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Sacrococcygeal teratomas: midline reconstruction improves cosmesis without compromising outcomes. Pediatr Surg Int 2022; 38:617-621. [PMID: 35175403 DOI: 10.1007/s00383-021-05055-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/13/2021] [Indexed: 10/19/2022]
Abstract
AIM Several studies have addressed the long-term functional, psychosexual and psychosocial outcomes following sacrococcygeal teratoma (SCT) excision. It is well reported that the classical chevron incision and reconstruction can leave a cosmetically unsatisfactory result; however, there is little in the literature focussed on improving this outcome. In our institution the preference is to perform a midline reconstruction, where possible, this is felt to improve appearance without compromising the oncological or functional outcome. The aim of this study was to evaluate patient-perceived cosmetic outcomes of the midline reconstruction. METHODS All patients undergoing surgery for SCT between 2007 and 2020 were included in the study. Patient demographics, operation type, functional outcome and recurrence were all recorded. The primary outcome measure was patient/parent satisfaction with the cosmetic appearance. This was assessed using both qualitative and quantitative methodologies. Following ethical approval parents were asked questions from two existing validated patient outcome questionnaires: "Patient and Observer Scar Assessment Scale" (POSAS) v2.0 and the "Patient Scar Assessment Questionnaire". RESULTS Thirty-two patients underwent surgery at our institution for SCT during the study period. Twenty-four had a posterior approach with midline reconstruction, two laparotomy and excision (excluded from this study) and six had a combined approach. Median follow-up was 35 months (8.5-96 months). There were no recurrences. 4/30 (13%) have persistent urological symptoms, and 1/30 (3%) has constipation requiring bowel management. Questionnaires were sent to 26/30 families with a 77% return rate. Median total score was 11 (7.4-17.5) on a 60-point scale (6, as normal skin, 60, worst imaginable scar). Twenty (95%) reported that the scar never affects the child's activities and 15 (71%) said they are "not at all" conscious of the scar. CONCLUSION Scars can lead to an array of cosmetic, functional, and psychological consequences and as such consideration needs to be given to scarring following surgery for sacrococcygeal teratomas. This study demonstrates that a midline reconstruction produces a cosmetically favourable outcome. We, therefore, recommend where appropriate a midline reconstruction should be considered for SCT.
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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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Muthee BW, Bray HJ. Approach to the postnatal sonographic evaluation of prenatally detected abdominopelvic cysts. Ultrasonography 2021; 41:53-73. [PMID: 34344138 PMCID: PMC8696132 DOI: 10.14366/usg.21070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Accepted: 05/22/2021] [Indexed: 11/10/2022] Open
Abstract
Prenatally detected abdominal and pelvic masses are commonly cystic in morphology and usually seen on mid-trimester sonography. Sonography is the favored imaging modality for the postnatal evaluation of these lesions in newborns, given its availability, low cost, lack of ionizing radiation, lack of sedation, and high spatial resolution in small patients. The differential diagnosis of abdominopelvic cystic masses in newborns is broad given that they can arise from many organs and may have overlapping features on imaging. This article illustrates an approach to the postnatal sonographic evaluation of prenatally detected cystic abdominal and pelvic masses based on their anatomic location and distinctive sonographic characteristics, which can aid in an accurate diagnosis and guide appropriate management.
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Affiliation(s)
- Bernadette Wambui Muthee
- Department of Radiology, British Columbia Children's Hospital, University of British Columbia, Vancouver, BC, Canada
| | - Heather J Bray
- Department of Radiology, British Columbia Children's Hospital, University of British Columbia, Vancouver, BC, Canada
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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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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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Kremer MEB, Althof JF, Derikx JPM, van Baren R, Heij HA, Wijnen MHWA, Wijnen RMH, van der Zee DC, van Heurn LWE. The incidence of associated abnormalities in patients with sacrococcygeal teratoma. J Pediatr Surg 2018; 53:1918-1922. [PMID: 29453131 DOI: 10.1016/j.jpedsurg.2018.01.013] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2017] [Revised: 01/14/2018] [Accepted: 01/16/2018] [Indexed: 10/18/2022]
Abstract
BACKGROUND Gross genetic causes for SCT are unknown; however, it might be associated with other abnormalities. We assessed the incidence of associated abnormalities in a large national cohort of neonates with SCT and aimed to identify predictive risk factors. PROCEDURE The medical records were reviewed of 235 consecutive neonates with SCT treated at the six pediatric surgical centers in the Netherlands from 1970 to 2010. Potential risk factors for associated abnormalities analyzed included sex, gestational age, tumor-volume/histology and Altman-classification. RESULTS In 76 patients (32.3%) at least one associated abnormality was diagnosed, with hydronephrosis as the most common (16.2%) and hip dysplasia in 4.3%. Multiple abnormalities were documented for 21 (9.0%). Prematurity and Altman type IV SCT were associated with an increased risk of any associated abnormality. No association between increased tumor-volume and hydronephrosis or hip dysplasia was found. Patients with type IV Altman SCT had a fourfold risk of suffering from hydronephrosis compared to Altman type I SCT. CONCLUSIONS SCT was associated with other abnormalities in one-third of children. Some were tumor-related while others were related to prematurity or occurred sporadically. In contrast to clinically obvious anomalies, hip dysplasia or hydronephrosis might be latently present with more subtle clinical presentation. We therefore suggest renal- and hip-ultrasound in all patients, certainly those with Altman type IV SCT. LEVEL OF EVIDENCE RATING Level II (retrospective study).
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Affiliation(s)
- Marijke E B Kremer
- Department of Paediatric Surgery-Maastricht University Medical Centre, The Netherlands
| | - Jessica F Althof
- Department of Paediatric Surgery-Maastricht University Medical Centre, The Netherlands
| | - Joep P M Derikx
- Department of Paediatric Surgery-Maastricht University Medical Centre, The Netherlands
| | - Robertine van Baren
- Department of Paediatric Surgery-University Medical Centre, Groningen, The Netherlands
| | - Hugo A Heij
- Pediatric Surgical Centre of Amsterdam (Emma Children's Hospital University Medical Centre and VU Medical Centre), The Netherlands
| | - Marc H W A Wijnen
- Department of Paediatric Surgery-University Medical Centre, Nijmegen, The Netherlands
| | - René M H Wijnen
- Department of Paediatric Surgery, Sophia Children's Hospital-Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - David C van der Zee
- Department of Paediatric Surgery, Wilhelmina Children's Hospital-University Medical Centre, Utrecht, The Netherlands
| | - L W Ernest van Heurn
- Department of Paediatric Surgery-Maastricht University Medical Centre, The Netherlands.
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Hambraeus M, Hagander L, Stenström P, Arnbjörnsson E, Börjesson A. Long-Term Outcome of Sacrococcygeal Teratoma: A Controlled Cohort Study of Urinary Tract and Bowel Dysfunction and Predictors of Poor Outcome. J Pediatr 2018; 198:131-136.e2. [PMID: 29656864 DOI: 10.1016/j.jpeds.2018.02.031] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2017] [Revised: 01/10/2018] [Accepted: 02/13/2018] [Indexed: 12/19/2022]
Abstract
OBJECTIVE To evaluate urinary tract and bowel function in children with sacrococcygeal teratoma, compare the findings with healthy children, and assess predictors of poor outcome. STUDY DESIGN This was a controlled cohort study of all patients operated for sacrococcygeal teratoma at a tertiary pediatric surgery center, 2000-2013. Urinary and bowel function were compared with healthy control patients matched for age and sex. Perioperative and histopathologic risk factors were analyzed. RESULTS In total, 17 patients with sacrococcygeal teratoma and 85 healthy control patients were included in the study. Patients with sacrococcygeal teratoma more often were reported to have uncontrolled voiding (12% vs 0%, P < .01), difficulty in bladder emptying (24% vs 0%, P < .001), and pyelonephritis (18% vs 1%, P < .05). Constipation was more common in patients with sacrococcygeal teratoma (47 % vs 14%, P < .05), but the overall bowel function score was equal in the 2 groups. Children with large tumors and immature histology were more likely to have a dysfunctional outcome (P < .05). CONCLUSIONS Uncontrolled voiding, difficulty in bladder emptying, pyelonephritis, and constipation were more common in patients with sacrococcygeal teratoma than in healthy children. Dysfunctional outcome was more prevalent in children with large and immature teratomas.
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Affiliation(s)
- Mette Hambraeus
- Department of Pediatric Surgery, Skåne University Hospital, Lund, Sweden; Department of Clinical Sciences Lund, Lund University, Lund, Sweden
| | - Lars Hagander
- Department of Pediatric Surgery, Skåne University Hospital, Lund, Sweden; Department of Clinical Sciences Lund, Lund University, Lund, Sweden.
| | - Pernilla Stenström
- Department of Pediatric Surgery, Skåne University Hospital, Lund, Sweden; Department of Clinical Sciences Lund, Lund University, Lund, Sweden
| | - Einar Arnbjörnsson
- Department of Pediatric Surgery, Skåne University Hospital, Lund, Sweden; Department of Clinical Sciences Lund, Lund University, Lund, Sweden
| | - Anna Börjesson
- Department of Pediatric Surgery, Skåne University Hospital, Lund, Sweden; Department of Clinical Sciences Lund, Lund University, Lund, Sweden
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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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10
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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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11
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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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12
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Yao W, Li K, Zheng S, Dong K, Xiao X. Analysis of recurrence risks for sacrococcygeal teratoma in children. J Pediatr Surg 2014; 49:1839-42. [PMID: 25487496 DOI: 10.1016/j.jpedsurg.2014.09.036] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2014] [Accepted: 09/05/2014] [Indexed: 11/25/2022]
Abstract
BACKGROUND/PURPOSE The purpose of this study was to investigate effects of risk factors on recurrence of sacrococcygeal teratoma (SCT). METHODS A retrospective review was conducted of 107 SCTs treated between January 2003 and December 2012 in our center. Risk factors were identified by univariate and multivariate analysis. RESULTS Sixteen children had recurrence of SCT a median interval of 16.25months after primary surgery. 15.6% tumors recurrence were Altman type I, 10.5% type II, 10.0% type III, and 31.3% type IV. The recurrence of mature teratoma was observed in 8 patients, immature in 2, malignant in 5. More than half of the recurrences showed a shift towards histological immaturity or malignancy, compared with the primary tumor pathology. Risk factors for recurrence were spillage of tumor parenchyma during operation (P=0.028), incomplete resection (p=0.000), and primary immature (P=0.029) and malignant histology (P=0.026). Size, Altman classification, and age were not risk factors for recurrence. There was a statistically significant difference in OS between patients who developed relapse (64.8%) and those who did not (95.0%) (P=0.0002). CONCLUSIONS Tumor recurrence affected the outcome of children with SCT. Risk factors were tumor spillage, immature and malignant histology, or incomplete resection. Regular follow-up after surgery is mandatory to find tumor relapse earlier and to improve the outcome.
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Affiliation(s)
- Wei Yao
- Department of Pediatric Surgery, Children's Hospital of Fudan University, Shanghai
| | - Kai Li
- Department of Pediatric Surgery, Children's Hospital of Fudan University, Shanghai.
| | - Shan Zheng
- Department of Pediatric Surgery, Children's Hospital of Fudan University, Shanghai
| | - Kuiran Dong
- Department of Pediatric Surgery, Children's Hospital of Fudan University, Shanghai
| | - Xianmin Xiao
- Department of Pediatric Surgery, Children's Hospital of Fudan University, Shanghai
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McPherson E, Cold C, Johnson P, Schema L, Zaleski C. Neuroblastoma in a 17-week fetus: A stimulus for investigation of tumors in a series of 2786 stillbirth and late miscarriages. Am J Med Genet A 2014; 167A:246-9. [DOI: 10.1002/ajmg.a.36829] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2014] [Accepted: 09/19/2014] [Indexed: 11/11/2022]
Affiliation(s)
| | - Christopher Cold
- Department of Lab Pathology; Marshfield Clinic; Marshfield Wisconsin
| | - Peter Johnson
- Department of Obstetrics and Gynecology; Marshfield Clinic; Marshfield Wisconsin
| | - Lynn Schema
- Department of Medical Genetics; Marshfield Clinic; Marshfield Wisconsin
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14
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Pauniaho SL, Heikinheimo O, Vettenranta K, Salonen J, Stefanovic V, Ritvanen A, Rintala R, Heikinheimo M. High prevalence of sacrococcygeal teratoma in Finland - a nationwide population-based study. Acta Paediatr 2013; 102:e251-6. [PMID: 23432104 DOI: 10.1111/apa.12211] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2013] [Revised: 02/18/2013] [Accepted: 02/19/2013] [Indexed: 11/30/2022]
Abstract
AIM The birth prevalence of sacrococcygeal teratoma (SCT) has been reported to range from 1:27 000 to 1:40 000. We assessed the population-based prevalence and clinical presentation of SCT over 22 years. METHODS We identified all cases of SCT, including live births, stillbirths and terminations of pregnancy (TOPs), in the Finnish Register of Congenital Malformations, covering 1987-2008. Data on prenatal diagnoses, pregnancy outcomes, infant deaths and associated anomalies were collected. RESULTS One hundred and twenty four SCT cases were identified among 1 331 699 pregnancies. There were 89 (72%) live births, 13 (10%) stillbirths and 22 (18%) TOPs. The total prevalence of SCT was 1:10 700. Tumours were detected in utero in 55% of the pregnancies with SCT. The proportion of perinatal deaths among all SCT births was 28%. Thirty percentage of the cases had associated abnormalities (mainly of the urinary tract and various syndromes). CONCLUSION This nationwide, population-based study on SCT shows that the total and birth prevalence of SCT in Finland is markedly higher than previously reported. This may reflect true differences between populations, but may also be explained by accurate nationwide registration of SCTs. The high perinatal mortality rate has an impact on counselling of families and planning of deliveries.
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Affiliation(s)
- Satu-Liisa Pauniaho
- Paediatric Research Centre; University of Tampere and Tampere University Hospital; Tampere Finland
- Department of Surgery; Central Hospital of Seinäjoki; Tampere Finland
| | - Oskari Heikinheimo
- Department of Obstetrics and Gynecology; University of Helsinki and Helsinki University Central Hospital; Helsinki Finland
| | - Kim Vettenranta
- Division of Hematology-Oncology and Stem Cell Transplantation; Children's Hospital; University of Helsinki and Helsinki University Central Hospital; Helsinki Finland
| | - Jonna Salonen
- Department of Obstetrics and Gynecology; University of Helsinki and Helsinki University Central Hospital; Helsinki Finland
| | - Vedran Stefanovic
- Department of Obstetrics and Gynecology; University of Helsinki and Helsinki University Central Hospital; Helsinki Finland
| | | | - Risto Rintala
- Department of Pediatric Surgery; Children's Hospital; University of Helsinki and Helsinki University Central Hospital; Helsinki Finland
| | - Markku Heikinheimo
- Department of Pediatrics; Children's Hospital; University of Helsinki and Helsinki University Central Hospital; Helsinki Finland
- Department of Pediatrics; St Louis Children's Hospital; Washington University School of Medicine; St Louis MO USA
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15
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Hager T, Sergi C, Hager J. Sacrococcygeal Teratoma – a single center study of 43 years (1968–2011) including follow-up data and histopathological reevaluation of specimens. Eur Surg 2012. [DOI: 10.1007/s10353-012-0098-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
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