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Zainal IA, Fuad NFN, Yang LY, Ismail NAN, Yaacob NY, Zakaria R. Role of pre-operative endovascular embolization of a giant sacrococcygeal teratoma in neonate: a case report. J Egypt Natl Canc Inst 2024; 36:15. [PMID: 38736004 DOI: 10.1186/s43046-024-00216-4] [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: 06/12/2023] [Accepted: 03/06/2024] [Indexed: 05/14/2024] Open
Abstract
BACKGROUND Giant sacrococcygeal teratomas (SCTs) are at risk of perinatal morbidity and mortality due to their high vascularity. Pre-operative embolization of the feeding arteries, prior to complete surgical resection, may assist in minimizing the intraoperative blood loss by occluding these feeding arteries. CASE PRESENTATION We present a case of a highly vascular giant SCT in a neonate, which was successfully embolized through an endovascular approach prior to surgery. The femoral artery approach was chosen, with access established using a Micropuncture introducer as a sheath. Embolization was performed using a combination of microcoils, Gelfoam slurry, and polyvinyl alcohol particles. The patient developed femoral artery spasm post-procedure, which resolved with the application of a glyceryl trinitrate patch. CONCLUSIONS Performing pre-operative endovascular embolization on a giant sacrococcygeal teratoma presents particular challenges, primarily due to the difficulty in assessing small vessels and the potential complications associated with this procedure. Nevertheless, this technique proves exceptionally valuable in helping the surgeon minimize blood loss during surgery, thereby reducing the risks of morbidity and mortality. Comprehensive planning for the embolization procedure is essential, encompassing the identification of potential vascular access points and alternatives, along with careful selection of the appropriate catheter.
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Affiliation(s)
- Isa Azzaki Zainal
- Department of Radiology, Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur, Malaysia.
| | - Nik Farhan Nik Fuad
- Department of Radiology, Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur, Malaysia
| | - Leong Yuh Yang
- Department of Radiology, Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur, Malaysia
| | - Nik Azuan Nik Ismail
- Department of Radiology, Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur, Malaysia
| | - Nur Yazmin Yaacob
- Department of Radiology, Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur, Malaysia
| | - Rozman Zakaria
- Department of Radiology, Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur, Malaysia
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2
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Konno H, Okpaise OO, Sbragia L, Tonni G, Ruano R. Perinatal Outcomes of Intrauterine Interventions for Fetal Sacrococcygeal Teratoma Based on Different Surgical Techniques-A Systematic Review. J Clin Med 2024; 13:2649. [PMID: 38731178 PMCID: PMC11084939 DOI: 10.3390/jcm13092649] [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: 02/28/2024] [Revised: 04/16/2024] [Accepted: 04/25/2024] [Indexed: 05/13/2024] Open
Abstract
Background: This study aims to evaluate the outcomes of fetal sacrococcygeal teratoma (SCT) submitted to prenatal interventions. Methods: We performed a systematic literature review of fetal SCT patients and compared the outcomes between open fetal surgery and percutaneous intervention. In addition, we also compared the results of SCT fetuses who did not undergo any surgical intervention (NI). Results: We identified 16 cases of open fetal surgery (OS), 48 cases of percutaneous fetal intervention (PI), and 93 NI patients. The survival rate was 56.2% in OS, 45.8% in PI (p = 0.568), and 71.0% in NI patients. The gestational age at delivery was earlier in cases where there was no survival compared to cases where the fetuses did survive across all evaluated cohorts (OS: p = 0.033, PI: p < 0.001, NI: p < 0.001). The gestational weeks at delivery in OS and PI fetuses were more similar; however, OS tended to be performed later on in pregnancy, and the affected fetuses had more severe presented findings. In our evaluation, we determined that the presence of fetal hydrops and cardiac failure had no significant impact on survival in SCT cases. In NI patients, polyhydramnios was much higher in fetuses who did not survive compared to their surviving cohorts (p < 0.001). Conclusions: In conclusion, gestational age at delivery can affect the short-term prognosis of fetuses affected with sacrococcygeal teratomas. Regardless of the mode of delivery or the necessity for intervention during the fetal period, monitoring for complications, including polyhydramnios, can prevent premature delivery.
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Affiliation(s)
- Hiroko Konno
- Division of Perinatology, Fetal Diagnosis and Therapy, Maternal and Perinatal Care Center, Seirei Hamamatsu General Hospital, Hamamatsu 430-0906, Japan;
| | | | - Lourenço Sbragia
- Division of Pediatric Surgery, Department of Surgery and Anatomy, Ribeirao Preto Medical School, University of Sao Paulo, Ribeirão Preto 14049-900, SP, Brazil;
| | - Gabriele Tonni
- Prenatal Diagnostic Centre, Department of Obstetrics and Neonatology, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), AUSL Reggio Emilia, 42122 Reggio Emilia, Italy;
| | - Rodrigo Ruano
- Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology & Reproductive Sciences, University of Miami, Miami, FL 33136, USA
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3
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Giant malignant sacrococcygeal germ cell tumor in a newborn: A rare case report. Radiol Case Rep 2022; 17:2416-2423. [PMID: 35601377 PMCID: PMC9118099 DOI: 10.1016/j.radcr.2022.03.107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Accepted: 03/30/2022] [Indexed: 11/23/2022] Open
Abstract
Malignant germ cell tumors constitute about 3%-4% of all neoplasms occurring before the age of 15. They arise in the ovaries, the testes, and in several other locations, including the lower back, the chest, the brain, and the abdomen. In infants and young children, the sacrococcygeal region is the most common site for extragonadal germ cell tumors, and teratomas account for the vast majority of sacrococcygeal germ cell tumors. Neonatal sacrococcygeal teratomas are usually benign and rarely they may contain a malignant component that is predominantly a yolk sac tumor. In this article, we describe a rare case of a male newborn with a giant sacrococcygeal mixed germ cell tumor composed of grade 3 immature teratoma and malignant yolk sac elements.
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Amaefule K, Ejagwulu F, Sholadoye T, Dahiru W. Osteosarcoma arising from a cervical teratoma in a 4-year old child: A report of a rare case and literature review. JOURNAL OF WEST AFRICAN COLLEGE OF SURGEONS 2022; 12:91-94. [PMID: 36203923 PMCID: PMC9531732 DOI: 10.4103/jwas.jwas_74_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/27/2022] [Accepted: 04/18/2022] [Indexed: 11/16/2022]
Abstract
Cervical teratomas consist of about 3% of all teratomas, and commonly present in childhood. They are often benign and very rarely turn malignant. Malignant transformation of teratomas occurs in about 3% - 6% of such tumours, and often results in carcinomas, and infrequently, sarcomas and yolk sac tumours. Squamous cell carcinoma accounts for about 80% - 90% of such malignant transformation. Osteosarcoma arising from a teratoma is a rare occurrence with the very few reported cases occurring in the ovaries, and no such transformation has been reported in a cervical teratoma. We present our experience with a child with osteosarcoma in a cervical teratoma.
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Tiwari C, Nagdeve N, Saoji R. Spontaneous Necrosis in a Type I Sacrococcygeal Teratoma. J Indian Assoc Pediatr Surg 2021; 26:274-275. [PMID: 34385777 PMCID: PMC8323583 DOI: 10.4103/jiaps.jiaps_371_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Revised: 01/25/2021] [Accepted: 02/03/2021] [Indexed: 11/04/2022] Open
Affiliation(s)
- Charu Tiwari
- Department of Paediatric Surgery, All India Institute of Medical Sciences, Raipur, Chhattisgarh, India.,Department of Paediatric Surgery, GMCH, Nagpur, Maharashtra, India
| | - Nilesh Nagdeve
- Department of Paediatric Surgery, GMCH, Nagpur, Maharashtra, India
| | - Rajendra Saoji
- Department of Paediatric Surgery, GMCH, Nagpur, Maharashtra, India
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Stavropoulou D, Hentschel R, Rädecke J, Kunze M, Niemeyer C, Uhl M, Grohmann J. Preoperative selective embolization with vascular coiling of giant sacrococcygeal teratoma. J Neonatal Perinatal Med 2020; 12:345-349. [PMID: 30932896 DOI: 10.3233/npm-180066] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Sacrococcygeal teratoma is one of the most common congenital tumors. Its optimal management requires interdisciplinary care by obstetricians, radiologists, pediatric surgeons, and neonatologists. Early surgery entailing complete tumor excision is the main therapy aim, but a substantial risk of life-threatening complications remains, especially uncontrollable intraoperative hemorrhage. To reduce the risk of bleeding in a female neonate with a giant sacrococcygeal teratoma, we successfully coil-embolized the tumor's main feeding arteries. Her subsequent complete surgical resection was uneventful, and the child is well with favorable reconstructive and functional status of all involved and adjacent organ systems.
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Affiliation(s)
- D Stavropoulou
- Department of General Pediatrics, Adolescent Medicine, Division of Neonatology, Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - R Hentschel
- Department of General Pediatrics, Adolescent Medicine, Division of Neonatology, Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - J Rädecke
- Department of Pediatric Surgery, Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - M Kunze
- Department of Obstetrics and Gynecology, Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - C Niemeyer
- Department of Pediatric Hematology and Oncology, Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - M Uhl
- Department of Radiology, Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - J Grohmann
- Department of Congenital Heart Defects and Pediatric Cardiology, Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany
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Fumino S, Tajiri T, Usui N, Tamura M, Sago H, Ono S, Nosaka S, Yoneda A, Souzaki R, Higashi M, Sakai K, Takahashi K, Sugiura T, Taguchi T. Japanese clinical practice guidelines for sacrococcygeal teratoma, 2017. Pediatr Int 2019; 61:672-678. [PMID: 30903638 DOI: 10.1111/ped.13844] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2018] [Revised: 01/04/2019] [Accepted: 03/14/2019] [Indexed: 11/30/2022]
Abstract
BACKGROUND Sacrococcygeal teratoma (SCT) is the most common extragonadal germ cell tumor in neonates and infants. Although most cases of infantile SCT are benign tumors by nature, some develop into extremely large lesions, leading to massive bleeding, high-output heart failure, disseminated intravascular coagulation, and even fatal outcomes during the neonatal period. In addition, some patients may present with tumor recurrence, malignant transformation, long-term sequelae (including bladder and bowel dysfunction) and lower leg palsy during the long-term follow up. SCT, however, is very rare, and there are few opportunities to encounter this disease, therefore general physicians without expert credentials currently lack information relevant to clinical practice. For this reason, the research project committee has compiled guidelines concerning SCT. METHODS The purpose of these guidelines was to share information concerning the treatment and follow up of infantile SCT. The guidelines were developed using the methodologies in the Medical Information Network Distribution System. A comprehensive search of the English- and Japanese-language articles in PubMed and Ichu-Shi Web identified only case reports or case series, and the recommendations were developed through a process of informal consensus. RESULTS The clinical questions addressed the risk factors, the efficacy of cesarean section, the initial devascularization of tumor feeding vessels, interventional radiology, recommended clinical studies for follow up and possible long-term complications. CONCLUSIONS These are the first guidelines for SCT to be established in Japan, and they may have huge clinical value and significance in terms of developing therapeutic strategies and follow up, potentially contributing to the improvement of the prognosis and quality of life of SCT patients.
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Affiliation(s)
- Shigehisa Fumino
- Department of Pediatric Surgery, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Tatsuro Tajiri
- Department of Pediatric Surgery, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Noriaki Usui
- Department of Pediatric Surgery, Osaka Women's and Children's Hospital, Osaka, Japan
| | - Masanori Tamura
- Department of Pediatrics, Saitama Medical Center, Saitama Medical University, Saitama, Japan
| | - Haruhiko Sago
- Department of Maternal-Fetal and Neonatal Medicine, National Center for Child Health and Development, Tokyo, Japan
| | - Shigeru Ono
- Department of Pediatric Surgery, Jichi Children's Medical Center Tochigi, Jichi Medical University, Tochigi, Japan
| | - Shunsuke Nosaka
- Division of Radiology, National Center for Child Health and Development, Tokyo, Japan
| | - Akihiro Yoneda
- Department of Pediatric Surgery, Osaka City General Hospital, Osaka, Japan
| | - Ryota Souzaki
- Department of Pediatric Surgery, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Mayumi Higashi
- Department of Pediatric Surgery, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Kohei Sakai
- Department of Pediatric Surgery, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Ken Takahashi
- Department of Obstetrics and Gynecology, Jikei University School of Medicine, Tokyo, Japan
| | - Takahiro Sugiura
- Department of Pediatrics, Toyohashi Municipal Hospital, Aichi, Japan
| | - Tomoaki Taguchi
- Department of Pediatric Surgery, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
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Hochwald O, Gil Z, Gordin A, Winer Z, Avrahami R, Abargel E, Khoury A, Lehavi A, Abecassis P, Eldor L, Ben-Izhak O, Borenstein-Levin L, Stienberg R, Kugelman A. Three-step management of a newborn with a giant, highly vascularized, cervical teratoma: a case report. J Med Case Rep 2019; 13:73. [PMID: 30851737 PMCID: PMC6409158 DOI: 10.1186/s13256-019-1976-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2018] [Accepted: 01/10/2019] [Indexed: 11/10/2022] Open
Abstract
Background A giant congenital cervical teratoma is often highly vascularized; thus, in addition to a life-threatening airway occlusion at birth it comprises a high risk for significant and lethal blood loss during resection. In the case presented, an endovascular embolization of the carotid artery that supplied a giant congenital cervical teratoma was done as part of a three-stage treatment soon after birth and contributed to an overall good outcome. Embolization in cases of cervical teratomas was not described previously. Case presentation We present a case of a preterm newborn from a Sephardic jewish origin with a giant, highly vascularized, congenital cervical teratoma that was managed successfully in three stages: (1) delivery by an ex utero intrapartum treatment procedure after extensive preoperative planning and followed by tracheostomy, (2) endovascular embolization of the carotid artery that supplied the tumor in order to decrease blood loss during resection, and (3) complete surgical resection. The parents were involved in all the ethical and medical decisions, starting just after the cervical mass was diagnosed prenatally. Conclusion The management of giant congenital cervical teratoma is often challenging from both a medical and ethical prospective. Meticulous perinatal planning and parents’ involvement is crucial. Endovascular embolization of the tumor feeding vessels can significantly improve the resection outcome and overall prognosis.
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Affiliation(s)
- Ori Hochwald
- Neonatal Intensive Care Unit, Ruth Rappaport Children's Hospital, Rambam Health Campus, Haifa, Israel.
| | - Ziv Gil
- Department of Otolaryngology Head and Neck Surgery, Rambam Health Campus, Haifa, Israel
| | - Arie Gordin
- Department of Otolaryngology Head and Neck Surgery, Rambam Health Campus, Haifa, Israel.,The Pediatric ENT service, Rambam Health Campus, Haifa, Israel
| | - Zeev Winer
- The Obstetrics & Gynecology Division, Rambam Health Campus, Haifa, Israel
| | - Ron Avrahami
- The Obstetrics & Gynecology Division, Rambam Health Campus, Haifa, Israel
| | - Eitan Abargel
- Invasive Neuroradiology Unit, Rambam Health Campus, Haifa, Israel
| | - Asaad Khoury
- Department of Pediatric Cardiology & Congenital Heart Disease in Adults, Ruth Rappaport Children's Hospital, Rambam Health Campus, Haifa, Israel
| | - Amit Lehavi
- The Department of Anesthesiology, Rambam Health Campus, Haifa, Israel
| | | | - Liron Eldor
- The Department of Plastic Surgery, Rambam Health Campus, Haifa, Israel
| | - Ofer Ben-Izhak
- The Department of Pathology, Rambam Health Campus, Haifa, Israel
| | - Liron Borenstein-Levin
- Neonatal Intensive Care Unit, Ruth Rappaport Children's Hospital, Rambam Health Campus, Haifa, Israel
| | - Ran Stienberg
- The Department of Pediatric Surgery, Rambam Health Campus, Haifa, Israel
| | - Amir Kugelman
- Neonatal Intensive Care Unit, Ruth Rappaport Children's Hospital, Rambam Health Campus, Haifa, Israel
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Spontaneous Hematoma of the Rectus Sheath: Urgent Embolization with Squidperi Liquid Embolic Device. Case Rep Radiol 2017; 2017:3420313. [PMID: 28785502 PMCID: PMC5530444 DOI: 10.1155/2017/3420313] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2017] [Accepted: 06/07/2017] [Indexed: 12/19/2022] Open
Abstract
We treated a 78-year-old female affected by nontraumatic spontaneous rectus sheath hematoma. We decided to perform the embolization with the new liquid agent Squidperi. Complete exclusion of the bleeding vessel was obtained without complications. Its use should be considered for treatment of nontraumatic rectus sheath hematoma.
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