | | | - Mohamed El-Debeiky
- Pediatric Surgery Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Mahmoud Mostafa
- Pediatric Surgery Unit, Department of Surgery, Faculty of Medicine, Assiut University, Assiut, Egypt
| | - Mohammed Hamada Takrouney
- Pediatric Surgery Unit, Department of Surgery, Faculty of Medicine, Assiut University, Assiut, Egypt
| | - Mohamed Abouheba
- Pediatric Surgery Unit, Department of Surgery, Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - Ahmed Khairi
- Pediatric Surgery Unit, Department of Surgery, Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - Sameh Shehata
- Pediatric Surgery Unit, Department of Surgery, Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - Sherif M Shehata
- Pediatric Surgery Unit, Department of Surgery, Faculty of Medicine, Tanta University, Tanta, Egypt
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12
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Lew CZ, Liu HC, Hou JY, Huang TH, Yeh TC. Pediatric Extracranial Germ Cell Tumors: Review of Clinics and Perspectives in Application of Autologous Stem Cell Transplantation. Cancers (Basel) 2023; 15:cancers15071998. [PMID: 37046659 PMCID: PMC10093083 DOI: 10.3390/cancers15071998] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2023] [Revised: 03/24/2023] [Accepted: 03/25/2023] [Indexed: 03/30/2023] Open
Abstract
Pediatric extracranial germ cell tumors (GCTs) are rare, accounting for approximately 3.5% of childhood cancers. Since the introduction of platinum-based chemotherapy, the survival rate of patients has improved to more than 80%. However, poor-risk subtypes of pediatric extracranial GCTs do not respond well to chemotherapy, leading to refractory or relapsed (R/R) diseases. For example, long-term survival rates of mediastinal GCTs or choriocarcinoma are less than 50%. According to reports in recent years for adult patients with R/R GCTs, the use of high-dose chemotherapy (HDCT) combined with autologous stem cell transplantation (ASCT) has clinical advantages; however, HDCT combined with ASCT has rarely been reported in pediatric GCTs. The R/R and poor-risk groups of pediatric GCTs could benefit from HDCT and ASCT.
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Affiliation(s)
- Chong-Zhi Lew
- Division of Pediatric Hematology-Oncology, Department of Pediatrics, Mackay Children’s Hospital, Mackay Medical College, Taipei 104, Taiwan
| | - Hsi-Che Liu
- Division of Pediatric Hematology-Oncology, Department of Pediatrics, Mackay Children’s Hospital, Mackay Medical College, Taipei 104, Taiwan
| | - Jen-Yin Hou
- Division of Pediatric Hematology-Oncology, Department of Pediatrics, Mackay Children’s Hospital, Mackay Medical College, Taipei 104, Taiwan
| | - Ting-Huan Huang
- Division of Pediatric Hematology-Oncology, Department of Pediatrics, Hsinchu Mackay Memorial Hospital, Hsinchu 300, Taiwan
| | - Ting-Chi Yeh
- Division of Pediatric Hematology-Oncology, Department of Pediatrics, Mackay Children’s Hospital, Mackay Medical College, Taipei 104, Taiwan
- Correspondence:
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13
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Salim A, Raitio A, Losty PD. Long-term functional outcomes of sacrococcygeal teratoma - A systematic review of published studies exploring 'real world' outcomes. EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2023; 49:16-20. [PMID: 36127201 DOI: 10.1016/j.ejso.2022.09.002] [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: 07/20/2022] [Accepted: 09/02/2022] [Indexed: 01/24/2023]
Abstract
Sacrococcygeal teratoma (SCT) is a rare neoplasm affecting 1:35,000 newborns. Long-term follow-up from small observational studies report impaired bladder/bowel function. This current study comprehensively analyses all published studies to better define true long-term functional sequelae. Medline/Embase databases were searched with PRISMA guidelines. Final analysis yielded 37 studies involving 1116 patients (854 female; 77%). Individual datasets were available in 14 studies (222 patients). According to Altman classification - 298/845 (35%) were Type I, 252/845 (30%) Type II, 133/845 (16%) Type III, and 128/845 (15%) Type IV tumours. Most neoplasms were benign (640/858; 75%), 77/858 (9%) immature and 141/858 (16%) malignant. Abnormal bladder function was reported in 7/39 (18%) Altman Type I, 23/61 (37.7%) Type II, 11/34 (32.4%) Type III, and 15/25 (60%) Type IV cases (p = 0.007). Adverse urological outcomes were notably common in immature/malignant neoplasms vs benign tumours and in patients requiring reoperation(s); p = 0.002 and p = 0.01. Bowel dysfunction was evident in 19% index cases and constipation in 26% with no significant association(s) with tumour characteristics. Higher Altman stage, unfavourable tumour biology and reoperation are associated with poor functional outcome(s). Multidisciplinary management from primary diagnosis of SCT is crucially important for all patients to best optimise functional outcomes across surgical specialities.
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Affiliation(s)
- Adeline Salim
- Department of Paediatric Surgery, Alder Hey Children's NHS Foundation Trust, Liverpool, United Kingdom
| | - Arimatias Raitio
- Department of Paediatric Surgery, University of Turku and Turku University Hospital, Turku, Finland
| | - Paul D Losty
- University of Liverpool, Liverpool, United Kingdom; Department of Paediatric Surgery, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.
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14
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Heriyanto DS, Lau V, Laiman V, Ardianto B. Sacrococcygeal Yolk Sac Tumor in a Two-Year-Old Girl With Multiple Metastases: A Case Report. Cureus 2022; 14:e29056. [PMID: 36118998 PMCID: PMC9465126 DOI: 10.7759/cureus.29056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/11/2022] [Indexed: 11/16/2022] Open
Abstract
Sacrococcygeal yolk sac tumor (YST) is an infrequent extra-gonadal malignant germ cell tumor (GCT) that occurs exclusively within the first two years of life. A two-year-old girl came with a massive mass on her left buttock, which continued to grow, and within three months had become extremely large and hindered her from walking. Physical examination revealed a sacrococcygeal mass of 15 cm in diameter. Multislice CT showed an intraluminal inferior cava vein mass extending into the pelvic cavity with coccygeal osseous destruction, pulmonary metastasis, and multiple hepatic metastases. Laboratory data revealed elevated tumor marker values for alpha-feto-protein (AFP), lactate dehydrogenase (LDH), and Ca-125. Cytopathology following fine needle aspiration biopsy evaluation of the smear sample revealed a cellular tumor with pseudo glandular, microcystic, and solid patterns. The cytopathology did not show pathognomic findings. An immunocytochemistry (IHC) examination of the cell block showed a positive result for anti-AFP antibody. The patient was diagnosed and treated with chemotherapy for a sacrococcygeal YST. Clinical follow-up on the fourth month showed that the tumor had shrunk to 4 cm in size. Laboratory follow-up data after four months showed significant improvement. Unfortunately, the patient passed away on the seventh cycle of chemotherapy due to lung and hepatic metastases.
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15
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Neupane D, Dahal A, Lageju N, Jaiswal LS, Bista N, Sapkota A. Giant sacrococcygeal teratoma in a neonate: illustrative case. JOURNAL OF NEUROSURGERY: CASE LESSONS 2022. [PMCID: PMC9379725 DOI: 10.3171/case22125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Abstract
BACKGROUND Sacrococcygeal teratomas (SCTs) are tumors that emerge in the sacrococcygeal area and contain tissue from all three germ layers. SCT affects about 1 in every 35,000–40,000 live births, with malignant transformation becoming more common as the patient gets older. Ultrasound helps in prenatal diagnosis. Surgical resection is the mainstay of treatment. OBSERVATIONS A couple gave birth to a neonate with a small mass over his sacral region that progressively increased in size. Diagnostic magnetic resonance imaging was performed, and a diagnosis of giant SCT was established. Complete resection with flap reconstruction was performed. In regular follow-up, he is in a good state of health. LESSONS One of the most common tumors in infancy, SCT should be carefully diagnosed. SCT is often confused with neural tube defects such as myelocystocele or myelomeningocele. Complete resection with appropriate reconstruction can ensure better treatment, and close follow-up until adulthood is recommended to keep a close view on its possible recurrence and to improve prognosis. Postoperative complications such as infection, bleeding, and urethral complications should be carefully watched.
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Affiliation(s)
| | - Alok Dahal
- Department of Surgery, Division of Neurosurgery, and
| | | | - Lokesh Shekher Jaiswal
- Department of Surgery, Division of CTVS, B.P. Koirala Institute of Health Sciences, Dharan, Nepal
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16
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How to classify, diagnose, treat and follow-up extragonadal germ cell tumors? A systematic review of available evidence. World J Urol 2022; 40:2863-2878. [PMID: 35554637 PMCID: PMC9712285 DOI: 10.1007/s00345-022-04009-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2021] [Accepted: 02/01/2022] [Indexed: 12/30/2022] Open
Abstract
PURPOSE To present the current evidence and the development of studies in recent years on the management of extragonadal germ cell tumors (EGCT). METHODS A systematic literature search was conducted in Medline and the Cochrane Library. Studies within the search period (January 2010 to February 2021) that addressed the classification, diagnosis, prognosis, treatment, and follow-up of extragonadal tumors were included. Risk of bias was assessed and relevant data were extracted in evidence tables. RESULTS The systematic search identified nine studies. Germ cell tumors (GCT) arise predominantly from within the testis, but about 5% of the tumors are primarily located extragonadal. EGCT are localized primarily mediastinal or retroperitoneal in the midline of the body. EGCT patients are classified according to the IGCCCG classification. Consecutively, all mediastinal non-seminomatous EGCT patients belong to the "poor prognosis" group. In contrast mediastinal seminoma and both retroperitoneal seminoma and non-seminoma patients seem to have a similar prognosis as patients with gonadal GCTs and metastasis at theses respective sites. The standard chemotherapy regimen for patients with a EGCT consists of 3-4 cycles (good vs intermediate prognosis) of bleomycin, etoposid, cisplatin (BEP); however, due to their very poor prognosis patients with non-seminomatous mediastinal GCT should receive a dose-intensified or high-dose chemotherapy approach upfront on an individual basis and should thus be referred to expert centers Ifosfamide may be exchanged for bleomycin in cases of additional pulmonary metastasis due to subsequently planned resections. In general patients with non-seminomatous EGCT, residual tumor resection (RTR) should be performed after chemotherapy. CONCLUSION In general, non-seminomatous EGCT have a poorer prognosis compared to testicular GCT, while seminomatous EGGCT seem to have a similar prognosis to patients with metastatic testicular seminoma. The current insights on EGCT are limited, since all data are mainly based on case series and studies with small patient numbers and non-comparative studies. In general, systemic treatment should be performed like in testicular metastatic GCTs but upfront dose intensification of chemotherapy should be considered for mediastinal non-seminoma patients. Thus, EGCT should be referred to interdisciplinary centers with utmost experience in the treatment of germ cell tumors.
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17
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van Heurn LJ, Coumans ABC, Derikx JPM, Bekker MN, Bilardo KM, Duin LK, Knapen MFCM, Pajkrt E, Sikkel E, van Heurn LWE, Oepkes D. Factors associated with poor outcome in fetuses prenatally diagnosed with sacrococcygeal teratoma. Prenat Diagn 2021; 41:1430-1438. [PMID: 34327722 PMCID: PMC9292788 DOI: 10.1002/pd.6026] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2020] [Revised: 07/08/2021] [Accepted: 07/11/2021] [Indexed: 11/08/2022]
Abstract
AIM OF THE STUDY Outcome of fetuses, prenatally diagnosed with sacrococcygeal teratoma (SCT), is still poorly documented. This study assesses the incidence and prenatal predictors of outcome in all fetuses prenatally diagnosed with SCT. METHODS This is a retrospective study on all fetuses prenatally diagnosed with SCT from 1998 to 2018 in the Netherlands. Poor outcome was defined as terminations of pregnancy (TOP) because of expected unfavorable outcome, intrauterine fetal death, or early neonatal death. Potential risk factors for poor outcome were analyzed. MAIN RESULTS Eighty-four fetuses were included. Sixteen (19.0%) TOPs were excluded from statistical analysis. Eleven of the remaining 68 fetuses had poor outcome. Overall mortality was 32.1%, with a mortality excluding TOPs of 13.1%. Thirteen fetal interventions were performed in 11 (13.1%) fetuses. Potential risk factors for poor outcome were the presence of fetal hydrops (OR: 21.0, CI: 2.6-275.1, p = 0.012) and cardiomegaly (OR: 10.3, CI: 1.9-55.8, p = 0.011). CONCLUSIONS The overall mortality of fetuses prenatally diagnosed with SCTs including tTOP was 32.1%. This high mortality rate was mainly due to termination of pregnancy. Mortality excluding TOP was 13.1%. Potential risk factors for poor outcome were fetal hydrops and cardiomegaly.
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Affiliation(s)
- Lieke J van Heurn
- Department of P(a)ediatric Surgery, Emma Children's Hospital, Amsterdam UMC, University of Amsterdam & Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Audrey B C Coumans
- Department of Obstetrics and Gynaecology, Maastricht UMC +, Maastricht, The Netherlands
| | - Joep P M Derikx
- Department of P(a)ediatric Surgery, Emma Children's Hospital, Amsterdam UMC, University of Amsterdam & Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Mireille N Bekker
- Department of Obstetrics, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Katia M Bilardo
- Department of Obstetrics and Gynaecology, Amsterdam University Medical Centers, Amsterdam, The Netherlands
| | - Leonie K Duin
- Department of Obstetrics, Gynaecology and Prenatal Diagnosis, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Maarten F C M Knapen
- Department of Obstetrics and Fetal Medicine, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Eva Pajkrt
- Department of Obstetrics, Amsterdam UMC, University of Amsterdam & Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Esther Sikkel
- Department of Obstetrics and Gynecology, Radboud University Medical Center Nijmegen, Nijmegen, The Netherlands
| | - L W Ernest van Heurn
- Department of P(a)ediatric Surgery, Emma Children's Hospital, Amsterdam UMC, University of Amsterdam & Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Dick Oepkes
- Department of Obstetrics and Fetal Medicine, Leiden University Medical Center, Leiden, The Netherlands
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18
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Bedabrata M, Chhanda D, Moumita S, Kumar SA, Madhumita M, Biswanath M. An Epidemiological Review of Sacrococcygeal Teratoma over Five Years in a Tertiary Care Hospital. Indian J Med Paediatr Oncol 2021. [DOI: 10.4103/ijmpo.ijmpo_239_14] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Abstract
Background: Teratoma refers to neoplasm containing at least two germ cell layers derivatives foreign to the site of origin. Sacrococcygeal teratoma is most common congenital tumor commonly present as an exophytic mass of varying size at coccyx. Aims and Objectives: (1) The aim is to find age, sex, and clinical presentation of cases of sacrococcygeal teratoma. (2) Application of American Academy of Pediatrics' surgical section classification and histological grading in all cases. Materials and Methods: A retrospective, observational study was conducted in the Department of Pathology in collaboration with the Department of Pediatric Surgery from February 2009 to January 2014. A total 13 cases of sacrococcygeal teratoma were included in the present study. The records of these patients were reviewed, and clinical profiles were noted. An average 12 slides were examined in each case to evaluate histological type and grades. Results: A retrospective study was conducted including thirteen cases of histologically confirmed sacrococcygeal teratoma over 5 years period. Male to female ratio was 1:2. As per as age distribution is concerned, 3 neonates (23%) presented with sacrococcygeal mass. Associated congenital malformation was seen in 2 cases (15.4%). According to the American Academy of Pediatrics (Altman's) classification, 23% of cases were Type I, 31% of cases patients Type II, 31% of cases Type III and 15% were for Type IV. The significant presacral component was noted in all malignant tumors. Conclusion: Two clinical patterns were observed in sacrococcygeal teratoma related to the age of presentation. As sacrococcygeal teratoma has potential to become malignant, meticulous search for the malignant component is required for histopathological categorization.
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Affiliation(s)
| | - Das Chhanda
- Department of Pathology, Institute of Post Graduate Medical Education and Research, Kolkata, West Bengal, India
| | - Sengupta Moumita
- Department of Pathology, Institute of Post Graduate Medical Education and Research, Kolkata, West Bengal, India
| | - Saha Ashis Kumar
- Department of Surgery, College of Medicine and Sagore Dutta Hospital, Kolkata, West Bengal, India
| | - Mukhopadhyay Madhumita
- Department of Pathology, Institute of Post Graduate Medical Education and Research, Kolkata, West Bengal, India
| | - Mukhopadhyay Biswanath
- Department of Pediatric Surgery, Nil Ratan Sircar Medical College and Hospital, Kolkata, West Bengal, India
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19
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Phi JH. Sacrococcygeal Teratoma : A Tumor at the Center of Embryogenesis. J Korean Neurosurg Soc 2021; 64:406-413. [PMID: 33906346 PMCID: PMC8128526 DOI: 10.3340/jkns.2021.0015] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Accepted: 03/10/2021] [Indexed: 02/02/2023] Open
Abstract
Sacrococcygeal teratoma (SCT) is an extragonadal germ cell tumor (GCT) that develops in the fetal and neonatal periods. SCT is a type I GCT in which only teratoma and yolk sac tumors arise from extragonadal sites. SCT is the most common type I GCT and is believed to originate through epigenetic reprogramming of early primordial germ cells migrating from the yolk sac to the gonadal ridges. Fetal SCT diagnosed in utero presents many obstetrical problems. For high-risk fetuses, fetal interventions (devascularization and debulking) are under development. Most patients with SCT are operated on after birth. Complete surgical resection is the key for tumor control, and the anatomical location of the tumor determines the surgical approaches. Incomplete resection and malignant histology are risk factors for recurrence. Approximately 10-15% of patients have a tumor recurrence, which is frequently of malignant histology. Long-term surveillance with monitoring of serum alpha fetoprotein and magnetic resonance imaging is required. Survivors of SCT may suffer anorectal, urological, and sexual sequelae later in their life, and comprehensive evaluation and care are required.
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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
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20
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Kramer KP, Chetty SP, Nawaytou H, Vu L, Rogers EE. Fetal Sacrococcygeal Teratoma and the Development of Hydrops. Neoreviews 2021; 22:e141-e147. [PMID: 33526646 DOI: 10.1542/neo.22-2-e141] [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)
- Katelin P Kramer
- Departments of Pediatrics.,University of California, San Francisco, Benioff Children's Hospital, San Francisco, CA
| | - Shilpa P Chetty
- Obstetrics/Gynecology and Reproductive Sciences, and.,University of California, San Francisco, Benioff Children's Hospital, San Francisco, CA
| | - Hythem Nawaytou
- Departments of Pediatrics.,University of California, San Francisco, Benioff Children's Hospital, San Francisco, CA
| | - Lan Vu
- Surgery, University of California, San Francisco, CA.,University of California, San Francisco, Benioff Children's Hospital, San Francisco, CA
| | - Elizabeth E Rogers
- Departments of Pediatrics.,University of California, San Francisco, Benioff Children's Hospital, San Francisco, CA
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21
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Rattan KN, Singh J. Neonatal sacrococcygeal teratoma: Our 20-year experience from a tertiary care centre in North India. Trop Doct 2020; 51:209-212. [PMID: 33356941 DOI: 10.1177/0049475520973616] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Advances in diagnostic and therapeutic interventions have improved the survival of neonates with sacrococcygeal teratoma in richer countries. These changes have not yet taken place in resource-limited settings. A retrospective analysis of neonates with sacrococcygeal teratoma operated at our centre during 1997-2016 was performed. Among 44 neonates enrolled, prenatal diagnosis of sacrococcygeal teratoma was available in 25% of pregnancies. All babies except one were born vaginally. Associated congenital malformations were seen in 20% (9/44). Types of sacrococcygeal teratoma were classified as Altman type I in 12 (27.3%), 24 (54.5%) as type II, 6 (13.6%) as type III and 2 (4.5%) as type IV. Morphologically, 77% (34/44) neonates had cystic lesions. All patients were managed successfully by total excision. Histopathology confirmed mature teratoma in 43 (97.7%). After a 12-month follow-up, no recurrence was observed. An uneventful pregnancy, absence of associated congenital anomalies, cystic morphology and a mature histology are good prognostic factors.
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Affiliation(s)
- Kamal N Rattan
- Senior Professor & Head, Department of Pediatric Surgery, PGIMS, Rohtak, Haryana, India
| | - Jasbir Singh
- Senior Resident, Department of Pediatrics, PGIMS, Rohtak, India; Assistant Professor, Department of Pediatrics, Guru Gobind Singh Medical College and Hospital, Faridkot, Punjab, India
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22
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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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23
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Sacrococcygeal teratoma with intraspinal extension: A case series and review of literature. J Pediatr Surg 2020; 55:2022-2025. [PMID: 32115228 DOI: 10.1016/j.jpedsurg.2020.02.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2019] [Revised: 12/03/2019] [Accepted: 02/05/2020] [Indexed: 11/23/2022]
Abstract
BACKGROUND Sacrococcygeal teratoma (SCT) is the most common teratoma in neonates and arises from the coccyx. SCT with intraspinal invasion is extremely rare and only reported in a few cases. METHODS 37 patients with SCT were identified at our institution between 2000 and 2018. Three of these patients had SCT with intraspinal extension. A literature review for intraspinal extension associated with SCT, including mode of diagnosis, presentation, surgical approach and neurological sequelae, between 1993 and 2018 was also conducted. RESULTS The authors report three cases of infants who were antenatally and/or postnatally diagnosed with a sacrococcygeal teratoma extending into the spinal canal. We illustrate the challenges of accurate diagnosis and therapeutic management. Postnatal magnet resonance imaging (MRI) was the best method to define spinal anatomy and extension of the tumors prior to surgery. Management with a multidisciplinary team approach including neuroradiology, neurosurgery and general surgery was used in our two most recent patients. The literature review yielded 6 cases of SCT with intraspinal extension. CONCLUSION Intraspinal extension in SCT is rare but should be excluded at birth before attempting any resection. In case of positive spinal invasion on Ultrasonography (US), MRI is essential to plan for surgery and possible laminectomy to be able to perform a radical resection of this congenital tumor. We recommend this multidisciplinary approach. LEVEL OF EVIDENCE Level IV.
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Pettit KA, Beardmore D. Constipation and Asymmetric Rectal Tone in a 10-month-old Girl. Pediatr Rev 2020; 41:S79-S81. [PMID: 33004590 DOI: 10.1542/pir.2018-0249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Affiliation(s)
- Kevin A Pettit
- Department of Pediatrics, American Family Children's Hospital, University of Wisconsin, Madison, WI
| | - Daniel Beardmore
- Department of Pediatrics, SSM Health Dean Medical Group, Janesville, WI
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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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Aihole JS. Pedunculated Perianal Mass in a Neonate: A Rare Case Report. Am J Dermatopathol 2020; 42:601-603. [PMID: 32701695 DOI: 10.1097/dad.0000000000001640] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Congenital perianal pedunculated masses are a rare occurrence in neonates. They are benign in nature and can be excised completely for definitive diagnosis. Here is a report of a rare case of pedunculated perianal mass occurring in a neonate managed successfully.
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Baró AM, Perez SP, Costa MM, Heredia CL, Azuara LS, Juanos JL, Lapiedra MZ. Sacrococcygeal teratoma with preterm delivery: a case report. J Med Case Rep 2020; 14:72. [PMID: 32552844 PMCID: PMC7304210 DOI: 10.1186/s13256-020-02395-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2019] [Accepted: 04/28/2020] [Indexed: 11/23/2022] Open
Abstract
Background Sacrococcygeal teratoma is one of the most frequently prenatally diagnosed neoplasias. Obstetric ultrasound has a role in the diagnosis and management of these tumors during pregnancy. In this report, we describe a multidisciplinary approach in a case of a patient with sacrococcygeal teratomas and preterm delivery, as well as postnatal outcomes. Case presentation A 26-year-old Caucasian woman at 20.3 weeks of gestation with a normal gestational course and no relevant medical or surgical history was referred to our institution with a sacrococcygeal mass diagnosis. Magnetic resonance imaging confirmed the diagnosis of sacrococcygeal teratoma type I according to the Altman classification. Follow-up with ultrasound showed an increase in the size of the mass up to 190 × 150 mm, high Doppler flow, and severe polyhydramnios. At 35.1 weeks of gestation, the patient had premature rupture of membranes, and an emergency cesarean section was performed due to recurrent late decelerations detected by fetal heart rate monitoring. Afterward, surgery was performed successfully at 36 hours of life. Posterior controls revealed normal and healthy child growth. Conclusions This case report demonstrates the importance of a multidisciplinary approach to offer the best neonatal outcomes by performing early surgery, as well as the need for follow-up by ultrasound in order to minimize complications by assessing mass growth, Doppler flow, and amniotic fluid.
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Affiliation(s)
- Anna Moreno Baró
- Gynecology and Obstetrics Department, Corporació Sanitària Parc Taulí, Parc Taulí s/n, 08208, Sabadell, Spain.
| | - Silvia Pina Perez
- Gynecology and Obstetrics Department, Corporació Sanitària Parc Taulí, Parc Taulí s/n, 08208, Sabadell, Spain
| | - Montserrat Mestre Costa
- Gynecology and Obstetrics Department, Corporació Sanitària Parc Taulí, Parc Taulí s/n, 08208, Sabadell, Spain
| | - Cristina Lesmes Heredia
- Gynecology and Obstetrics Department, Corporació Sanitària Parc Taulí, Parc Taulí s/n, 08208, Sabadell, Spain
| | - Laura Serra Azuara
- Gynecology and Obstetrics Department, Corporació Sanitària Parc Taulí, Parc Taulí s/n, 08208, Sabadell, Spain
| | - Judith Lleberia Juanos
- Gynecology and Obstetrics Department, Corporació Sanitària Parc Taulí, Parc Taulí s/n, 08208, Sabadell, Spain
| | - Marc Zamora Lapiedra
- Gynecology and Obstetrics Department, Corporació Sanitària Parc Taulí, Parc Taulí s/n, 08208, Sabadell, Spain
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Anderson E, Heller RS, Arkun K, Winer J. Occipital teratoma in a neonate with CHARGE syndrome: a case report. Childs Nerv Syst 2020; 36:661-664. [PMID: 31797071 DOI: 10.1007/s00381-019-04433-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2019] [Accepted: 11/06/2019] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Teratomas of the head and neck region are rare lesions, representing just 5% of all congenital teratomas. Usually found in the pineal region orneurohypophysis, teratomas are uncommonly located in the posterior occiput. CASE PRESENTATION Herein, we present a case of a female neonate born at 37-week gestation with hydrocephalus, an occipital scalp lesion, and several craniofacial abnormalities consistent with a diagnosis of coloboma, heart defect, atresia choanae, retarded growth, genital abnormality, and ear abnormality (CHARGE) syndrome. The occipital scalp lesion was initially thought to be an encephalocele. On day of life 3, the neonate was taken to the operating room for placement of a ventriculoperitoneal shunt and repair of the occipital lesion. Intra-operatively, the lesion resembled a dural-based meningocele; however, during histologic evaluation, it was found to contain tissue derived from all three germ layers and thus, it was determined to be more consistent with a teratoma. CONCLUSION We hypothesize that a germline mutation in CHD7 or other similar regulatory gene causative of CHARGE syndrome and craniofacial developmental abnormalities may have contributed to the unusual location of the teratoma in this case.
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Affiliation(s)
- Emily Anderson
- Department of Neurosurgery, Tufts Medical Center, 800 Washington Street, Boston, MA, 02111, USA
| | - Robert S Heller
- Department of Neurosurgery, Tufts Medical Center, 800 Washington Street, Boston, MA, 02111, USA
| | - Knarik Arkun
- Department of Pathology and Laboratory Medicine, Tufts Medical Center, 800 Washington Street, Boston, MA, 02111, USA
| | - Jesse Winer
- Department of Neurosurgery, Tufts Medical Center, 800 Washington Street, Boston, MA, 02111, USA.
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Ravindra VM, Ruggieri L, Vasudevan SA, Hicks MJ, Muscal JA, Quintanilla NM, Schady DA, Aldave G. Salvage sacrococcygeal resection for yolk sac tumors after chemotherapy: report of 2 cases. J Neurosurg Pediatr 2020; 25:13-20. [PMID: 31585411 DOI: 10.3171/2019.7.peds19321] [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: 06/01/2019] [Accepted: 07/12/2019] [Indexed: 11/06/2022]
Abstract
Pediatric germ cell tumors (GCTs) are neoplasms that originate from primordial germ cells and, according to their site of presentation, are classified as gonadal or extragonadal. The most common site of extragonadal GCTs in children is the sacrococcygeal region, and the standard management is multimodal with a focus on chemotherapy. In selected instances, sacrococcygeal resection is performed. Herein, the authors report on 2 patients who presented with presacral yolk sac tumors managed with multimodal treatment. Both patients underwent salvage sacrococcygeal resection for oncological control and surgical removal of the sacral vertebral elements: a 27-month-old girl with a recurrent sacrococcygeal yolk sac tumor following chemotherapy and initial resection and a 24-month-old boy in whom a primary sacrococcygeal yolk sac tumor was resected following chemotherapy. These 2 cases illustrate the complexity in the management of these unusual tumors and will help neurosurgeons with the understanding of yolk sac tumors in the sacrococcygeal region.
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Affiliation(s)
- Vijay M Ravindra
- 1Division of Pediatric Neurosurgery, Department of Surgery, Texas Children's Hospital, Baylor College of Medicine
| | - Lucia Ruggieri
- 1Division of Pediatric Neurosurgery, Department of Surgery, Texas Children's Hospital, Baylor College of Medicine
| | - Sanjeev A Vasudevan
- 2Division of Pediatric Surgery, Texas Children's Surgical Oncology Program, M.E. DeBakey Department of Surgery, Baylor College of Medicine; and
| | | | - Jodi A Muscal
- 4Texas Children's Cancer Center, Department of Pediatrics, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas
| | | | | | - Guillermo Aldave
- 1Division of Pediatric Neurosurgery, Department of Surgery, Texas Children's Hospital, Baylor College of Medicine
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Can't Poop, Can't Pee…What's Going On With Me? CLINICAL PEDIATRIC EMERGENCY MEDICINE 2019. [DOI: 10.1016/j.cpem.2019.100722] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Meshram RM, Nikila R, Nagdive N. Giant Sacrococcygeal Teratoma in Neonate: A Case Report and Review of Literature. Indian J Med Paediatr Oncol 2019. [DOI: 10.4103/ijmpo.ijmpo_16_18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
AbstractSacrococcygeal teratoma is considered the most common tumor in the neonatal period with a female-to-male ratio of 3–4:1. They are believed to arise early in gestation from the totipotential cells of Hensen’s node and the derived ectoderm, mesoderm, and endoderm. A 2.25 kg cesarean-delivered male, term neonate presented with large nonpulsatile, globular erythematous mass with lobulated surface and variable consistency. Magnetic resonance imaging of the lumbosacral spine showed multilocular cystic and solid lesion with foci of calcification and subtle communication with spinal canal. Histopathological examination showed mature endodermal, ectodermal, and mesenchymal elements such as cartilage, glial tissues, keratin cyst, and glandular elements with focus of primary neuroepithelial and pancreatic elements. Entire tumor was excised. The baby expired secondary to wound infection. Early diagnosis by improving antenatal care with timely surgical intervention and good nursing care improves the outcome.
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Affiliation(s)
| | - R Nikila
- Department of Paediatric, Neonatology Unit, Nagpur, Maharashtra, India
| | - Nilesh Nagdive
- Department of Paediatric Surgery, Govt. Medical College, Nagpur, Maharashtra, India
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Need for urodynamic evaluation as a regular follow-up tool in assessment of long-term urological outcomes in patients with sacrococcygeal teratoma. J Pediatr Surg 2019; 54:2107-2111. [PMID: 30686521 DOI: 10.1016/j.jpedsurg.2018.11.020] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2018] [Revised: 10/21/2018] [Accepted: 11/01/2018] [Indexed: 11/22/2022]
Abstract
AIM To assess the long-term urologic outcomes in follow-up of patients of sacrococcygeal teratoma (SCT) using urodynamic study (UDS) in addition to clinical and radiologic evaluation. METHODS A prospective study of clinical, radiological and urodynamic evaluation in patients with SCT who underwent resection between January 2002-June 2015 and were followed up till January 2016 was conducted. RESULTS Total 57 patients, 42 (73.7%) females and 15 (26.3%) males with 35 (62.4%) following treatment for benign and 22 (38.5%) for malignant disease were included. Twenty-eight of 57 (49.12%) had urological problems. Clinical complaints in 21 (36.8%) patients included stress urinary incontinence-14 (66.7%), enuresis-9 (42.9%), and poor stream or dribbling of urine-6 (28.6%). Eight of 51 patients (15.7%) had abnormal ultrasound findings, which included contracted, trabeculated thick walled bladder (3), bilateral hydronephrosis (3) and significant post void residue (PVR) (6). Seven of 57 underwent micturating cystourethrogram (MCU), 5 had an abnormal report[significant PVR (4), small trabeculated bladder (3), reflux (2) and large capacity bladder (1)]. Urodynamic study was done in 27 patients, 18/27 (66.7%) had abnormalities. Six patients without any clinical or ultrasonographic abnormalities had abnormal UDS. Total 28 (49.12%) had urological comorbidities. Three patients had overactive bladder, five dysfunctional voiding, one underactive bladder and one had giggle incontinence. Children were managed by behaviour therapy and pharmacotherapy. CONCLUSION Urodynamic evaluation could detect abnormalities in patients who had no urinary complaints or abnormality on ultrasound. The abnormalities have a potential for progressive upper tract damage. Urodynamics should be an integral part of urological surveillance in patients operated for SCT. TYPE OF STUDY Prognostic study. LEVEL OF EVIDENCE Level II (Prospective cohort study).
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Huang Y, Feng M, Yin J, Fu B, Lang J. Unresectable recurrence malignant sacrococcygeal teratoma in children treated with chemoradiotherapy: Case report and literature review. Rep Pract Oncol Radiother 2019; 24:392-398. [PMID: 31293363 DOI: 10.1016/j.rpor.2019.06.002] [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: 01/21/2019] [Revised: 05/05/2019] [Accepted: 06/01/2019] [Indexed: 10/26/2022] Open
Abstract
Sacrococcygeal teratoma is the most common germ cell neoplasia that consists of tissues derived from primitive germ layers. Approximately 10-20% of patients are malignant. Because of the high rate of recurrence, treatment strategies for malignant sacrococcygeal teratomas are limited. Hence, we report a case of malignant sacrococcygeal teratoma treated with concurrent chemoradiotherapy plus adjuvant chemotherapy and review the literature. This case report indicates that chemoradiation plus adjuvant chemotherapy may be a treatment option for malignant SCT which is not technically resectable or with residual lesion after surgery.
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Affiliation(s)
- Yecai Huang
- Department of Radiation Oncology, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Mei Feng
- Department of Radiation Oncology, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Jun Yin
- Department of Radiation Oncology, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Bingyu Fu
- Department of Radiation Oncology, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Jinyi Lang
- Department of Radiation Oncology, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
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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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Fumino S, Tajiri T, Usui N, Tamura M, Sago H, Ono S, Nosaka S, Yoneda A, Souzaki R, Higashi M, Sakai K, Takahashi K, Sugiura T, Taguchi T. Japanese clinical practice guidelines for sacrococcygeal teratoma, 2017. Pediatr Int 2019; 61:672-678. [PMID: 30903638 DOI: 10.1111/ped.13844] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2018] [Revised: 01/04/2019] [Accepted: 03/14/2019] [Indexed: 11/30/2022]
Abstract
BACKGROUND Sacrococcygeal teratoma (SCT) is the most common extragonadal germ cell tumor in neonates and infants. Although most cases of infantile SCT are benign tumors by nature, some develop into extremely large lesions, leading to massive bleeding, high-output heart failure, disseminated intravascular coagulation, and even fatal outcomes during the neonatal period. In addition, some patients may present with tumor recurrence, malignant transformation, long-term sequelae (including bladder and bowel dysfunction) and lower leg palsy during the long-term follow up. SCT, however, is very rare, and there are few opportunities to encounter this disease, therefore general physicians without expert credentials currently lack information relevant to clinical practice. For this reason, the research project committee has compiled guidelines concerning SCT. METHODS The purpose of these guidelines was to share information concerning the treatment and follow up of infantile SCT. The guidelines were developed using the methodologies in the Medical Information Network Distribution System. A comprehensive search of the English- and Japanese-language articles in PubMed and Ichu-Shi Web identified only case reports or case series, and the recommendations were developed through a process of informal consensus. RESULTS The clinical questions addressed the risk factors, the efficacy of cesarean section, the initial devascularization of tumor feeding vessels, interventional radiology, recommended clinical studies for follow up and possible long-term complications. CONCLUSIONS These are the first guidelines for SCT to be established in Japan, and they may have huge clinical value and significance in terms of developing therapeutic strategies and follow up, potentially contributing to the improvement of the prognosis and quality of life of SCT patients.
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Affiliation(s)
- Shigehisa Fumino
- Department of Pediatric Surgery, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Tatsuro Tajiri
- Department of Pediatric Surgery, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Noriaki Usui
- Department of Pediatric Surgery, Osaka Women's and Children's Hospital, Osaka, Japan
| | - Masanori Tamura
- Department of Pediatrics, Saitama Medical Center, Saitama Medical University, Saitama, Japan
| | - Haruhiko Sago
- Department of Maternal-Fetal and Neonatal Medicine, National Center for Child Health and Development, Tokyo, Japan
| | - Shigeru Ono
- Department of Pediatric Surgery, Jichi Children's Medical Center Tochigi, Jichi Medical University, Tochigi, Japan
| | - Shunsuke Nosaka
- Division of Radiology, National Center for Child Health and Development, Tokyo, Japan
| | - Akihiro Yoneda
- Department of Pediatric Surgery, Osaka City General Hospital, Osaka, Japan
| | - Ryota Souzaki
- Department of Pediatric Surgery, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Mayumi Higashi
- Department of Pediatric Surgery, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Kohei Sakai
- Department of Pediatric Surgery, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Ken Takahashi
- Department of Obstetrics and Gynecology, Jikei University School of Medicine, Tokyo, Japan
| | - Takahiro Sugiura
- Department of Pediatrics, Toyohashi Municipal Hospital, Aichi, Japan
| | - Tomoaki Taguchi
- Department of Pediatric Surgery, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
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Osei H, Munoz-Abraham AS, Bates KS, Kim JS, Saxena S, Greenspon J, Villalona GA. Laparoscopic Division of Median Sacral Artery and Dissection of Types III and IV Sacrococcygeal Teratomas to Decrease Intraoperative Hemorrhagic Complications: Case Series and Review of the Literature. J Laparoendosc Adv Surg Tech A 2019; 29:272-277. [DOI: 10.1089/lap.2018.0189] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Hector Osei
- Division of Pediatric Surgery, Saint Louis University School of Medicine, St. Louis, Missouri
- Department of Pediatric Surgery, SSM Cardinal Glennon Children's Hospital, St. Louis, Missouri
| | - Armando Salim Munoz-Abraham
- Division of Pediatric Surgery, Saint Louis University School of Medicine, St. Louis, Missouri
- Department of Pediatric Surgery, SSM Cardinal Glennon Children's Hospital, St. Louis, Missouri
| | - Katherine S. Bates
- Department of Surgery, Saint Louis University School of Medicine, St. Louis, Missouri
| | - Jin Sun Kim
- Department of Surgery, Saint Louis University School of Medicine, St. Louis, Missouri
| | - Saurabh Saxena
- Division of Pediatric Surgery, Saint Louis University School of Medicine, St. Louis, Missouri
- Department of Pediatric Surgery, SSM Cardinal Glennon Children's Hospital, St. Louis, Missouri
| | - Jose Greenspon
- Division of Pediatric Surgery, Saint Louis University School of Medicine, St. Louis, Missouri
- Department of Pediatric Surgery, SSM Cardinal Glennon Children's Hospital, St. Louis, Missouri
| | - Gustavo A. Villalona
- Division of Pediatric Surgery, Saint Louis University School of Medicine, St. Louis, Missouri
- Department of Pediatric Surgery, SSM Cardinal Glennon Children's Hospital, St. Louis, Missouri
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Masmejan S, Baud D, Ryan G, Van Mieghem T. Management of fetal tumors. Best Pract Res Clin Obstet Gynaecol 2019; 58:107-120. [PMID: 30770283 DOI: 10.1016/j.bpobgyn.2019.01.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2018] [Revised: 01/07/2019] [Accepted: 01/08/2019] [Indexed: 12/28/2022]
Abstract
In this review article, we discuss the most common fetal tumors, their prenatal management, and outcomes. Overall, the most important outcome predictors are tumor histology, size, vascularity, and location. Very large lesions, lesions causing cardiac failure, and hydrops and lesions obstructing the fetal airway have the poorest outcome, as they may cause fetal death or complications at the time of delivery. Fetal therapy has been developed to improve outcomes for the most severe cases and can consist of transplacental therapy (sirolimus for rhabdomyomas or steroids for hemangiomas and microcystic lung lesions) or surgical intervention (shunting of cystic masses, tumor ablation, occlusion of blood flow or airway exploration, and protection). Given the rarity of fetal tumors, patients should be referred to expert centers where care can be optimized and individualized to allow the best possible outcomes.
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Affiliation(s)
- Sophie Masmejan
- Fetal Medicine Unit, Department of Obstetrics and Gynaecology, Mount Sinai Hospital and University of Toronto, Toronto, Canada; Obstetrics Unit, Mother-Child Department, University Hospital Lausanne, Switzerland
| | - David Baud
- Obstetrics Unit, Mother-Child Department, University Hospital Lausanne, Switzerland
| | - Greg Ryan
- Fetal Medicine Unit, Department of Obstetrics and Gynaecology, Mount Sinai Hospital and University of Toronto, Toronto, Canada
| | - Tim Van Mieghem
- Fetal Medicine Unit, Department of Obstetrics and Gynaecology, Mount Sinai Hospital and University of Toronto, Toronto, Canada.
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Sacrococcygeal Teratoma Presenting with Vaginal Discharge and Polyp in an Infant. J Pediatr Adolesc Gynecol 2018; 31:318-320. [PMID: 29269272 DOI: 10.1016/j.jpag.2017.12.004] [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: 09/22/2017] [Revised: 11/29/2017] [Accepted: 12/09/2017] [Indexed: 11/21/2022]
Abstract
BACKGROUND Sacrococcygeal teratoma accounts for the most common solid tumor in neonates. Because of improved technology, 50%-70% of cases can be diagnosed antenatally during routine ultrasound screenings. If not diagnosed antenatally, clinical findings at birth are distinct in most cases including a palpable or visible mass. CASE We report an unusual case of a 1-year-old girl who presented with persistent vaginal discharge leading to diagnosis of a mucosal polypoid lesion of the vagina, ultimately revealing a hidden sacrococcygeal teratoma. SUMMARY AND CONCLUSION We suggest thorough investigation of all infants who present with purulent discharge and recurrent vaginal mass; sacrococcygeal teratoma should routinely be considered as a differential diagnosis.
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Bagrodia N, Carlisle EM, Mak GZ. Sacrococcygeal teratoma: Atypical presentations in two neonates. JOURNAL OF PEDIATRIC SURGERY CASE REPORTS 2018. [DOI: 10.1016/j.epsc.2018.03.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022] Open
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Yoon HM, Byeon SJ, Hwang JY, Kim JR, Jung AY, Lee JS, Yoon HK, Cho YA. Sacrococcygeal teratomas in newborns: a comprehensive review for the radiologists. Acta Radiol 2018; 59:236-246. [PMID: 28530139 DOI: 10.1177/0284185117710680] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
Sacrococcygeal teratomas are the most common solid tumor in newborn infants. The diagnosis is not difficult in many cases; however, there should be additional information on imaging studies in order to manage those infants properly. Details include histology, morphologic classification, complications such as rupture, bleeding, and mass effects on the adjacent structures. Although imaging features cannot accurately predict the histologic subtypes of the tumors, thorough evaluation of the imaging features can help distinguish malignant tumors from benign tumors. In this article, pathogenesis, histological characteristics, clinical considerations, and morphologic characteristics will be discussed.
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Affiliation(s)
- Hee Mang Yoon
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea
| | - Sun-ju Byeon
- Department of Pathology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea
| | - Jae-Yeon Hwang
- Department of Radiology, Pusan National University Children's Hospital, Yangsan-Si, Republic of Korea
| | - Jeong Rye Kim
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea
| | - Ah Young Jung
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea
| | - Jin Seong Lee
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea
| | - Hye-Kyung Yoon
- Department of Radiology, Kangwon National University Hospital, Chuncheon-Si, Republic of Korea
| | - Young Ah Cho
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea
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Villamil V, Girón Vallejo O, Fernández-Ibieta M, Sánchez Sánchez Á, Reyes Ríos PY, Martínez Castaño I, Rojas-Ticona J, Ruiz Pruneda R, Ruiz Jiménez JI. [Functional and aesthetic evaluation of sacrococcygeal teratomas. Not everything ends with surgery]. An Pediatr (Barc) 2018; 88:39-46. [PMID: 28669487 DOI: 10.1016/j.anpedi.2017.03.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2016] [Revised: 02/03/2017] [Accepted: 03/16/2017] [Indexed: 11/23/2022] Open
Abstract
INTRODUCTION Sacrococcygeal teratoma is the most common solid neonatal tumour. The improvement in survival has meant that postoperative sequelae can be diagnosed and treated. The aim of this article is to evaluate the long-term outcomes of patients treated in our centre. MATERIAL AND METHODS Records of patients treated for a sacrococcygeal teratoma in our hospital from 1977 to 2014 were retrospectively reviewed. Personal data was collected and a telephone questionnaire was used to assess long-term bowel and urinary habits, as well as an aesthetic and functional self-assessment. RESULTS A total of 14 patients were treated during the study period, of whom 11 were females and 3 males, with a mean age at the time of the survey of 17 years (8 months-37 years). Eight patients completed the questionnaire (57.1%). The mean age of the 8 patients was 23 years (4-37 years), of whom 37.5% were operated on due to a sacrococcygeal teratoma type i, 25% type ii, 25% type iii, and 12.5% type iv. Two of them (25%) had constipation, and one (12.5%) had faecal incontinence. Two (25%) patients suffered from recurrent urinary tract infections, and 3 (37.5%) patients had urinary incontinence. Five patients (62.5%) had a perception of being physically impaired, with limitation of their social life. CONCLUSIONS The incidence of constipation does not differ from that found in the literature. Faecal incontinence is slightly improved compared to what has been published. However, urinary tract infections and incontinence are more prevalent in our series. Five patients out of the eight that responded suffered from psychosocial problems, according to DAS-59 questionnaire. Patients with SCT require urological, bowel, and psychological counselling, until they have a complete functional and emotional development.
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Affiliation(s)
- Vanesa Villamil
- Servicio de Cirugía Pediátrica, Hospital Clínico Universitario Virgen de la Arrixaca, El Palmar, Murcia, España.
| | - Oscar Girón Vallejo
- Servicio de Cirugía Pediátrica, Hospital Clínico Universitario Virgen de la Arrixaca, El Palmar, Murcia, España
| | - María Fernández-Ibieta
- Servicio de Cirugía Pediátrica, Hospital Clínico Universitario Virgen de la Arrixaca, El Palmar, Murcia, España
| | - Ángela Sánchez Sánchez
- Servicio de Cirugía Pediátrica, Hospital Clínico Universitario Virgen de la Arrixaca, El Palmar, Murcia, España
| | - Paulo Y Reyes Ríos
- Servicio de Cirugía Pediátrica, Hospital Clínico Universitario Virgen de la Arrixaca, El Palmar, Murcia, España
| | - Irene Martínez Castaño
- Servicio de Cirugía Pediátrica, Hospital Clínico Universitario Virgen de la Arrixaca, El Palmar, Murcia, España
| | - Javier Rojas-Ticona
- Servicio de Cirugía Pediátrica, Hospital Clínico Universitario Virgen de la Arrixaca, El Palmar, Murcia, España
| | - Ramón Ruiz Pruneda
- Servicio de Cirugía Pediátrica, Hospital Clínico Universitario Virgen de la Arrixaca, El Palmar, Murcia, España
| | - José I Ruiz Jiménez
- Servicio de Cirugía Pediátrica, Hospital Clínico Universitario Virgen de la Arrixaca, El Palmar, Murcia, España
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Villamil V, Girón Vallejo O, Fernández-Ibieta M, Sánchez Sánchez Á, Reyes Ríos PY, Martínez Castaño I, Rojas-Ticona J, Ruiz Pruneda R, Ruiz Jiménez JI. Functional and aesthetic evaluation of sacrococcygeal teratomas. Not everything ends with surgery. ANALES DE PEDIATRÍA (ENGLISH EDITION) 2018. [DOI: 10.1016/j.anpede.2017.03.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
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Padilla BE, Vu L, Lee H, MacKenzie T, Bratton B, O'Day M, Derderian S. Sacrococcygeal teratoma: late recurrence warrants long-term surveillance. Pediatr Surg Int 2017; 33:1189-1194. [PMID: 28894920 DOI: 10.1007/s00383-017-4132-1] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/01/2017] [Indexed: 11/26/2022]
Abstract
BACKGROUND Sacrococcygeal teratoma (SCT) is a rare childhood malignancy. Although overall survival is favorable, recurrent tumors are associated with poor outcomes. As most recurrences occur within 3 years of presentation, the utility of long-term surveillance is uncertain. METHODS Patients with SCTs evaluated and managed by our pediatric surgery department between 1986 and 2013 were included. Details pertaining to laboratory values, operative findings, tumor histology, management, recurrence, and outcomes were recorded and analyzed. RESULTS During the study period, 40 children with the diagnosis of SCT were managed by our practice. Five (13%) developed a recurrence. The median age at the initial resection was day of life two (range day of life 0-2.5 years). The median time to recurrence was 5 years (range 5 months-15 years). Among those with recurrences, mature teratoma was the most common histological type on the initial resection (n = 3), with yolk sac and immature teratomas comprising the other two. At the time of recurrence, three patients had mature teratomas, and all are alive and well following resection. Two patients had yolk sac tumors at the time of recurrence and both died. CONCLUSION SCT can recur many years after the initial resection. Our findings suggest that all patients with SCT should be closely followed into adulthood.
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Affiliation(s)
- Benjamin E Padilla
- University of California San Francisco School of Medicine, San Francisco, CA, USA.
| | - Lan Vu
- University of California San Francisco School of Medicine, San Francisco, CA, USA
| | - Hanmin Lee
- University of California San Francisco School of Medicine, San Francisco, CA, USA
| | - Tippi MacKenzie
- University of California San Francisco School of Medicine, San Francisco, CA, USA
| | - Barbara Bratton
- University of California San Francisco School of Medicine, San Francisco, CA, USA
| | - Maura O'Day
- University of California San Francisco School of Medicine, San Francisco, CA, USA
| | - Sarkis Derderian
- University of California San Francisco School of Medicine, San Francisco, CA, USA
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A pilgrim's progress: Seeking meaning in primordial germ cell migration. Stem Cell Res 2017; 24:181-187. [PMID: 28754603 DOI: 10.1016/j.scr.2017.07.017] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2016] [Revised: 06/08/2017] [Accepted: 07/15/2017] [Indexed: 01/08/2023] Open
Abstract
Comparative studies of primordial germ cell (PGC) development across organisms in many phyla reveal surprising diversity in the route of migration, timing and underlying molecular mechanisms, suggesting that the process of migration itself is conserved. However, beyond the perfunctory transport of cellular precursors to their later arising home of the gonads, does PGC migration serve a function? Here we propose that the process of migration plays an additional role in quality control, by eliminating PGCs incapable of completing migration as well as through mechanisms that favor PGCs capable of responding appropriately to migration cues. Focusing on PGCs in mice, we explore evidence for a selective capacity of migration, considering the tandem regulation of proliferation and migration, cell-intrinsic and extrinsic control, the potential for tumors derived from failed PGC migrants, the potential mechanisms by which migratory PGCs vary in their cellular behaviors, and corresponding effects on development. We discuss the implications of a selective role of PGC migration for in vitro gametogenesis.
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Agarwala S, Mitra A, Bansal D, Kapoor G, Vora T, Prasad M, Chinnaswamy G, Arora B, Radhakrishnan V, Laskar S, Kaur T, Dhaliwal RS, Rath GK, Bakhshi S. Management of Pediatric Malignant Germ Cell Tumors: ICMR Consensus Document. Indian J Pediatr 2017; 84:465-472. [PMID: 28364343 DOI: 10.1007/s12098-017-2308-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2016] [Accepted: 02/01/2017] [Indexed: 11/24/2022]
Abstract
With the introduction of cisplatin, the outcome of children with malignant germ cell tumors (MGCT) has improved to nearly 90% 5 year survival. Over the years, through the results of various multinational co-operative trials, the chemotherapy and surgical guidelines for both the gonadal and extra-gonadal MGCTs have been refined to decrease the early and late morbidities and at the same time improve survival. Introduction of risk categorization has further added to this effort. There has been no recommendation on how the children with malignant germ cell tumors should be treated in India. The current manuscript is written with the objective of developing a consensus guideline for practitioners at a National level. Based on extensively reviewed literature and personal experience of the major pediatric oncology centres in India, the ICMR Expert group has made recommendations for management of children with MGCT India.
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Affiliation(s)
- Sandeep Agarwala
- Department of Pediatric Surgery, All India Institute of Medical Sciences, New Delhi, 110029, India.
| | - Aparajita Mitra
- Department of Pediatric Surgery, All India Institute of Medical Sciences, New Delhi, 110029, India
| | - Deepak Bansal
- Pediatric Hematology Oncology Unit, Department of Pediatrics, Advanced Pediatric Center, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Gauri Kapoor
- Department of Pediatric Hematology & Oncology, Rajiv Gandhi Cancer Institute & Research Center, Delhi, India
| | - Tushar Vora
- Department of Pediatric Oncology, Tata Memorial Hospital, Parel, Mumbai, India
| | - Maya Prasad
- Department of Pediatric Oncology, Tata Memorial Hospital, Parel, Mumbai, India
| | - Girish Chinnaswamy
- Department of Pediatric Oncology, Tata Memorial Hospital, Parel, Mumbai, India
| | - Brijesh Arora
- Department of Pediatric Oncology, Tata Memorial Hospital, Parel, Mumbai, India
| | - Venkatraman Radhakrishnan
- Department of Medical Oncology and Pediatric Oncology, Cancer Institute (W.I.A), Adyar, Chennai, India
| | - Siddharth Laskar
- Department of Radiation Oncology, Tata Memorial Hospital, Parel, Mumbai, India
| | - Tanvir Kaur
- NCD Division, Indian Council of Medical Research (ICMR), New Delhi, India
| | | | - G K Rath
- Dr. B.R.A Institute-Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi, India
| | - Sameer Bakhshi
- Department of Medical Oncology, Dr. B.R.A Institute-Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi, India
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Zhelnin KE, Gebhard GM, Mirsky DM, Oliver SC, Lovell MA, Galambos C, Crombleholme TM, McCourt EA. Pediatric Intraocular Immature Teratoma Associated With Sacrococcygeal Teratoma. Pediatr Dev Pathol 2017; 20:240-244. [PMID: 28521629 DOI: 10.1177/1093526616686233] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Intraocular teratomas are rare neoplasms with only three previously reported cases. We present the fourth case of intraocular teratoma and the second associated with sacrococcygeal teratoma. While the nature of the association between intraocular teratomas and sacrococcygeal teratomas is unclear, it suggests a need for careful ophthalmologic follow-up of infants with congenital sacrococcygeal teratomas.
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Egler RA, Gosiengfiao Y, Russell H, Wickiser JE, Frazier AL. Is surgical resection and observation sufficient for stage I and II sacrococcygeal germ cell tumors? A case series and review. Pediatr Blood Cancer 2017; 64. [PMID: 27786428 DOI: 10.1002/pbc.26311] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2016] [Revised: 09/13/2016] [Accepted: 09/21/2016] [Indexed: 11/06/2022]
Abstract
BACKGROUND Sacrococcygeal teratoma (SCT) is the most common germ cell tumor (GCT) of infancy. Up to 35% of infants may have malignant elements. The standard of care for SCT with malignant elements (SCT-ME) has been surgery and chemotherapy. However, cases where low-stage SCT-ME have been successfully observed following resection have been reported. PROCEDURE To better understand the outcomes of low-stage SCT-ME that do not receive chemotherapy, we reviewed SCT pathology reports from five children's hospitals from 1999 to 2009. Information regarding staging workup, tumor markers, treatment, and outcome was collected for patients with stage I or II SCT-ME. An English language literature review was also performed. RESULTS Seventy-four SCT were identified: 51 stage I and 23 stage II; 13 (18%) were SCT-ME: 5 stage I and 8 stage II; four stage I and four stage II tumors were not treated with chemotherapy. No stage I tumors recurred; all of the stage II tumors recurred and were successfully salvaged, two had no ME at recurrence. We identified another 10 stage I SCT-ME in the literature managed with active surveillance-two recurred and were successfully treated with surgery and chemotherapy. CONCLUSIONS Overall, of the 14 cases of stage I SCT-ME, 12 survived with no recurrence and the two who did recur were successfully treated with platinum-based chemotherapy (EFS = 86%, overall survival [OS] = 100%); this suggests that patients with stage I SCT-ME could be observed after surgery and treated only upon recurrence. Stage II SCT-ME require further study in a clinical trial setting.
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Affiliation(s)
- Rachel A Egler
- Division of Pediatric Hematology and Oncology, Department of Pediatrics, Rainbow Babies and Children's Hospital, Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Yasmin Gosiengfiao
- Division of Hematology, Oncology & Transplantation, Robert Lurie Comprehensive Cancer Center, Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Heidi Russell
- Department of Pediatrics, Section of Hematology-Oncology, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas
| | - Jonathan E Wickiser
- Division of Pediatric Hematology-Oncology, Children's Medical Center of Dallas, University of Texas Southwestern Medical Center, Dallas, Texas
| | - A Lindsay Frazier
- Department of Pediatric Oncology, Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Harvard Medical School, Boston, Massachusetts
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Rydzewska M, Krawczuk-Rybak M, Zajkowska A, Jurczuk N, Polnik D, Szalecki M, Moszczyńska E, Savage MO, Bossowski A. Cushing's syndrome in infancy due to ectopic ACTH secretion by a sacro-coccygeal teratoma. J Pediatr Endocrinol Metab 2017; 30:475-478. [PMID: 28328532 DOI: 10.1515/jpem-2016-0339] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2016] [Accepted: 02/06/2017] [Indexed: 11/15/2022]
Abstract
BACKGROUND Adenocorticotropic hormone (ACTH)-dependent Cushing's syndrome in infancy is extremely rare. We describe the case of a sacro-coccygeal ectopic ACTH-secreting immature teratoma in an infant who also presented the triad of defects characteristic of Currarino syndrome. CASE PRESENTATION A girl was born with a large immature teratoma in the sacro-coccygeal region associated with anal atresia. At the age of 7 days, the concentration of α-fetoprotein (AFP) was above the age-specific normal range. Two non-radical surgical excisions of the tumour were performed. At the age of 7 months, she developed polyphagia, acne, hirsutism, hypertension and hypokalemia with elevated ACTH and absence of serum cortisol circadian rhythm. Immunostaining of tumour tissue showed ACTH-immunoreactive cells. Due to unsuccessful therapy with ketoconazole and resistance to antihypertensive medications [blood pressure (BP) 210/160 mmHg], metyrapone was administered, which controlled her ACTH and cortisol levels in the normal range. Following further removal of tumour bulk after three operations during the first year of life, there was a decrease of BP to normal values. CONCLUSIONS A rare case of ectopic ACTH syndrome causing Cushing's syndrome in infancy in the context of Currarino syndrome is reported. Radical surgery has resulted in excision of the tumour and current control of Cushing's syndrome.
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Affiliation(s)
- Marta Rydzewska
- Department of Pediatrics, Endocrinology and Diabetes with a Cardiology Unit, Medical University in Bialystok, Bialystok
| | - Maryna Krawczuk-Rybak
- Department of Pediatric Oncology and Hematology, Medical University of Bialystok, Bialystok
| | - Adrianna Zajkowska
- Department of Pediatrics, Endocrinology and Diabetes with a Cardiology Unit, Medical University in Bialystok, Bialystok
| | - Natalia Jurczuk
- Department of Pediatrics, Endocrinology and Diabetes with a Cardiology Unit, Medical University in Bialystok, Bialystok
| | - Dariusz Polnik
- Department of Children's Surgery and Transplantology, Children's Memorial Health Institute, Warsaw
| | - Mieczysław Szalecki
- Department of Endocrinology and Diabetology, Children's Memorial Health Institute, Warsaw
| | - Elżbieta Moszczyńska
- Department of Endocrinology and Diabetology, Children's Memorial Health Institute, Warsaw
| | - Martin O Savage
- Barts and the London School of Medicine and Dentistry, London
| | - Artur Bossowski
- Department of Pediatrics, Endocrinology and Diabetes with a Cardiology Unit, Medical University in Bialystok, ul. Waszyngtona 17, 15-274 Białystok
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Use of intraoperative lateral pelvic X-ray to localize and ensure coccyx removal during sacrococcygeal teratoma resection. Pediatr Surg Int 2017; 33:389-392. [PMID: 27858188 DOI: 10.1007/s00383-016-4025-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/14/2016] [Indexed: 10/20/2022]
Abstract
En bloc removal of the coccyx during sacrococcygeal teratoma resection is necessary to decrease the risk of recurrence. However, variable anatomy often makes the border between the coccyx and sacrum difficult to identify. We describe the use of intraoperative lateral pelvic X-ray to localize this border and ensure complete coccygectomy.
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50
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Wang Y, Wu Y, Wang L, Yuan X, Jiang M, Li Y. Analysis of Recurrent Sacrococcygeal Teratoma in Children: Clinical Features, Relapse Risks, and Anorectal Functional Sequelae. Med Sci Monit 2017; 23:17-23. [PMID: 28042962 PMCID: PMC5223781 DOI: 10.12659/msm.900400] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Sacrococcygeal teratoma (SCT) is a relatively uncommon tumor. Recurrence with poor survival and anorectal dysfunction are the 2 leading problems for patients. Here, we would review the clinic features of patients with SCTs in our hospital to identify risk factors of recurrent SCTs and to analyze anorectal functional sequelae. MATERIAL AND METHODS A retrospective review of all patients with SCTs in our center between 2007 and 2013 was performed. We analyzed the recorded data on each patient and performed follow-up through phone calls. RESULTS Our study included 105 inpatients (78 girls and 27 boys); 104 cases underwent surgical resection, and 62.5% cases had a mature histopathology. The proportion of malignant teratomas rose with increasing age. Fifteen children developed recurrent SCTs with a median of 11.5 months, and most of them had an elevation of AFP levels. Four recurrent children experienced a second tumor relapse. We observed a statistically significant difference in survival rate through Kaplan-Meier method between relapsed (66.7%) and non-relapsed (94.4%) patients. In univariate analysis, incomplete primary resection and malignant histology were proven to increase recurrence risks. Nearly half of patients had at least 1 of the parameters reflecting abnormal bowel function (e.g., involuntary bowel movements, fecal incontinence, and constipation). For those recurrent SCTs patients, difficulty defecating was a major problem. CONCLUSIONS Tumor recurrence affected the prognosis of children with SCT. In our research, incomplete resection and malignant histology were considered risk factors. Constipation was the main problem in anorectal functional sequelae for children who had recurrence.
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Affiliation(s)
- Yi Wang
- Department of Pediatric Surgery, Xinhua Hospital Affiliated to Medicine School of Shanghai Jiaotong University, Shanghai, China (mainland)
| | - Yeming Wu
- Department of Pediatric Surgery, Xinhua Hospital Affiliated to Medicine School of Shanghai Jiaotong University, Shanghai, China (mainland)
| | - Lifeng Wang
- Department of Pathology, Xinhua Hospital Affiliated to Medicine School of Shanghai Jiaotong University, Shanghai, China (mainland)
| | - Xiaojun Yuan
- Department of Pediatric Hematology and Oncology, Xinhua Hospital Affiliated to Medicine School of Shanghai Jiaotong University, Shanghai, China (mainland)
| | - Mawei Jiang
- Department of Radiotherapy, Xinhua Hospital Affiliated to Medicine School of Shanghai Jiaotong University, Shanghai, China (mainland)
| | - Yuhua Li
- Department of Radiology, Xinhua Hospital Affiliated to Medicine School of Shanghai Jiaotong University, Shanghai, China (mainland)
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