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Rwomurushaka ES, Lodhia J. Diagnosis and management of a sacrococcygeal teratoma at a tertiary hospital in northern Tanzania: A case report. Int J Surg Case Rep 2024; 120:109895. [PMID: 38852569 PMCID: PMC11193032 DOI: 10.1016/j.ijscr.2024.109895] [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: 05/06/2024] [Revised: 06/05/2024] [Accepted: 06/06/2024] [Indexed: 06/11/2024] Open
Abstract
INTRODUCTION AND IMPORTANCE Sacrococcygeal teratoma is a rare extragonadal germ cell tumor occurring at the lower end of the back. It is congenital, and can be diagnosed in utero or just after birth. These tumors are sporadic in nature, more common in females than in males. They can be solid, cystic or a mixture of the two in consistency. Authors present this case to share their experience because these congenital tumors are rare and a lapse in appropriate management can be devastating because of chances of recurrence and the possibility of a malignant nature of the disease. CASE PRESENTATION Authors in this case present a baby that was referred to their center 5 days post vaginal delivery with a huge mass on the sacrococcygeal region. MRI revealed sacrococcygeal teratoma type II. Wide local excision was done. Tumor margins were microscopically negative. The patient recovered well and was discharged. The patient did not require adjuvant treatment. CLINICAL DISCUSSION Routine obstetric ultrasound can diagnose sacrococcygeal teratoma with 100 % sensitivity. Fetuses with tumors <5 cm in size can be delivered vaginally. Tumors larger than that should be delivered at term through cesarean section. High risk sacrococcygeal teratomas can be delivered at 28 weeks of gestation by cesarean section followed by ex-utero intrapartum therapy. MRI is useful to assess the intrapelvic extent of the tumor and to plan management. Surgical intervention should be done after delivery. CONCLUSION Intrauterine diagnosis is not an indication for termination of pregnancy. Surgical resection with negative margins provides a cure. Histological examination of the tumor is mandatory. For malignant sacrococcygeal teratomas, adjuvant chemotherapy is necessary for positive tumor margin after surgical resection. Positive margins may require chemotherapy. Neoadjuvant chemotherapy may be used for tumor debulking prior to surgery if the tumor infiltrates neighboring structures or is metastatic.
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Affiliation(s)
- Evance Salvatory Rwomurushaka
- Department of General Surgery, Kilimanjaro Christian Medical Centre, P O Box 3010, Moshi, Tanzania; Department of Anatomy and Neuroscience, Kilimanjaro Christian Medical University College, P O Box 2240, Moshi, Tanzania
| | - Jay Lodhia
- Department of General Surgery, Kilimanjaro Christian Medical Centre, P O Box 3010, Moshi, Tanzania; Faculty of Medicine, Kilimanjaro Christian Medical University College, P O Box 2240, Moshi, Tanzania.
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Hao Y, Zhang F, Ma Y, Luo Y, Zhang Y, Yang N, Liu M, Liu H, Li J. Potential biomarkers for the early detection of bone metastases. Front Oncol 2023; 13:1188357. [PMID: 37404755 PMCID: PMC10315674 DOI: 10.3389/fonc.2023.1188357] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Accepted: 06/01/2023] [Indexed: 07/06/2023] Open
Abstract
The clinical manifestations of bone metastases are diversified while many sites remain asymptomatic at early stage. As the early diagnosis method is not perfect and the early symptoms of tumor bone metastasis are not typical, bone metastasis is not easy to be detected. Therefore, the search for bone metastasis-related markers is effective for timely detection of tumor bone metastases and the development of drugs to inhibit bone metastases. As a result, bone metastases can only be diagnosed when symptoms are found, increasing the risk of developing skeletal-related event (SREs), which significantly impairs the patient's quality of life. Therefore, the early diagnosis of bone metastases is of great importance for the treatment and prognosis of cancer patients. Changes of bone metabolism indexes appear earlier in bone metastases, but the traditional biochemical indexes of bone metabolism lack of specificity and could be interfered by many factors, which limits their application in the study of bone metastases. Some new biomarkers of bone metastases have good diagnostic value, such as proteins, ncRNAs, circulating tumor cells (CTCs). Therefore, this study mainly reviewed the initial diagnostic biomarkers of bone metastases which were expected to provide references for the early detection of bone metastases.
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Affiliation(s)
- Yang Hao
- Laboratory of Molecular Biology, Henan Luoyang Orthopedic Hospital (Henan Provincial Orthopedic Hospital), Zhengzhou, China
- Henan University of Chinese Medicine, Zhengzhou, China
| | - Feifan Zhang
- Laboratory of Molecular Biology, Henan Luoyang Orthopedic Hospital (Henan Provincial Orthopedic Hospital), Zhengzhou, China
- Hunan University of Chinese Medicine, Changsha, China
| | - Yan Ma
- Laboratory of Molecular Biology, Henan Luoyang Orthopedic Hospital (Henan Provincial Orthopedic Hospital), Zhengzhou, China
| | - Yage Luo
- Laboratory of Molecular Biology, Henan Luoyang Orthopedic Hospital (Henan Provincial Orthopedic Hospital), Zhengzhou, China
| | - Yongyong Zhang
- Laboratory of Molecular Biology, Henan Luoyang Orthopedic Hospital (Henan Provincial Orthopedic Hospital), Zhengzhou, China
| | - Ning Yang
- Laboratory of Molecular Biology, Henan Luoyang Orthopedic Hospital (Henan Provincial Orthopedic Hospital), Zhengzhou, China
| | - Man Liu
- Laboratory of Molecular Biology, Henan Luoyang Orthopedic Hospital (Henan Provincial Orthopedic Hospital), Zhengzhou, China
| | - Hongjian Liu
- Department of Orthopaedics, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Jitian Li
- Laboratory of Molecular Biology, Henan Luoyang Orthopedic Hospital (Henan Provincial Orthopedic Hospital), Zhengzhou, China
- Henan University of Chinese Medicine, Zhengzhou, China
- Hunan University of Chinese Medicine, Changsha, China
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Diagnostic, Prognostic and Predictive Markers in Pediatric Germ Cell Tumors—Past, Present and Future. Diagnostics (Basel) 2022; 12:diagnostics12020278. [PMID: 35204369 PMCID: PMC8871072 DOI: 10.3390/diagnostics12020278] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Revised: 01/14/2022] [Accepted: 01/15/2022] [Indexed: 02/06/2023] Open
Abstract
Germ cell tumors (GCTs) are a heterogenous group of neoplasms in children and young adults, in which serum tumor markers have been demonstrated to be highly sensitive diagnostic and monitoring tools. The known "old" serum biomarkers, alpha-fetoprotein (AFP), human choriogonadotropin (β-hCG) and lactate dehydrogenase (LDH), have some limitations in sensitivity and specificity. MIRNAs from the miR-371~373 (chromosomal locus 19q13.41) and miR-302/367 (4q25) clusters are universally over-expressed in malignant GCT tissue samples. The levels of miRNAs from these clusters are elevated in the serum. They seem to be highly sensitive and specific in malignant GCTs diagnosis and disease assessment during treatment and follow-up. The aim of our review was to present the role of serum tumor markers in the clinical staging, treatment monitoring and follow-up of pediatric patients with GCTs and show new possibilities. The serum levels of miRNAs seem to be a new, promising essential tool in the clinical management of GCTs.
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D'Angelo P, De Pasquale MD, Barretta F, Affinita MC, Conte M, Dall'Igna P, Di Cataldo A, Inserra A, Provenzi M, Quaglietta L, Riccipetitoni G, Spreafico F, Trizzino A, Terenziani M. Malignant sacrococcygeal germ cell tumors in childhood: The Associazione Italiana Ematologia Oncologia Pediatrica (AIEOP) experience. Pediatr Blood Cancer 2021; 68:e28812. [PMID: 33219741 DOI: 10.1002/pbc.28812] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Revised: 10/28/2020] [Accepted: 10/29/2020] [Indexed: 11/08/2022]
Abstract
PURPOSE To evaluate clinical features at diagnosis, prognostic factors, and outcomes of malignant sacrococcygeal germ cell tumors (SC-GCTs) in patients enrolled in the Associazione Italiana Ematologia Oncologia Pediatrica (AIEOP) TCG 2004 protocol. PATIENTS AND METHODS A prospective analysis was conducted on all consecutive patients diagnosed with malignant SC-GCTs between January 2004 and May 2017. Patients with stage I underwent surgery and subsequent surveillance, the others received pediatric cisplatinum-etoposide-bleomycin (pPEB) regimen and eventual deferred surgery. RESULTS Of 45 patients, 35 were females. Age at diagnosis ranged from 1 day to 3.6 years (median 1.6 years); 26 were stage IV. Of 38 patients who underwent surgery, pathology revealed yolk sac tumor (YST) in 27 and teratoma + YST/embryonal carcinoma in 11, while seven patients were diagnosed based on imaging and elevated levels of alpha-fetoprotein (AFP). Of six patients approached with surgery, only one relapsed and was rescued with first-line chemotherapy. Overall, 38 out of 45 achieved complete remission, three a partial remission, and four were resistant. Ten out of 41 patients who entered remission later relapsed and nine were rescued with a second-line treatment. We observed a global failure percentage of 31% and a 5-year overall survival (OS) and event-free survival (EFS) of 95% and 69%, respectively. CONCLUSIONS Chemotherapyis generally effective in malignant SC-GCTs, even though almost one-third of our patients experienced events salvageable with second-line treatment. Most of the relapses occurred within 1 year from diagnosis. A close follow up with serial AFP level monitoring should be done for at least 2 years after diagnosis.
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Affiliation(s)
- Paolo D'Angelo
- Pediatric Hematology and Oncology Unit, ARNAS "Civico, Di Cristina and Benfratelli" Hospitals, Palermo, Italy
| | - Maria Debora De Pasquale
- Pediatric Hematology and Oncology Department, Ospedale Pediatrico Bambino Gesù IRCCS, Rome, Italy
| | - Francesco Barretta
- Unit of Clinical Epidemiology and Trial Organization, Fondazione IRCCS Istituto Nazionale dei Tumori di Milan, Milan, Italy
| | - Maria Carmen Affinita
- Hematology/Oncology Division, Department of Women's and Children's Health, University of Padua, Padua, Italy
| | - Massimo Conte
- Department of Hematology and Oncology, Istituto G. Gaslini, Genoa, Italy
| | - Patrizia Dall'Igna
- Pediatric Surgery Division, Department of Women's and Children's Health, University of Padua, Padua, Italy
| | - Andrea Di Cataldo
- Pediatric Hematology and Oncology Unit, Catania University, Catania, Italy
| | | | - Massimo Provenzi
- Pediatric Hematology and Oncology Unit, Papa Giovanni XXIII Hospital, Bergamo, Italy
| | - Lucia Quaglietta
- Pediatric Oncology Unit, Santobono-Pausilipon Hospitals, Naples, Italy
| | | | - Filippo Spreafico
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
| | - Angela Trizzino
- Pediatric Hematology and Oncology Unit, ARNAS "Civico, Di Cristina and Benfratelli" Hospitals, Palermo, Italy
| | - Monica Terenziani
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
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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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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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Büyükpamukcu M, Varan A, Küpeli S, Ekinci S, Yalcin S, Kale G, Yalcin B, Kutluk T, Akyüz C. Malignant Sacrococcygeal Germ Cell Tumors in Children: A 30-year Experience from a Single Institution. TUMORI JOURNAL 2018; 99:51-6. [DOI: 10.1177/030089161309900109] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background Our aim was to analyze treatment results and survival characteristics of our patients with malignant sacrococcygeal germ cell tumors. Procedure Patient files of children with malignant sacrococcygeal germ cell tumors, treated at our institution between 1979 and 2009, were searched. Patient characteristics, histopathological subtypes, extension of disease, alpha-fetoprotein (AFP) level at the time of diagnosis and relapse, extent of surgical resection, chemotherapy protocols, details of radiotherapy and survival characteristics were recorded. Results A total of 58 patients (M/F = 20/38) with malignant sacrococcygeal germ cell tumor was included in analysis. With a mean follow-up of 156 months (range, 26 days to 288.8 months) overall and event-free survival rates of the 58 patients were 50.9% and 43.8%, respectively. AFP status of the patients (37% in patients with <10,000 ng/ml, 68.9% in patients with ≥10,000 ng/ml), type of resection (total vs others), coccygeal resection, chemotherapy protocol (PEB vs others) and number of chemotherapy courses had an impact on event-free survival in univariate analysis. In multivariate analysis, AFP status had the greatest effect on prognosis. Conclusions Our treatment results are worse than those reported in the literature. Elevated AFP level at the time of diagnosis had a beneficial effect on prognosis, but year of diagnosis, tumor stage, presence of metastasis, tumor size and histopathological subtype had no impact on survival in patients with malignant sacrococcygeal germ cell tumors.
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Affiliation(s)
| | - Ali Varan
- Institute of Oncology, Department of Pediatric Oncology
| | - Serhan Küpeli
- Institute of Oncology, Department of Pediatric Oncology
| | - Saniye Ekinci
- Faculty of Medicine, Department of Pediatric Surgery
| | - Sule Yalcin
- Faculty of Medicine, Department of Pediatric Surgery
| | - Gülsev Kale
- Faculty of Medicine, Department of Pediatric Pathology, Hacettepe University, Ankara, Turkey
| | | | - Tezer Kutluk
- Institute of Oncology, Department of Pediatric Oncology
| | - Canan Akyüz
- Institute of Oncology, Department of Pediatric Oncology
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8
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Szigeti DL, Sutton DE. Pediatric Germ Cell Tumor: Case Study. JOURNAL OF DIAGNOSTIC MEDICAL SONOGRAPHY 2018. [DOI: 10.1177/8756479317712187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Germ cell (yolk sac) tumors are rare tumors that often have a poor prognosis because they are not usually found until metastases have occurred. The diagnosis of yolk sac tumors is usually a multimodality diagnosis in conjunction with a biopsy of the lesion. This case study outlines the initial stages of diagnosing and treating a 22-month-old male patient who was found to have a widespread malignant yolk sac tumor in his abdominopelvic cavity. Sonography was used as the primary imaging modality due to the patient’s age, but it was soon determined that a follow-up with computed tomography was necessary. Because of the complicated nature and progression of the tumor, a surgical biopsy was then performed. During the procedure, it was also noted that the mass was hypervascular with extensive blood flow throughout the mass. Excision was not an option and chemotherapy treatment was recommended.
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Affiliation(s)
- Deborah L. Szigeti
- UCONN Health, Farmington, CT, USA
- American Institute, White Plains, NY, USA
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Yolk sac tumor in the abdominal wall of an 18-month-old girl: a case report. J Med Case Rep 2017; 11:47. [PMID: 28215183 PMCID: PMC5317054 DOI: 10.1186/s13256-017-1216-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2016] [Accepted: 01/21/2017] [Indexed: 11/22/2022] Open
Abstract
Background Pediatric germ cell tumors account for approximately 3.5 % of all childhood cancers for children under the age of 15 years. Up to one-third are extragonadal neoplasms. Germ cell tumors are a heterogeneous group of malignant tumors with a wide variety of histopathological features. Yolk sac tumor is the predominant variant in newborns and younger children. We report for the first time, the presentation of a primary yolk sac tumor in the abdominal wall of a small child. Case presentation An 18-month-old white girl underwent resection of a small, round subcutaneous lump (1.5×1.3×0.8 cm) of the abdominal wall in her right hypochondriac region. The histopathology was compatible with yolk sac tumor. Her alpha-fetoprotein was initially elevated but normalized after the resection. Magnetic resonance imaging of her abdomen was normal. The surgeon decided to observe and follow her alpha-fetoprotein level closely. One year after resection a local recurrence appeared and her alpha-fetoprotein rose to 58 ng/mL. The surgeon performed a wide resection of the lesion with normalization of her alpha-fetoprotein. Follow-up consisted of measuring alpha-fetoprotein, clinical evaluation, and abdominal ultrasound. Conclusions Clinicians should be aware that a yolk sac tumor can present in an unusual extragonadal place, for example in this case it was subcutaneous. In some cases, conservative treatment can be carried out with careful monitoring of the patient and their alpha-fetoprotein.
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Denney JM, Stanley C, Armstrong LA, Marshall J, Settle B, Haldeman-Englert C. Fetus in Fetu in Lieu of a Sacrococcygeal Teratoma: A Case Illuminating the Utility of Serial Prenatal Sonographic Examinations in Diagnosis. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2017; 36:453-455. [PMID: 28026891 DOI: 10.7863/ultra.16.02040] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Affiliation(s)
- Jeffrey M Denney
- Department of Obstetrics and Gynecology, Section on Maternal-Fetal Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Christy Stanley
- Department of Obstetrics and Gynecology, Section on Maternal-Fetal Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Lou Ann Armstrong
- Prenatal Assessment Center at Forsyth, Wake Forest Baptist Health, Winston-Salem, North Carolina, USA
| | - Jayne Marshall
- Prenatal Assessment Center at Forsyth, Wake Forest Baptist Health, Winston-Salem, North Carolina, USA
| | - Bethany Settle
- Prenatal Assessment Center at Forsyth, Wake Forest Baptist Health, Winston-Salem, North Carolina, USA
| | - Chad Haldeman-Englert
- Department of Pediatrics, Section on Medical Genetics, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
- Fullerton Genetics Center, Asheville, North Carolina, USA
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Emerson RE, Kao CS, Eble JN, Grignon DJ, Wang M, Zhang S, Wang X, Fan R, Masterson TA, Roth LM, Cheng L. Evidence of a dual histogenetic pathway of sacrococcygeal teratomas. Histopathology 2016; 70:290-300. [DOI: 10.1111/his.13062] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2016] [Accepted: 08/12/2016] [Indexed: 12/19/2022]
Affiliation(s)
- Robert E Emerson
- Department of Pathology and Laboratory Medicine; Indiana University School of Medicine; Indianapolis IN USA
| | - Chia-Sui Kao
- Department of Pathology; Stanford University Medical Center; Stanford CA USA
| | - John N Eble
- Department of Pathology and Laboratory Medicine; Indiana University School of Medicine; Indianapolis IN USA
| | - David J Grignon
- Department of Pathology and Laboratory Medicine; Indiana University School of Medicine; Indianapolis IN USA
| | - Mingsheng Wang
- Department of Pathology and Laboratory Medicine; Indiana University School of Medicine; Indianapolis IN USA
| | - Shaobo Zhang
- Department of Pathology and Laboratory Medicine; Indiana University School of Medicine; Indianapolis IN USA
| | - Xiaoyan Wang
- Department of Pathology and Laboratory Medicine; Indiana University School of Medicine; Indianapolis IN USA
| | - Rong Fan
- Department of Pathology and Laboratory Medicine; Indiana University School of Medicine; Indianapolis IN USA
| | - Timothy A Masterson
- Department of Urology; Indiana University School of Medicine; Indianapolis IN USA
| | - Lawrence M Roth
- Department of Pathology and Laboratory Medicine; Indiana University School of Medicine; Indianapolis IN USA
| | - Liang Cheng
- Department of Pathology and Laboratory Medicine; Indiana University School of Medicine; Indianapolis IN USA
- Department of Urology; Indiana University School of Medicine; Indianapolis IN USA
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Kremer MEB, Derikx JPM, Kremer LCM, van Baren R, Heij HA, Wijnen MHWA, Wijnen RMH, van der Zee DC, van Heurn LWE. Evaluation of chemotherapeutic sequelae and quality of life in survivors of malignant sacrococcygeal teratoma. Pediatr Surg Int 2016; 32:261-8. [PMID: 26667016 DOI: 10.1007/s00383-015-3842-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/17/2015] [Indexed: 11/24/2022]
Abstract
PURPOSE The impact of chemotherapeutic sequelae on long-term quality of life (QoL) for survivors of malignant sacrococcygeal teratoma (SCT) is unknown. The incidence of chemotherapeutic toxicity in patients treated for malignant SCT and possible effects on the QoL were analyzed. METHODS Retrospective chart review of patients ≥18 years treated for SCT in the Netherlands was performed. Present QoL was evaluated using the SF-36 questionnaire. The results of survivors of malignant SCT were compared to those of patients treated for benign SCT. RESULTS Fifty-one of 76 traceable patients consented to participate. The results of 47 (92.2 %), 9 men and 38 women (median age 25.4 years, range 18.3-41.2), were analyzed. Eleven had been treated for malignancy; 63.6 % suffered from at least one chemotherapeutic sequel with hearing loss as the most common one. Results for both groups were similar on all but one SF-36 subcategory; those treated for malignant tumor scored significantly lower on the subcategory physical functioning (p = 0.02). CONCLUSION Despite the high incidence of chemotherapeutic sequelae among survivors of malignant SCT, their QoL does not differ from that of those treated for benign SCT. Even though their physical functioning is restricted, daily activities and psychosocial functioning of survivors of malignant SCT are not restricted.
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Affiliation(s)
- Marijke E B Kremer
- Department of Pediatric Surgery, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Joep P M Derikx
- Department of Pediatric Surgery, Maastricht University Medical Center, Maastricht, The Netherlands.,Paediatric Surgical Center of Amsterdam Emma Children's Hospital AMC and VU University Medical Center, P.O. Box 22660, 1100 DD, Amsterdam, The Netherlands
| | - Leontien C M Kremer
- Department of Pediatric Oncology, Emma Children's Hospital, University Medical Center Amsterdam, Amsterdam, The Netherlands
| | - Robertine van Baren
- Department of Pediatric Surgery, University Medical Center Groningen, Groningen, The Netherlands
| | - Hugo A Heij
- Pediatric Surgical Center of Amsterdam (Emma Children's Hospital University Medical Center and VU Medical Center Amsterdam), Amsterdam, The Netherlands
| | - Marc H W A Wijnen
- Department of Pediatric Surgery, University Medical Center Nijmegen, Nijmegen, The Netherlands
| | - René M H Wijnen
- Department of Pediatric Surgery, Sophia Children's Hospital, Erasmus University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - David C van der Zee
- Department of Pediatric Surgery, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, The Netherlands
| | - L W Ernest van Heurn
- Department of Pediatric Surgery, Maastricht University Medical Center, Maastricht, The Netherlands. .,Paediatric Surgical Center of Amsterdam Emma Children's Hospital AMC and VU University Medical Center, P.O. Box 22660, 1100 DD, Amsterdam, The Netherlands.
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Kim J, Lee NH, Lee SH, Yoo KH, Sung KW, Koo HH, Seo JM, Lee SK. Prognostic factors in children with extracranial germ cell tumors treated with cisplatin-based chemotherapy. KOREAN JOURNAL OF PEDIATRICS 2015; 58:386-91. [PMID: 26576183 PMCID: PMC4644767 DOI: 10.3345/kjp.2015.58.10.386] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/14/2014] [Revised: 10/29/2014] [Accepted: 11/05/2014] [Indexed: 12/04/2022]
Abstract
Purpose To evaluate the outcomes and prognostic factors in children with extracranial germ cell tumors (GCTs) treated at a single institution. Methods Sixty-six children diagnosed with extracranial GCTs between 1996 and 2012 were included in the study. Primary treatment was surgical excision, followed by six cycles of cisplatin-based chemotherapy. The survival rates were compared according to the International Germ Cell Cancer Cooperative Group classification used for GCTs in adults to validate the classification guidelines for GCTs in children. Results The median patient age was 4.4 years. In 34 patients (51.5%), the primary tumor site was the gonad. Extragonadal GCTs were detected in 32 patients. The 5-year overall survival and event-free survival (EFS) were 92.0%±3.5% and 90.4%±3.7%, respectively. In univariate analysis, tumor histology, metastasis, and elevated alpha-fetoprotein were not prognostic factors in children with extracranial GCTs. However, EFS was poorer in patients with mediastinal disease (n=12, 66.7%±13.6 %) than in those with nonmediastinal disease (n=54, 96.0%±2.8%) (P=0.001). The 5-year EFS was lower in patients older than 10 years, (n=21, 80.0%±8.9%) compared with those younger than 10 years (n=45, 95.2%±3.3%) (P=0.04). Multivariate analysis identified the mediastinal tumor site as the only independent prognostic factor. Conclusion The prognosis of children with extracranial GCTs was favorable. However, nongerminomatous mediastinal tumors were associated with poor survival in children. Further research is needed to improve the prognosis of children with malignant mediastinal GCTs.
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Affiliation(s)
- Jinsup Kim
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Na Hee Lee
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Soo Hyun Lee
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Keon Hee Yoo
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Ki Woong Sung
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Hong Hoe Koo
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jeong-Meen Seo
- Division of Pediatric Surgery, Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Suk-Koo Lee
- Division of Pediatric Surgery, Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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Abstract
We describe a boy with Schinzel-Giedion syndrome who developed refractory sacrococcygeal germ cell tumor with elements of embryonal carcinoma and immature teratoma. He developed local recurrence soon after tumor resection. The tumor was highly resistant to platinum-based combination chemotherapy, local irradiation, and salvage chemotherapy. Frequent infections resulted in a delay in treatment, although apparent fragility had not been observed clinically. He died from tumor progression at 32 months of age. Intensification of chemotherapy does not seem to be feasible for tumors in patients with Schinzel-Giedion syndrome.
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Wessalowski R, Schneider DT, Göbel U, Calaminus G. Salvage treatment of relapsed or refractory germ-cell tumours - authors' reply. Lancet Oncol 2013; 14:e486-7. [PMID: 24176561 DOI: 10.1016/s1470-2045(13)70474-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Rüdiger Wessalowski
- Clinic of Paediatric Oncology, Haematology and Immunology, Centre for Child and Adolescent Health, Medical Faculty, Heinrich-Heine University, Moorenstrasse 5, Düsseldorf 40225, Germany.
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De Giorgi U, Amadori D. Salvage treatment of relapsed or refractory germ-cell tumours. Lancet Oncol 2013; 14:e486. [PMID: 24176560 DOI: 10.1016/s1470-2045(13)70440-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- Ugo De Giorgi
- Department of Medical Oncology, IRCCS Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST), Via Piero Maroncelli 40, 47014 Meldola, Italy.
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Wessalowski R, Schneider DT, Mils O, Friemann V, Kyrillopoulou O, Schaper J, Matuschek C, Rothe K, Leuschner I, Willers R, Schönberger S, Göbel U, Calaminus G. Regional deep hyperthermia for salvage treatment of children and adolescents with refractory or recurrent non-testicular malignant germ-cell tumours: an open-label, non-randomised, single-institution, phase 2 study. Lancet Oncol 2013; 14:843-52. [PMID: 23823158 DOI: 10.1016/s1470-2045(13)70271-7] [Citation(s) in RCA: 63] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Although the survival of children and adolescents with malignant germ-cell tumours has improved greatly in recent years, the outcome remains poor for those with refractory or recurrent malignant germ-cell tumours. We aimed to determine whether objective tumour response could be achieved in patients with refractory or recurrent malignant germ-cell tumours with PEI-regional deep hyperthermia as salvage treatment. METHODS Patients with refractory or recurrent non-testicular malignant germ-cell tumours after standard cisplatin-based chemotherapy were treated prospectively with PEI chemotherapy (cisplatin 40 mg/m(2), delivered intravenously on days 1 and 4; etoposide 100 mg/m(2), intravenously on days 1-4; and ifosfamide 1800 mg/m(2), intravenously on days 1-4) plus simultaneous 1-h regional deep hyperthermia (41-43°C) on days 1 and 4. Patients received three to four treatment courses at 21-day intervals until residual tumour resection was possible; they subsequently received one or two additional courses of PEI-regional deep hyperthermia. Local radiotherapy was given for incompletely resected tumours. Chemotherapy and hyperthermia toxic effects were assessed using WHO grading. The primary endpoint was the proportion of patients who had an objective response as assessed with Response Evaluation Criteria in Solid Tumors version 1.0 guidelines. Secondary endpoints were the event-free survival and overall survival after 5 years. This ongoing PEI-regional deep hyperthermia study (Hyper-PEI protocol) is registered at the German Cancer Society, number 50-2732. FINDINGS 44 patients aged 7 months to 21 years (median 2 years 7 months) with refractory or recurrent malignant germ-cell tumours (nine patients with poor response, 23 patients with first relapse, 12 patients with multiple relapses) were included in this study. We identified 34 yolk sac tumours, eight embryonal carcinomas, one choriocarcinoma, and one dysgerminoma by histology analysis. Of the 35 patients who had sufficient clinical and radiographical data available for response assessment, 30 (86%) had an objective response to treatment (16 patients had complete remission and 14 had partial remission). 5-year event-free survival was 62% (95% CI 45-75), and 5-year overall survival was 72% (95% CI 55-83). The median follow-up of surviving patients was 82 months (range 9-195). WHO grade 3-4 neutropenia and thrombocytopenia occurred in all 181 chemotherapy cycles. Granulocytopenic fever, which required intercurrent hospital admission, was noted in 29 (66%) of 44 patients after 53 (29%) of 181 courses. Five patients experienced treatment-related grade-3 acute renal toxic effects. INTERPRETATION A multimodal strategy integrating PEI-regional deep hyperthermia and tumour resection with or without radiation can successfully treat children and adolescents with refractory or recurrent malignant non-testicular germ-cell tumours. The long-term prognosis of patients with poor response or after first relapse was almost similar to those receiving first-line treatment. This strategy merits further investigation. FUNDING Deutsche Krebshilfe eV, Bonn, Elterninitiative Kinderkrebsklinik Düsseldorf eV, the Barbara and Hubertus-Trettnerstiftung, and the Marie Quendt Fund.
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Affiliation(s)
- Rüdiger Wessalowski
- Paediatric Oncology Clinic, Haematology and Immunology, Centre for Child and Adolescent Health, Medical Faculty, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany.
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Sacrococcygeal tumors: clinical characteristics and outcome of pediatric patients treated at South Egypt Cancer Institute. A retrospective analysis. J Pediatr Surg 2013; 48:1604-8. [PMID: 23895980 DOI: 10.1016/j.jpedsurg.2013.04.015] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2012] [Revised: 04/02/2013] [Accepted: 04/25/2013] [Indexed: 11/20/2022]
Abstract
BACKGROUND Sacrococcygeal tumors (SCT) are relatively uncommon tumors affecting neonates, infants and children. The aim of this article is to clarify any special characterizations in natural history, clinical presentation and outcome of such tumors treated at South Egypt Cancer Institute, the only research center located in South Egypt. METHODS A retrospective analysis of children with SCT treated at the Pediatric Oncology department South Egypt Cancer Institute, Assiut University between 2004 and 2010. RESULTS Nineteen children were included in the study. Age ranged between 10 days and 5 years. All but three had sacral mass at presentation. AFP levels ranged between normal age-related levels and 217,200 ng/ml. Initial resection was possible in 11, while eight patients with clinical suggestion of advanced malignant disease were inoperable. They received initial chemotherapy followed by delayed surgery. Yolk sac tumor (YST) was reported in 52.9% of patients. Recurrence was reported in 5 patients (3 mature teratomas and 2 YST). Five-year OS and RFS rates of patients who had malignant disease were 81.8% and 77.8% respectively. CONCLUSIONS Older age and delay in presentation that resulted in predominance of extensive disease and malignant transformation at presentation were the main challenges we faced in managing patients with SCT in our locality.
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Göbel U, von Kries R, Teske C, Schneider DT, Beyerlein A, Bernbeck B, Calaminus G. Brain metastases during follow-up of children and adolescents with extracranial malignant germ cell tumors: risk adapted management decision tree analysis based on data of the MAHO/MAKEI-registry. Pediatr Blood Cancer 2013; 60:217-23. [PMID: 22693072 DOI: 10.1002/pbc.24229] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/29/2012] [Accepted: 05/16/2012] [Indexed: 11/10/2022]
Abstract
BACKGROUND The overall risk for brain metastases among children and adolescents with extracranial malignant germ cell tumors (mGCT) is low but may vary between subgroups. Early identification of subgroups with an increased risk for brain metastasis is therefore important. PROCEDURE We analyzed 900/2,160 patients from the German MAHO/MAKEI registry on children and adolescents with malignant extracranial GCT (pure teratomas (grade 0-3) were not included). For follow-up evaluation, patients with brain metastases at diagnosis and those with a follow-up shorter than 32 months after diagnosis (longest interval to brain metastases in our cohort) were excluded. Patients were censored at detection of brain metastases or death due to other causes. A decision tree analysis considering age, gender, site of primary tumor, and presence of other metastases at diagnosis as risk factors for brain metastases was performed. RESULTS Among 838 eligible patients, 9 acquired brain metastases during follow-up, accounting for death in 5. There were no brain metastases in absence of extracranial metastases at diagnosis. If extracranial metastases were detected in absence of mediastinal mGCT the risk for brain metastases was 1.2% (95% CI: 0.2-3.5.%). In contrast, risk was increased to 37.5 (95% CI 15.2-64.6%) in patients with mediastinal GCTs and extracranial metastases. CONCLUSION A high-risk subgroup is detected with a decision tree analysis approach. These patients may benefit from an intensified chemotherapy. Close surveillance for CNS-metastases is warranted in this high-risk group while less close monitoring in low-risk patients is justified. Pediatr Blood Cancer 2013;60:217-223. © 2012 Wiley Periodicals, Inc.
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Affiliation(s)
- Ulrich Göbel
- ESPED Surveillance Unit for Rare Pediatric Diseases in Germany
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20
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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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Schneider DT, Terenziani M, Cecchetto G, Olson TA. Gonadal and Extragonadal Germ Cell Tumors, Sex Cord Stromal and Rare Gonadal Tumors. RARE TUMORS IN CHILDREN AND ADOLESCENTS 2012. [DOI: 10.1007/978-3-642-04197-6_39] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
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Khalil BA, Aziz A, Kapur P, Humphrey G, Morabito A, Bruce J. Long-term outcomes of surgery for malignant sacrococcygeal teratoma: 20-year experience of a regional UK centre. Pediatr Surg Int 2009; 25:247-50. [PMID: 19184053 DOI: 10.1007/s00383-009-2329-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/16/2009] [Indexed: 11/28/2022]
Abstract
BACKGROUND The timing of surgery for malignant sacrococcygeal teratoma is controversial. The long-term outcomes and complications of surgery for this rare tumour are presented. METHODS All cases of malignant sacrococcygeal teratoma in the 20-year period 1987-2006 were identified and the case notes retrieved. The age at diagnosis, investigations, presentation, type of surgery, early complications, recurrence rates, long-term complications and outcomes were recorded. RESULTS Twelve patients (three males, nine females) were identified. Mean age at presentation was 20.8 months (range: 12-39 months). All had the Carboplatin-Etoposide-Bleomycin chemotherapeutic protocol. The average time of follow-up was 10.6 years (range: 1-17 years). Ten patients had excision of their tumours following chemotherapy, whilst two patients had excision prior to chemotherapy. Two patients had recurrence of their tumours. There was one death (8%), which was due to disseminated metastasis. The other 11 children were all well at the last follow-up. CONCLUSION Surgery for malignant sacrococcygeal teratoma is safe and has a low complication rate. The long-term outcomes are favourable with minimal side effects.
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Affiliation(s)
- Basem A Khalil
- Department of Paediatric Surgery, Royal Manchester Children's Hospital, Pendlebury, Manchester, UK.
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Yanagisawa T, Bartels U, Bouffet E. Role of prognostic factors in the management of pediatric solid tumors. Ann N Y Acad Sci 2008; 1138:32-42. [PMID: 18837880 DOI: 10.1196/annals.1414.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
The importance of prognostic factors in predicting outcome in pediatric oncology is largely recognized, and most current protocols tailor treatment based on risk stratification. Further refinements of classical staging systems are ongoing, and the future of pediatric oncology is in the development of strategies based on individual tumor characteristics. This review details significant advances in our understanding of prognostic factors in the most common pediatric solid tumors and potential applications for clinical management.
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Affiliation(s)
- Takaaki Yanagisawa
- Division of Paediatric Neuro-Oncology, Department of Neuro-Oncology, Saitama Medical University International Medical Center, Saitama, Japan
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Frazier AL, Rumcheva P, Olson T, Giller R, Cushing B, Cullen J, Marina N, London WB. Application of the adult international germ cell classification system to pediatric malignant non-seminomatous germ cell tumors: a report from the Children's Oncology Group. Pediatr Blood Cancer 2008; 50:746-51. [PMID: 18085675 PMCID: PMC3836436 DOI: 10.1002/pbc.21304] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND The purpose of this analysis is to explore whether the International Germ Cell Classification Consensus (IGCCC) tumor marker criteria, developed for adult males with metastatic malignant germ cell tumors (MGCT), are prognostic among pediatric patients and whether tumor marker data may be relevant in pediatric risk stratification. PROCEDURE The IGCCC was applied to 436 pediatric germ cell patients treated on Pediatric Intergroup Studies from 1990 to 1996. Multivariable Cox proportional hazards model identified prognostic variables; survival rates among IGCCC risk groups were compared using the log-rank test. Concordance and relative performance of IGCCC versus COG risk stratification was evaluated. RESULTS Applying the IGCCC, 21% of pediatric patients were good risk (GR), 35% intermediate risk (IR), and 44% poor risk (PR). Only modest concordance between IGCCC and COG stratification systems was noted (49%). Nonetheless, the IGCCC identified a group of PR patients who had significantly worse event-free survival (EFS) versus GR/IR patients (6-year EFS 80% vs. 91%), which was similar to the difference observed using the COG system (6-year EFS 77% vs. 90%). The IGCCC performed well within subgroups for which the IGCCC is not intended (prepubertal, female, and non-metastatic patients). CONCLUSIONS Applying the IGCCC system to pediatric patients produces a different stratification than does the application of the COG system, although both are prognostic. Development of a de novo pediatric prognostic classification is warranted.
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Affiliation(s)
- A. Lindsay Frazier
- Department of Pediatric Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts,Correspondence to: A. Lindsay Frazier, Department of Pediatric Oncology, Dana-Farber Cancer Institute, 44 Binney St., Boston, MA 02115.
| | - Pavlina Rumcheva
- University of Florida, Department of Epidemiology and Health Policy Research, Children’s Oncology Group, Gainesville, Florida
| | | | | | | | - John Cullen
- Presbyterian/St Lukes Medical Center, Denver, Colorado
| | | | - Wendy B. London
- University of Florida, Department of Epidemiology and Health Policy Research, Children’s Oncology Group, Gainesville, Florida
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Abstract
We report a case in which a sacrococcygeal teratoma was identified and characterized on prenatal and postnatal MRI, and correlated with subsequent surgical resection.
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Cotta CV, Konoplev S, Medeiros LJ, Bueso-Ramos CE. Metastatic tumors in bone marrow: histopathology and advances in the biology of the tumor cells and bone marrow environment. Ann Diagn Pathol 2006; 10:169-92. [PMID: 16730315 DOI: 10.1016/j.anndiagpath.2006.04.001] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
The nonhematopoietic tumors most often diagnosed in the bone marrow are metastatic. Currently, accurate diagnosis of tumor metastasis requires integration of the clinical findings; morphological features; and results of immunohistochemical stains, cytogenetics, and molecular studies. This review focuses on a practical approach to the diagnosis of metastatic tumors in the bone marrow according to current standards of practice and discusses recent advances in understanding of tumor metastasis and the interaction between tumors and the bone marrow environment.
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Affiliation(s)
- Claudiu V Cotta
- Department of Hematopathology, The University of Texas MD Anderson Cancer Center, Houston, 77030, USA
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Muscatello L, Giudice M, Feltri M. Malignant cervical teratoma: report of a case in a newborn. Eur Arch Otorhinolaryngol 2005; 262:899-904. [PMID: 15895292 DOI: 10.1007/s00405-005-0917-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2004] [Accepted: 12/28/2004] [Indexed: 10/25/2022]
Abstract
Malignant cervical teratoma (MCT) usually appears in newborns as an enlarging mass of the neck that causes respiratory distress, requiring prompt airway control. We report a case of MCT in an infant electively delivered at 32 weeks to prevent airway impairment. At first, the preoperative diagnosis was hygroma of the neck, and a surgical excision was performed when the newborn was 9 days old. Diagnosis was benign extragonadic immature teratoma, but it was changed in MCT when cervical metastases appeared and the alpha-fetoprotein (AFP) level increased. Subsequent surgical procedures and chemotherapy were necessary. The child has been free from disease and healthy for 7 years since the last surgery. The preoperative diagnosis of MCT is difficult because of its rarity and non-specific clinical findings. Surgical excision is required for an adequate cure and airway repair; a long-term follow-up is mandatory to promptly treat any recurrence.
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Affiliation(s)
- Luca Muscatello
- Department of Otorhinolaryngology, Hospital of Varese, Italy
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van den Berg H. Biology and therapy of malignant solid tumors in childhood. ACTA ACUST UNITED AC 2005; 22:643-76. [PMID: 16110632 DOI: 10.1016/s0921-4410(04)22028-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Affiliation(s)
- Henk van den Berg
- Department of Paediatric Oncology, Emma Children's Hospital, Academic Medical Centre, University of Amsterdam, The Netherlands.
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Falavigna A, Gandara C, Ferraz FAP, Saciloto B. [Sacrococcigeal teratoma: report of three cases]. ARQUIVOS DE NEURO-PSIQUIATRIA 2004; 62:334-8. [PMID: 15235741 DOI: 10.1590/s0004-282x2004000200026] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Germ cell tumors are originated from the primary stem cell located either in or outside the gonadal system. Teratomas are the major group, with the sacrococcygeal location being the most common extragonadal site, independent they are benign or malignant. We describe three cases of sacrococcygeal teratoma and emphasize aspects of diagnosis, surgical techniques and complementary approaches.
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Schneider DT, Calaminus G, Koch S, Teske C, Schmidt P, Haas RJ, Harms D, Göbel U. Epidemiologic analysis of 1,442 children and adolescents registered in the German germ cell tumor protocols. Pediatr Blood Cancer 2004; 42:169-75. [PMID: 14752882 DOI: 10.1002/pbc.10321] [Citation(s) in RCA: 110] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Germ cell tumors (GCTs) constitute a heterogeneous group of tumors that significantly vary with respect to their clinical presentation and biology. The objective of this analysis was to analyze a large population-based pediatric cohort of GCTs and to evaluate the parameters age, sex, site of the tumor, histology, and potential correlations between these parameters. PROCEDURE Between 1981 and 2000, 1,442 patients were prospectively enrolled onto the German protocols for testicular and non-testicular GCTs. Tumors were histologically classified according to the WHO. RESULTS We observed a bimodal age distribution with a first peak during infancy and a second after the onset of puberty. At birth, almost all tumors were teratomas, sometimes with microfoci of yolk sac tumor, which on the other hand, was the predominant histology during childhood. After the onset of puberty, germinomatous GCTs represented the most frequent histological subtype, and malignant non-germinomatous GCTs often presented as mixed tumors with choriocarcinoma and embryonal carcinoma components. During infancy, non-gonadal GCTs accounted for the majority of GCTs, while after the onset of puberty, gonadal GCTs predominated. Notably, among non-gonadal GCTs, there was a female predominance during childhood and a strong male predominance during adolescence. CONCLUSIONS Two separate groups of GCTs with distinct clinical features relevant for differential diagnosis and the diagnostic assessment can be distinguished. This observation correlates with genetic studies that reveal different genetic changes in childhood and adolescence GCTs. Further studies are needed to elucidate the molecular mechanisms of germ cell and GCT development that account for the age- and sex-dependent clinical manifestation.
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Affiliation(s)
- Dominik T Schneider
- Clinic of Pediatric Hematology and Oncology, Heinrich-Heine-University, Medical Center, Duesseldorf, Germany.
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