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Bista A, Ghimire S, Gaire NS, Bataju P, Mishra D. Giant Sacrococcygeal Teratoma in a Neonate: A Case Report. JNMA J Nepal Med Assoc 2023; 61:675-679. [PMID: 38289807 PMCID: PMC10566610 DOI: 10.31729/jnma.8251] [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: 07/31/2023] [Indexed: 02/01/2024] Open
Abstract
Sacrococcygeal teratomas are common tumours in neonates and infants, primarily affecting females. A 35-year-old primigravida presented with a large sacrococcygeal teratoma that was detected during the 30th week of gestation in the fetus. The baby was delivered via elective caesarean section at 36+3 weeks, and surgical excision of the 10x10x5 cm³ mass was performed successfully on the third day of life. Despite a surgical site infection, the patient had a favourable outcome with normal vital signs, bowel, bladder, and lower extremity functions upon discharge. Early diagnosis and prompt management of sacrococcygeal teratoma in newborns is vital for optimal outcomes, providing valuable insights and guidance to medical practitioners. Keywords anaesthesia; case reports; neonate; teratoma.
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Affiliation(s)
- Anup Bista
- Department of Anaesthesia and Critical Care,
Patan Academy of Health Sciences, Lagankhel, Lalitpur,
Nepal
| | - Suson Ghimire
- Department of Anaesthesia and Critical Care,
Patan Academy of Health Sciences, Lagankhel, Lalitpur,
Nepal
| | - Niharika Sharma Gaire
- Department of Anaesthesia and Critical Care,
Patan Academy of Health Sciences, Lagankhel, Lalitpur,
Nepal
| | - Pujan Bataju
- Department of Intensive Care Unit and
Neurosurgery, Metrocity Hospital, Srijana Cnowk, Pokhara,
Nepal
| | - Dipesh Mishra
- Department of Intensive Care Unit, Chirayu
National Hospital and Medical Institute, Basundhara, Kathmandu,
Nepal
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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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3
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Yadav DK, Acharya SK, Bagga D, Jain V, Dhua A, Goel P. Sacrococcygeal Teratoma: Clinical Characteristics, Management, and Long-term Outcomes in a Prospective Study from a Tertiary Care Center. J Indian Assoc Pediatr Surg 2019; 25:15-21. [PMID: 31896894 PMCID: PMC6910050 DOI: 10.4103/jiaps.jiaps_219_18] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2018] [Revised: 02/23/2019] [Accepted: 05/25/2019] [Indexed: 11/09/2022] Open
Abstract
Introduction: The study focuses on the clinical presentation, management, and outcomes (both short term and long term) in patients with sacrococcygeal teratoma managed over a decade in a tertiary care center. Materials and Methods: This is a prospective study on children with sacrococcygeal teratoma over 12 years data collected included antenatal diagnosis, mode of delivery, age at diagnosis, clinical presentation, physical extent of mass (including Altman classification), levels of alpha-fetoprotein, surgical approach, histopathology, clinical outcome, recurrence and long-term results including bladder-bowel dysfunction and neurological impairment. Functional results were evaluated clinically and radiologically. Results: During the study, 41 patients (male to female ratio of 1:3.1) with a median age of 36 days (1 day–11.6 years) with sacrococcygeal teratoma were managed at our center. The mean follow-up duration was 54 months (range 19–110 months). Nearly, two-thirds of the tumors were either Altman Type 1 or 2. Yolk sac tumor was present in 8 (19.5%) patients, while the rest has either mature or immature teratoma. Tumors were removed through a posterior sagittal or a chevron incision. In seven patients, abdominosacral approach was necessary. Eight patients with malignant disease received chemotherapy (neoadjuvant in 5). Overall survival was 95% at a mean follow-up of 54 months. Among the late complications, three patients had a local recurrence of tumor, and urinary dribbling was present in three patients. Conclusions: Teratomas are the most common germ cell tumors of the sacrococcygeal region. Most of the tumors are benign, and the incidence of malignancy increases with age. The evaluation of malignancy is, therefore, necessary in these children. Excellent survival of 95% was achieved in this series. Morbidity due to associated malformation, disease recurrence, and treatment may persist in these patients; hence, proper follow-up is needed.
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Affiliation(s)
- Devendra Kumar Yadav
- Department of Pediatric Surgery, All India Institute of Medical Sciences, New Delhi, India
| | - Samir Kant Acharya
- Department of Pediatric Surgery, Vardhman Mahavir Medical College and Associated Safdarjang Hospital, New Delhi, India
| | - Deepak Bagga
- Department of Pediatric Surgery, Vardhman Mahavir Medical College and Associated Safdarjang Hospital, New Delhi, India
| | - Vishesh Jain
- Department of Pediatric Surgery, All India Institute of Medical Sciences, New Delhi, India
| | - Anjan Dhua
- Department of Pediatric Surgery, All India Institute of Medical Sciences, New Delhi, India
| | - Prabudh Goel
- Department of Pediatric Surgery, All India Institute of Medical Sciences, New Delhi, India
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4
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Katusiime C. Perineal wound disruption and postoperative infection following resection of a benign cystic sacrococcygeal teratoma in a neonate in a resource-limited setting: A case report. Clin Case Rep 2019; 7:949-952. [PMID: 31110721 PMCID: PMC6509671 DOI: 10.1002/ccr3.2124] [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: 11/23/2018] [Revised: 01/12/2019] [Accepted: 01/28/2019] [Indexed: 11/09/2022] Open
Abstract
Case reports highlighting the complications of SCT surgical resection in resource-limited settings particularly sub-Saharan Africa are few. It is imperative to take into account that achieving the desirable cosmetic results may not be possible because of large tumor size and postoperative infection. It is therefore of necessity to consider integration of plastic surgical reconstructive programs into pediatric surgery follow-up programs in resource-limited settings.
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Gupta B, Yadav S, Khurana N, Raj P. Sacrococcygeal Teratoma in a Seven-Day-Old Child with Pulmonary Differentiation. J Clin Diagn Res 2017; 11:SD01-SD02. [PMID: 28969230 DOI: 10.7860/jcdr/2017/27273.10357] [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: 02/04/2017] [Accepted: 05/13/2017] [Indexed: 11/24/2022]
Abstract
Sacrococcygeal Teratoma (SCT) showing pulmonary differentiation has been rarely reported in the literature. Till date, only eight cases have been reported, out of which six belong to teratomas arising from female genital tract. Spinal teratomas showing pulmonary differentiation are rarer and only two cases have been reported so far in the literature both of which had associated congenital spinal anomaly. We present a rare case of seven day old infant with sacrococcygeal teratoma showing mature lung differentiation as one of its components. The infant was otherwise asymptomatic and had no associated spinal anomaly. This case has been presented for its rarity. Extensive review of the literature along with the possible pathogenesis is also included for better understanding.
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Affiliation(s)
- Barkha Gupta
- Senior Resident, Department of Pathology, Maulana Azad Medical College, New Delhi, India
| | - Surekha Yadav
- Senior Resident, Department of Pathology, Maulana Azad Medical College, New Delhi, India
| | - Nita Khurana
- Professor, Department of Pathology, Maulana Azad Medical College, New Delhi, India
| | - Prince Raj
- Assistant Professor, Department of Paediatric Surgery, Lok Nayak Hospital, New Delhi, India
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Yekula MSKK, Yekula A. Adult Sacrococcygeal Teratoma: The third leg: A rare case report in a 25 year old man. Int J Surg Case Rep 2015; 14:146-8. [PMID: 26275739 PMCID: PMC4573611 DOI: 10.1016/j.ijscr.2015.07.026] [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: 04/15/2015] [Revised: 07/25/2015] [Accepted: 07/26/2015] [Indexed: 11/26/2022] Open
Abstract
A rare case of Sacrococcygeal Teratoma(SCT) with an accessory limb in an adult of 25 years. MRI and histopathology have been vital in conclusion of the diagnosis. Histopathology revealed the presence of tissue derivatives of all three germ layers. Complete surgical excision with coccygectomy was done.
Introduction Sacrococcygeal Teratoma (SCT) is a rare benign neoplasm comprised of mixed elements derived from two or more germ cell layers. They are extremely rare in adults. They attract attention because of their gross appearance and bizarre histology. Presentation of case A 25 year old male presented to Surgical OPD, Government General Hospital, Guntur Medical College, Guntur with a large mass comprising a partially developed 3rd leg and rudimentary external genitalia in the lower back. He complained of cosmetic blemish, difficulty in sitting, sleeping and walking. Discussion He was diagnosed mature Sacrococcygeal Teratoma Altman Type II based on history, clinical examination, ultrasound, MRI. Histopathology confirmed the diagnosis. He had complete surgical excision with primary wound closure and a good postoperative recovery. A 3-year follow-up using clinical, biochemical and radiological assessment revealed no evidence of recurrence. Conclusion Mature SCT, though very rare in adults, are usually benign. Complete surgical excision remains the mainstay of treatment.
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Affiliation(s)
- M S Kiran Kumar Yekula
- Department of General Surgery, Government General Hospital GGH, Guntur Medical College GMC, Guntur 522004, Andhra Pradesh, India.
| | - Anudeep Yekula
- Guntur Medical College GMC, Guntur 522004, Andhra Pradesh, India.
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Ayed A, Tonks AM, Lander A, Kilby MD. A review of pregnancies complicated by congenital sacrococcygeal teratoma in the West Midlands region over an 18-year period: population-based, cohort study. Prenat Diagn 2015; 35:1037-47. [DOI: 10.1002/pd.4641] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2015] [Revised: 06/02/2015] [Accepted: 06/18/2015] [Indexed: 12/13/2022]
Affiliation(s)
- Amal Ayed
- The Fetal Medicine Centre; Birmingham Women's Foundation Trust; Birmingham UK
| | - Ann M. Tonks
- West Midlands Congenital Anomaly Register; Public Health England; Birmingham UK
| | | | - Mark D. Kilby
- The Fetal Medicine Centre; Birmingham Women's Foundation Trust; Birmingham UK
- Centre for Women's and Children's Health, Section Theme of Reproduction and Development, Institute of Metabolism & Allied Health Science; College of Medical and Dental Sciences; Birmingham UK
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Ahmad M, Arora M, Ullah E, Malik AM. Neonatal sacrococcygeal teratoma with acute renal failure. BMJ Case Rep 2013; 2013:bcr-2013-009304. [PMID: 23704437 DOI: 10.1136/bcr-2013-009304] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Teratomas are germ cell tumours composed of multiple types of cells derived from more than a single germ cell layer. The most common site of an extragonadal teratoma is the sacrococcygeal region. We report a case of a 16-day-old female child with a large swelling in the sacrococcygeal region extending laterally into the buttocks with severely deranged renal functions. Ultrasonography and CT helped in making the diagnosis and, more importantly, to delineate the extent of the tumour and the involvement of adjacent organs and tissues: in our case, lower bilateral ureters. Imaging findings and clinical presentation led to the diagnosis of sacrococcygeal teratoma with renal failure.
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Affiliation(s)
- Mehtab Ahmad
- Department of Radiodiagnosis, Jawaharlal Nehru Medical College, Aligarh Muslim University, Aligarh, Uttar Pradesh, India
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Cama JK, Nagra S. Sacrococcygeal teratoma with an accessory limb an unusual presentation. JOURNAL OF PEDIATRIC SURGERY CASE REPORTS 2013. [DOI: 10.1016/j.epsc.2013.02.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
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10
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Neonatal sacrococcygeal teratoma: our experience with 10 cases. J Neonatal Surg 2013; 2:4. [PMID: 26023424 PMCID: PMC4420341] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2012] [Accepted: 09/21/2012] [Indexed: 11/25/2022] Open
Abstract
AIM To analyse the outcome of neonatal sacrococcygeal teratomas (SCT) in our setup. MATERIALS AND METHODS Hospital records of 10 neonates, who were operated for SCT during 14 years time period, were retrieved and analysed. Letters were sent to 6 parents/ caretakers of children who were lost to follow up; none of them responded. RESULTS Seven girls and 3 boys with a mean age of 9 days (range 1-30 days) underwent excision of SCT in the neonatal period. Antenatal pickup rates were poor (2/10). Two patients presented with tumor rupture. Though all had an obvious mass at birth, only half of them presented on day 1 of life. The remaining 5 patients came late at a mean age of 11 days. Half of the SCTs were 10 cm or larger in size. One patient was misdiagnosed as meningomyelocoele. All underwent complete excision with coccygectomy by posterior approach in prone position. There were only 2 patients who could be classified as Altman Type II, the rest were all Altman Type I. Histopathology (HPE) revealed mature cystic teratoma (n=8), grade 1 immature teratoma (n=1) and grade 3 immature teratoma (n=1). There was no mortality; and complications were seen in 3/10 patients (1 neurogenic bladder, 1 major wound infection with ventriculitis and 1 minor wound infection). The mean follow up was 25 months (range 1 month to 6 years) in 4 patients with no recurrence. CONCLUSIONS Neonatal SCTs are usually benign with a good outcome after complete surgical excision with a low complication rate. Although long term follow up has been advocated, the follow up was poor in this series.
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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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Takamatsu M, Aoki H, Hirose Y, Kobayashi K, Tomita H, Kuno T, Koumura H, Hara A. Teratoma showing the features of retinal structure: A case of sacrococcygeal teratoma. Oncol Lett 2012; 3:1023-1026. [PMID: 22783384 DOI: 10.3892/ol.2012.636] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2011] [Accepted: 02/29/2012] [Indexed: 01/17/2023] Open
Abstract
Teratoma is a tumor that forms triploblastic tissues and the common sites of occurrence are sacrococcygeal lesions and the ovaries. The majority of cases are curable with surgical resection and the prognosis depends on the extent and histological scoring of the tumor. In the present study, we report a case of sacrococcygeal teratoma of a newborn showing features of a retina-like structure. A 29-year-old woman gave birth prematurely to an infant girl with sacrococcygeal teratoma. Surgical resection was performed 10 days after delivery. The tumor contained immature components as well as a retina-like structure. Several investigations, including immunohistochemical analysis, confirmed the similarities between the normal mouse retina and the retina-like structure of the tumor. The vascular arrangement and polarity surrounding the retina-like structure are unique and this is thought to be significant in the induction of structural differentiation. Our findings may provide insights into the matter of teratogenic activity in stem cell therapies for clinical applications.
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Affiliation(s)
- Manabu Takamatsu
- Department of Tumor Pathology, Gifu University Graduate School of Medicine, Gifu 501-1194, Japan
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Prognosis of malignant sacrococcygeal germ cell tumours according to their natural history and surgical management. Surg Oncol 2012; 21:e31-7. [PMID: 22459912 DOI: 10.1016/j.suronc.2012.03.001] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2011] [Revised: 02/03/2012] [Accepted: 03/04/2012] [Indexed: 11/20/2022]
Abstract
INTRODUCTION Malignant sacrococcygeal (SC) germ cell tumours (GCT) may be diagnosed as primary pelvic tumour or malignant recurrence of foetal SC teratoma (FSCT) operated during the neonatal period. In order to evaluate the difference between these two populations, the authors report their experience with SC-GCT registered in the French TGM 95 protocol. POPULATION AND METHODS The protocol comprised risk-adapted-chemotherapy (CT) followed by surgery. Standard risk (SR: localized tumour completely resected) had no adjuvant therapy. Intermediate-Risk (IR: localized tumour, incomplete or no initial surgery with αFP<15,000 ng/ml) received Vinblastine-Bleomycin-Cisplatin regimen; while High-Risk (HR: αFP > 15,000 ng/ml and/or metastases) received Etoposide-Ifosfamide-Cisplatin. RESULTS Fifty-seven patients with SC-GCT, aged 0-80 months (median 16), were registered between 1995 and 2005. Nineteen patients had secondary SC-GCT after FSCT. All patients received CT: 17 IR and 1 SR after reevolution; 39 HR (25 with metastases). 51 patients underwent delayed surgery, which was incomplete in 8 patients. EVOLUTION Seventy-two percent of the secondary SC-GCT had systematic biological follow-up. αFP increasing was the first presenting sign in 80% of the cases. Patients with secondary SC-GCT had a lower median αFP level at diagnosis, were less frequently classified as HR and received less CT. The two groups with secondary vs. primary SC-GCT had a statistically similar favourable outcome (Overall Survival: 93.8% vs. 86.2%; Event-Free Survival: 89.2 vs. 78.2%; p > 0.34 and >0.32), respectively, but with less burden of therapy. CONCLUSIONS SC-GCT has a good overall prognosis provided complete surgery is achieved and CT is administered to IR and HR patients. SC-GCT in patients followed by αFP after treatment for FSCT had less tumour extension than newly-diagnosed patients, probably because of earlier detection of the disease.
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Sacrococcygeal teratoma in infants and children. Acta Neurochir (Wien) 2011; 153:1781-6. [PMID: 21604208 DOI: 10.1007/s00701-011-1048-8] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2011] [Accepted: 05/05/2011] [Indexed: 10/18/2022]
Abstract
BACKGROUND The purpose of this study is to share our experience with extensive sacrococcygeal teratoma, paying particular attention to neurological function, intraoperative hemorrhage, rate of tumor recurrence, and the surgical procedure. METHODS Infants and children with sacrococcygeal teratoma were selected and generally examined in order to detect other associated anomalies. Patients with giant sacrococcygeal tumor and high output heart failure were managed by the abdominosacral route while patients with small sacrococcygeal tumor and normal cardiac function were managed by the sacral approach. All operated patients were observed and followed-up regularly for a period of 1-3 years after tumor excision. RESULTS This study presents 22 patients with sacrococcygeal teratoma managed over a period of 40 months; 18 patients presented in the first 2 months of life and four children aged 2-4 years. Fifteen patients were treated by sacral excision and seven patients were corrected by abdomenosacral excision and temporary colostomy. Benign teratoma presented in 17 patients, one of whom died (6%), and five patients had malignant tumor, one of whom died (20%). The fecal and urinary state was good in all patients treated by the sacral route. Patients corrected by abdominosacral excision showed varied degrees of urinary incontinence and constipation. Survival in excised malignant tumor was good following chemotherapy; three patients received chemotherapy with a 70% survival rate. CONCLUSION Benign sacrococcygeal teratoma has an excellent outcome after early surgery, but the incidences of malignancy increase if resection is delayed.
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Abstract
OBJECTIVE The purpose of this article is to describe the radiologic features of unusual tumors that occur in the perineum. CONCLUSION The perineal space is often overlooked because of the infrequency of abnormalities. Accurate image interpretation and visualization of extent of pathology is important for proper management. Trauma and infectious diseases occur in the acute setting, whereas tumors are common in the chronic setting. Cross-sectional imaging plays a crucial role in depicting perineal anatomy and evaluating the extent of disease.
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Tumor volume to fetal weight ratio as an early prognostic classification for fetal sacrococcygeal teratoma. J Pediatr Surg 2011; 46:1182-5. [PMID: 21683219 DOI: 10.1016/j.jpedsurg.2011.03.051] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2011] [Accepted: 03/26/2011] [Indexed: 11/22/2022]
Abstract
PURPOSE This study was designed to develop a prognostic factor for fetuses with sacrococcygeal teratoma (SCT) that may be useful to predict outcome and guide counseling early in pregnancy. We hypothesize that, in fetuses with SCT, the ratio of tumor size to estimated fetal weight in the second trimester predicts outcome. METHODS We retrospectively reviewed charts of all patients evaluated at our Fetal Center for SCT between 2004 and 2009. Estimated fetal weight and tumor volume were calculated based on prenatal ultrasound or fetal magnetic resonance imaging. Patients were stratified based on tumor volume to fetal weight ratio (TFR), and their outcomes were analyzed by Fisher's Exact test. RESULTS Tumor volume to fetal weight ratio before 24 weeks' gestation was predictive of outcome. Those with a TFR less than or equal to 0.12 (n = 5) had a significantly better outcome than patients with a TFR greater than 0.12 (n = 5, P < .05). All patients with poor outcomes had a TFR greater than 0.12 by 24 weeks' gestation. A TFR greater than 0.12 predicted poor outcome with 100% sensitivity and 83% specificity. All 4 patients who developed hydrops had a TFR greater than 0.12. CONCLUSION In our series of fetuses with SCT, TFR before 24 weeks' gestation correlates with outcome. This novel, prenatal diagnostic tool may be useful in prenatal counseling and for early identification of high-risk fetuses.
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Fadler KM, Askin DF. Sacrococcygeal teratoma in the newborn: a case study of prenatal management and clinical intervention. Neonatal Netw 2008; 27:185-91. [PMID: 18557266 DOI: 10.1891/0730-0832.27.3.185] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Sacrococcygeal teratomas (SCTs) are the most common germinal cell neoplasms of the fetus and neonate. They originate during embryonic development when the primitive streak fails to differentiate among mesodermal, ectodermal, and endodermal tissues in the embryonic disc. This article discusses the fetal pathophysiology of SCTs and the impact of the condition on the newborn. Fetal SCTs can have life-threatening physiologic effects--such as premature labor, dystocia, and high-output cardiac failure--if not managed appropriately. Clinical manifestations, prenatal diagnosis, therapeutic approaches and treatment options for the fetus and newborn, and current research related to SCTs are addressed to aid practitioners caring for a fetus or infant diagnosed with an SCT.
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Affiliation(s)
- Kara M Fadler
- Children's Mercy Hospital and Clinics, Kansas City, MO 64108, USA.
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18
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Derikx JPM, De Backer A, van de Schoot L, Aronson DC, de Langen ZJ, van den Hoonaard TL, Bax NMA, van der Staak F, van Heurn LWE. Long-term functional sequelae of sacrococcygeal teratoma: a national study in The Netherlands. J Pediatr Surg 2007; 42:1122-6. [PMID: 17560233 DOI: 10.1016/j.jpedsurg.2007.01.050] [Citation(s) in RCA: 61] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND Long-term functional sequelae after resection of sacrococcygeal teratoma (SCT) are relatively common. This study determines the incidence of these sequelae associated clinical variables and its impact on quality of life (QoL). PATIENTS AND METHODS Patients with SCT treated from 1980 to 2003 at the pediatric surgical centers in The Netherlands aged more than 3 years received age-specific questionnaires, which assessed parameters reflecting bowel function (involuntary bowel movements, soiling, constipation), urinary incontinence, subjective aspect of the scar, and QoL. These parameters were correlated with clinical variables, which were extracted from the medical records. Risk factors were identified using univariate analysis. RESULTS Of the 99 posted questionnaires, 79 (80%) were completed. The median age of the patients was 9.7 years (range, 3.2-22.6 years). There were 46% who reported impaired bowel function and/or urinary incontinence (9% involuntary bowel movements, 13% soiling, 17% constipation), and 31% urinary incontinence. In 40%, the scar was cosmetically unacceptable. Age at completion of the questionnaire, Altman classification, sex, and histopathology were not risk factors for any long-term sequelae. Size of the tumor (>500 cm3) was a significant risk factor for cosmetically unacceptable scar (odds ration [OR], 4.73; confidence limit [CL], 1.21-18.47; P = .026). Long-term sequelae were correlated with diminished QoL. CONCLUSION A large proportion of the patients with SCT have problems with defecation, urinary incontinence, or a cosmetically unacceptable scar that affects QoL. Patients who are at higher risk for the development of long-term sequelae cannot be clearly assessed using clinical variables.
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Affiliation(s)
- Joep P M Derikx
- Department of Surgery, University Hospital, PO Box 5800, Maastricht 6200 AZ, The Netherlands
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19
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Abstract
The complexity of the congenital anomalies of the spine can make the neuroradiologic diagnosis challenging. Knowledge of spinal embryology greatly helps in the understanding and classification of these anomalies. We use the classification devised by Tortori-Donati and Rossi and find it helpful from clinical and imaging standpoints. We believe that most patients who have known or suspected congenital spinal anomalies benefit from MR imaging.
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Affiliation(s)
- John D Grimme
- Department of Radiology, University of North Carolina School of Medicine, Chapel Hill, NC 27599-7510, USA
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Cowles RA, Stolar CJH, Kandel JJ, Weintraub JL, Susman J, Spigland NA. Preoperative angiography with embolization and radiofrequency ablation as novel adjuncts to safe surgical resection of a large, vascular sacrococcygeal teratoma. Pediatr Surg Int 2006; 22:554-6. [PMID: 16479404 DOI: 10.1007/s00383-006-1650-7] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/23/2006] [Indexed: 10/25/2022]
Abstract
Sacrococcygeal teratomas (SCTs) can present a challenging problem and can be associated with significant perinatal morbidity and mortality. A female child was born at 36 weeks' gestation with a large, vascular Type 1 SCT originally identified by prenatal ultrasound. A CT scan showed two large feeding vessels arising from both internal iliac arteries that were successfully embolized during angiography. A radiofrequency probe was then used to ablate a zone between normal tissue and the tumor. The SCT was subsequently surgically excised with minimal blood loss. This case is presented to illustrate two useful and previously unreported postnatal adjuncts to the surgical treatment of massive, hypervascular sacrococcygeal tumors.
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Affiliation(s)
- Robert A Cowles
- Division of Pediatric Surgery, Morgan Stanley Children's Hospital of New York-Presbyterian, Columbia University, College of Physicians and Surgeons and Weill Medical College of Cornell University, New York, NY 10032, USA.
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21
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Abstract
Embryonic stem (ES) cells are typically derived from the inner cell mass of the preimplantation blastocyst and can both self-renew and differentiate into all the cells and tissues of the embryo. Because they are pluripotent, ES cells have been used extensively to analyze gene function in development via gene targeting. The embryonic stem cell is also an unsurpassed starting material to begin to understand a critical, largely inaccessible period of development. If their differentiation could be controlled, they would also be an important source of cells for transplantation to replace cells lost through disease or injury or to replace missing hormones or genes. Traditionally, ES cells have been differentiated in suspension culture as embryoid bodies, named because of their similarity to the early postimplantation-staged embryo. Unlike the pristine organization of the early embryo, differentiation in embryoid bodies appears to be largely unpatterned, although multiple cell types form. It has recently been possible to separate the desired cell types from differentiating ES cells in embryoid bodies by using cell-type-restricted promoters driving expression of either antibiotic resistance genes or fluorophores such as EGFP. In combination with growth factor exposure, highly differentiated cell types have successfully been derived from ES cells. Recent technological advances such as RNA interference to knock down gene expression in ES cells are also producing enriched populations of cells and elucidating gene function in early development.
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Affiliation(s)
- K Sue O'Shea
- Department of Cell and Developmental Biology, University of Michigan Medical School, Ann Arbor, Michigan 48109-0616, USA.
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22
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Abstract
A great deal has been learned regarding the natural history and pathophysiology of fetal SCT. The logic behind fetal intervention for SCT and hydrops appears to be correct, and open and minimal access techniques of fetal intervention have been shown to be feasible. The development of fetal intervention for SCT has mirrored those developed for other diseases such as congenital diaphragmatic hernia. In a recent presentation, Harrison, the original pioneer in fetal surgery, outlined trends in fetal intervention. The first trend is that of moving from open, invasive techniques to minimally invasive techniques. In the case of SCT surgeons are moving from open resection to RFA and possibly to fetoscopic resection. The second trend outlined by Harrison is a movement away from total in utero repair of a defect that recapitulates postnatal treatment and toward manipulation of fetal pathophysiology to reverse life-threatening events. In SCT surgeons employ RFA to ablate causative blood vessels to reverse fetal hydrops with the knowledge that these fetuses will require postnatal resection of the tumor. In contrast to resection, RFA requires less time and significantly less maternal morbidity than open resection. Further study is required to determine the role of minimal access techniques in SCT. Future directions for treatment of fetal SCT with hydrops might include fetoscopic resection or high-intensity ultrasound ablation.
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Affiliation(s)
- Shinjiro Hirose
- Fetal Treatment Center, University of California-San Francisco, 513 Parnassus Avenue, HSW 1601, San Francisco, CA 94143-0570, USA
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