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Fumino S, Hirohata Y, Takayama S, Tajiri T, Usui N, Taguchi T. Long-Term Outcomes of Infantile Sacrococcygeal Teratoma: Results from a Multi-Institutional Retrospective Observational Study in Japan. J Pediatr Surg 2024; 59:587-592. [PMID: 38158258 DOI: 10.1016/j.jpedsurg.2023.11.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Accepted: 11/20/2023] [Indexed: 01/03/2024]
Abstract
BACKGROUND Tumor recurrence, anorectal and urinary dysfunction, and lower limb dysfunction after surgery are observed in infantile sacrococcygeal teratoma (SCT). In this paper, a multi-institutional retrospective observational study was conducted to clarify the long-term functional prognosis in Japan. METHODS This study was conducted using a paper-based questionnaire distributed to 192 facilities accredited by the Japanese Society of Pediatric Surgeons, covering patients who underwent radical surgery at less than 1 year old and who survived for at least 180 days after birth from 2000 to 2019. RESULTS A total of 355 patients were included in this analysis. Altman type was I-II in 248 and type III-IV in 107, and the median maximum tumor diameter was 6.1 (range: 0.6-36.0) cm. There were 269 mature teratomas, 69 immature teratomas, and 10 malignant tumors. Total resection was performed in 325, subtotal or partial resection in 27, and surgical complications were noted in 54. The median postoperative follow-up was 6.6 (0.5-21.7) years. Eighty-three patients (23.4 %) had functional sequelae, including 62 (17.5 %) with anorectal dysfunction, 56 (13.0 %) with urinary dysfunction, and 15 (4.2 %) with lower limb motor dysfunction. Recurrence occurred in 42 (11.8 %) at a median age of 16.8 (1.7-145.1) months old. Risk factors for dysfunction included preterm delivery, a large tumor diameter, Altman type III-IV, incomplete resection, and surgical complications. Risk factors for recurrence included immature teratoma or malignancy, incomplete resection, and surgical complications. CONCLUSIONS Postoperative dysfunction was not low at 23.4 %, and 11.8 % of the patients experienced recurrence occurring more than 10 years after surgery, suggesting the need for periodic imaging and tumor markers evaluations in patients with risk factors. It is necessary to establish treatment guidelines for best practice monitoring of the long-term quality of life. LEVEL OF EVIDENCE Level II Retrospective Study.
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Affiliation(s)
- Shigehisa Fumino
- Department of Pediatric Surgery, Kyoto Prefectural University of Medicine, Kyoto, Japan.
| | - Yoshiaki Hirohata
- Department of Pediatric Surgery, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Shohei Takayama
- Department of Pediatric Surgery, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Tatsuro Tajiri
- Department of Pediatric Surgery, Reproductive and Developmental Medicine, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Noriaki Usui
- Department of Pediatric Surgery, Osaka Women's and Children's Hospital, Izumi, Japan
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Gil LA, Knaus ME, Stanek JR, Srivatsa S, Patterson KN, Wood RJ, Minneci PC, Ranalli MA, Aldrink JH. Variability in Surveillance Strategies Following Resection of Sacrococcygeal Teratoma. J Surg Res 2024; 295:423-430. [PMID: 38070256 DOI: 10.1016/j.jss.2023.11.040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Revised: 10/17/2023] [Accepted: 11/12/2023] [Indexed: 02/25/2024]
Abstract
INTRODUCTION Surveillance following sacrococcygeal teratoma (SCT) resection varies. The purpose of this study was to describe the clinical characteristics and outcomes of patients undergoing SCT resection and examine current institutional practices to detect recurrence. METHODS A single-institution retrospective review of children who underwent resection of an SCT from January 1, 2010 to December 31, 2020 was performed. Data were summarized and surveillance strategies compared between histopathologic subtypes using nonparametric methods. RESULTS Thirty six patients (75.0% female) underwent SCT removal at a median age of 8 d. Histopathology revealed 27 mature teratomas (75.0%), eight immature teratomas (22.2%), and one malignant germ cell tumor (2.8%). Median postoperative follow-up was 3.17 y (interquartile range [IQR]: 2.31-4.38 y). Patients had a median of 2.32 clinic visits per year (IQR: 2.00-2.70), alpha-fetoprotein levels were obtained at a median of 2.01 times per year (IQR: 0-1.66), and surveillance imaging was performed at a median of 2.31 times per year (IQR: 0-2.84). Patients with immature teratomas had alpha-fetoprotein laboratories obtained more frequently than patients with mature teratomas (3.10 times/year versus 0.93 times/year, P = 0.001). There was no significant difference in the number of imaging studies obtained between groups. Two patients (5.6%) developed recurrence, which were identified on magnetic resonance imaging at 191 and 104 d postresection, respectively. CONCLUSIONS Postoperative surveillance practices varied widely. Recurrence was noted in a single malignant case in the first year following resection. Multi-institutional studies are needed to determine the optimal surveillance strategy to detect recurrence of SCT.
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Affiliation(s)
- Lindsay A Gil
- Center for Surgical Outcomes Research, Abigail Wexner Research Institute, Nationwide Children's Hospital, Columbus, Ohio; Department of Pediatric Surgery, Nationwide Children's Hospital, The Ohio State University College of Medicine, Columbus, Ohio
| | - Maria E Knaus
- Center for Surgical Outcomes Research, Abigail Wexner Research Institute, Nationwide Children's Hospital, Columbus, Ohio; Department of Pediatric Surgery, Nationwide Children's Hospital, The Ohio State University College of Medicine, Columbus, Ohio
| | - Joseph R Stanek
- Department of Pediatric Hematology/Oncology, Nationwide Children's Hospital, Columbus, Ohio
| | - Shachi Srivatsa
- Center for Surgical Outcomes Research, Abigail Wexner Research Institute, Nationwide Children's Hospital, Columbus, Ohio; Department of Pediatric Surgery, Nationwide Children's Hospital, The Ohio State University College of Medicine, Columbus, Ohio
| | - Kelli N Patterson
- Center for Surgical Outcomes Research, Abigail Wexner Research Institute, Nationwide Children's Hospital, Columbus, Ohio; Department of Pediatric Surgery, Nationwide Children's Hospital, The Ohio State University College of Medicine, Columbus, Ohio
| | - Richard J Wood
- Department of Pediatric Surgery, Nationwide Children's Hospital, The Ohio State University College of Medicine, Columbus, Ohio; Department of Pediatric Colorectal and Pelvic Reconstructive Surgery, Nationwide Children's Hospital, Columbus, Ohio
| | - Peter C Minneci
- Center for Surgical Outcomes Research, Abigail Wexner Research Institute, Nationwide Children's Hospital, Columbus, Ohio; Department of Pediatric Surgery, Nationwide Children's Hospital, The Ohio State University College of Medicine, Columbus, Ohio
| | - Mark A Ranalli
- Department of Pediatric Hematology/Oncology, Nationwide Children's Hospital, Columbus, Ohio
| | - Jennifer H Aldrink
- Department of Pediatric Surgery, Nationwide Children's Hospital, The Ohio State University College of Medicine, Columbus, Ohio.
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van Heurn LJ, Kremer MEB, de Blaauw I, van Baren R, van Gemert WG, van Goudoever JB, Sloots CEJ, Witvliet MJ, Ernest van Heurn LW, Derikx JPM. The Diagnostic Accuracy of Serum Alpha-Fetoprotein Levels in Follow-up for Recurrence of Sacrococcygeal Teratoma; a Nationwide Review of SCT Cases in the Netherlands. J Pediatr Surg 2024:S0022-3468(24)00080-0. [PMID: 38418277 DOI: 10.1016/j.jpedsurg.2024.01.048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2023] [Revised: 01/20/2024] [Accepted: 01/31/2024] [Indexed: 03/01/2024]
Abstract
BACKGROUND Serum alpha-fetoprotein (AFP) is often used as tumour marker for recurrent sacrococcygeal teratoma (SCT). We aimed to assess the normal dynamics of serum AFP levels after initial resection and diagnostic accuracy of serum AFP levels the follow-up for recurrence in SCT. METHODS This retrospective study included 57 patients treated for SCT in the six pediatric surgical centers in the Netherlands from 1980 to 2018. MAIN RESULTS 57 patients were included in the study of whom 19 children developed 20 recurrences at a median of 14.0 months after initial resection. No significant difference was found in serum AFP level dynamics between the recurrence and non-recurrence group after initial resection (p = 0.950). Serum AFP levels did not significantly increase before recurrence (p = 0.106) compared to serum AFP levels of children without recurrence at the same time. However, serum AFP levels did significantly increase in malignant recurrences (n = 7) (p = 0.03) compared to patients without recurrence. A cut-off value of 55 μg/L was found to be predictive for recurrent SCT with an Area Under the Curve (AUC) of 0.636 with sensitivity of 50% and specificity of 100%. CONCLUSION Dynamics of serum AFP levels are not different between patients with and without recurrence after initial resection of SCT. Serum AFP levels are not predictive for mature or immature recurrent SCT and normal AFP levels do not rule out recurrent SCT. However, serum AFP levels exceeding 55 μg/L can indicate recurrent SCT, especially malignant recurrences.
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Affiliation(s)
- Lieke J van Heurn
- Emma Children's Hospital, Amsterdam UMC, University of Amsterdam & Vrije Universiteit Amsterdam, Department of Pediatric Surgery, Amsterdam, the Netherlands.
| | - Marijke E B Kremer
- Department of Pediatric Surgery, University Medical Centre Maastricht, Maastricht, the Netherlands
| | - Ivo de Blaauw
- Department of Pediatric Surgery, Radboud University Medical Center, Amalia Children's Hospital, Nijmegen, the Netherlands
| | - Robertine van Baren
- Department of Surgery and Pediatric Surgery, University Medical Center Groningen, Groningen, the Netherlands
| | - Wim G van Gemert
- Department of Pediatric Surgery, University Medical Centre Maastricht, Maastricht, the Netherlands
| | - Johannes B van Goudoever
- Department of Pediatrics, Amsterdam UMC, University of Amsterdam, Vrije Universiteit, Emma Children 's Hospital, Amsterdam, the Netherlands
| | - Cornelius E J Sloots
- Department of Pediatric Surgery and Intensive Care, Erasmus MC-Sophia Children's Hospital, Rotterdam, the Netherlands
| | - Marieke J Witvliet
- Department of Pediatric Surgery, University of Utrecht, Wilhelmina Children's Hospital, UMC Utrecht, Utrecht, the Netherlands
| | - L W Ernest van Heurn
- Emma Children's Hospital, Amsterdam UMC, University of Amsterdam & Vrije Universiteit Amsterdam, Department of Pediatric Surgery, Amsterdam, the Netherlands
| | - Joep P M Derikx
- Emma Children's Hospital, Amsterdam UMC, University of Amsterdam & Vrije Universiteit Amsterdam, Department of Pediatric Surgery, Amsterdam, the Netherlands
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Sperber J, Zachem TJ, Prakash R, Owolo E, Yamamoto K, Nguyen AD, Hockenberry H, Ross WA, Herndon JE, Codd PJ, Goodwin CR. A blinded study using laser induced endogenous fluorescence spectroscopy to differentiate ex vivo spine tumor, healthy muscle, and healthy bone. Sci Rep 2024; 14:1921. [PMID: 38253556 PMCID: PMC10803777 DOI: 10.1038/s41598-023-50995-4] [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: 07/11/2023] [Accepted: 12/28/2023] [Indexed: 01/24/2024] Open
Abstract
Ten patients undergoing surgical resection for spinal tumors were selected. Samples of tumor, muscle, and bone were resected, de-identified by the treating surgeon, and then scanned with the TumorID technology ex vivo. This study investigates whether TumorID technology is able to differentiate three different human clinical fresh tissue specimens: spine tumor, normal muscle, and normal bone. The TumorID technology utilizes a 405 nm excitation laser to target endogenous fluorophores, thereby allowing for the detection of tissue based on emission spectra. Metabolic profiles of tumor and healthy tissue vary, namely NADH (bound and free emission peak, respectively: 487 nm, 501 nm) and FAD (emission peak: 544) are endogenous fluorophores with distinct concentrations in tumor and healthy tissue. Emission spectra analyzed consisted of 74 scans of spine tumor, 150 scans of healthy normal bone, and 111 scans of healthy normal muscle. An excitation wavelength of 405 nm was used to obtain emission spectra from tissue as previously described. Emission spectra consisted of approximately 1400 wavelength intensity pairs between 450 and 750 nm. Kruskal-Wallis tests were conducted comparing AUC distributions for each treatment group, α = 0.05. Spectral signatures varied amongst the three different tissue types. All pairwise comparisons among tissues for Free NADH were statistically significant (Tumor vs. Muscle: p = 0.0006, Tumor vs. Bone: p < 0.0001, Bone vs. Muscle: p = 0.0357). The overall comparison of tissues for FAD (506.5-581.5 nm) was also statistically significant (p < 0.0001), with two pairwise comparisons being statistically significant (Tumor vs. Muscle: p < 0.0001, Tumor vs. Bone: p = 0.0045, Bone vs. Muscle: p = 0.249). These statistically significant differences were maintained when stratifying tumor into metastatic carcinoma (N = 57) and meningioma (N = 17). TumorID differentiates tumor tissue from normal bone and normal muscle providing further clinical evidence of its efficacy as a tissue identification tool. Future studies should evaluate TumorID's ability to serve as an adjunctive tool for intraoperative assessment of surgical margins and surgical decision-making.
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Affiliation(s)
- Jacob Sperber
- Department of Neurosurgery, Duke University School of Medicine, Durham, USA
| | - Tanner J Zachem
- Department of Neurosurgery, Duke University School of Medicine, Durham, USA
- Department of Mechanical Engineering and Materials Science, Duke University, Durham, USA
| | - Ravi Prakash
- Department of Mechanical Engineering and Materials Science, Duke University, Durham, USA
| | - Edwin Owolo
- Department of Neurosurgery, Duke University School of Medicine, Durham, USA
| | - Kent Yamamoto
- Department of Mechanical Engineering and Materials Science, Duke University, Durham, USA
| | - Annee D Nguyen
- Department of Neurosurgery, Duke University School of Medicine, Durham, USA
| | | | - Weston A Ross
- Department of Neurosurgery, Duke University School of Medicine, Durham, USA
| | - James E Herndon
- Department of Biostatistics & Bioinformatics, Duke University School of Medicine, Durham, USA
| | - Patrick J Codd
- Department of Neurosurgery, Duke University School of Medicine, Durham, USA
- Department of Mechanical Engineering and Materials Science, Duke University, Durham, USA
- Duke Cancer Institute, Duke University Medical Center, 200 Trent Drive DUMC 3807, Durham, NC, 27710, USA
| | - C Rory Goodwin
- Department of Neurosurgery, Duke University School of Medicine, Durham, USA.
- Duke Cancer Institute, Duke University Medical Center, 200 Trent Drive DUMC 3807, Durham, NC, 27710, USA.
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Li S, Peng J, Zhang Y, Liu D, Li L, Nai M. Subsequent ovarian yolk sac tumor after operation of ovarian mature teratoma: a case report and review of the literature. Front Oncol 2024; 13:1327724. [PMID: 38298441 PMCID: PMC10828046 DOI: 10.3389/fonc.2023.1327724] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Accepted: 12/29/2023] [Indexed: 02/02/2024] Open
Abstract
Ovarian mature teratoma represents a benign ovarian tumor, while ovarian yolk sac tumor (YST, endodermal sinus tumor) is a rare malignant tumor predominantly affecting young women, often associated with a grim prognosis post-metastasis. Both ovarian mature teratoma and ovarian YST are germ cell tumors. There are few studies on the correlation between ovarian YST and mature teratoma. Recurrence or malignant transformation may occur following the surgical intervention for ovarian mature teratoma. However, the occurrence of YST subsequent to such procedures is notably rare. In this investigation, we reported a case involving a 24-year-old unmarried woman with both mature ovarian teratoma and YST within a brief 1-year interval. Regular reexamination protocols facilitated the early-stage detection of YST. The patient underwent surgical treatment, chemotherapy, and measures to preserve ovarian function, resulting in a favorable prognosis. Our primary purpose is to distill clinical insights from the diagnostic and therapeutic journey of this patient. Our purpose is to enhance medical professionals' awareness that YST may be secondary to mature teratoma. Additionally, we underscore the critical importance of routine postoperative surveillance for ovarian mature teratoma, emphasizing its pivotal role in early malignant tumor detection-a factor paramount to the prognosis of patients.
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Affiliation(s)
- Shuqing Li
- The Department of Obstetrics and Gynecology, The Third Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Juan Peng
- The Department of Obstetrics and Gynecology, The Third Affiliated Hospital of Zhengzhou University, Zhengzhou, China
- Zhengzhou Key Laboratory of Endometrial Disease Prevention and Treatment, Zhengzhou Science and Technology Bureau, Zhengzhou, China
| | - Yajun Zhang
- The Department of Obstetrics and Gynecology, The Third Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Dongxia Liu
- The Department of Obstetrics and Gynecology, The Third Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Lei Li
- The Department of Obstetrics and Gynecology, The Third Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Manman Nai
- The Department of Obstetrics and Gynecology, The Third Affiliated Hospital of Zhengzhou University, Zhengzhou, China
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Kane GA, Mortell A, Gillick J, Thambipillai SP, Cascio S. The Irish Experience with Sacrococcygeal Teratomas: Are Type IV Lesions More Common than We Think? Eur J Pediatr Surg 2023. [PMID: 37793425 DOI: 10.1055/a-2185-9018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/06/2023]
Abstract
INTRODUCTION Sacrococcygeal teratomas (SCTs) are rare tumors occurring in approximately 1 in 35,000 to 40,000 live births. The Altman classification is used to describe SCTs. There are four types, with type 1 predominantly external through to type IV which is a presacral, completely internal mass. As far as the authors are aware, this is the first study to focus on type IV SCT lesions. MATERIALS AND METHODS Using ICD-10-AM (The International Statistical Classification of Diseases and Related Health Problems, Tenth Revision, Australian Modification) codes, we identified all patients in the Republic of Ireland with a diagnosis of SCT from 2004 to 2020. The following information was obtained for each patient: gender, time of diagnosis, clinical presentation, method of diagnosis, Altman classification, biomarkers, age at operation, surgical technique, pathology, recurrence, and age at most recent follow-up. RESULTS There were 29 patients in total; 23 females (79%) and 6 males (21%). In total, 16 (55%) were diagnosed antenatally, 4 (14%) at less than 1 month, 4 (14%) less than 1 year, 3 (10%) age 2 to 4 years, and 2 (7%) were aged 5 to 12 years. In addition, 22 (76%) were mature teratomas, 2 (7%) immature teratomas, and 5 (17%) were malignant tumors. There were 6 (21%) type I lesions, 9 (30%) type II, 6 (21%) type III, and 8 (28%) type IV lesions. CONCLUSION In Altman's original 1974 study, type IV lesions were present in 10% of cases. As a result, this is the most frequently quoted figure. Type IV lesions were present in 28% of cases in our study. We propose that type IV lesions may be more common than the current literature suggests and consequently a higher index of suspicion of their presence should be entertained.
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Affiliation(s)
- Gavin Alan Kane
- Department of Paediatric Surgery, Our Lady's Hospital Crumlin, Cooley Rd, Crumlin, Dublin, Crumlin, Ireland
| | - Alan Mortell
- Department of Paediatric Surgery, Our Lady's Hospital Crumlin, Cooley Rd, Crumlin, Dublin, Crumlin, Ireland
| | - John Gillick
- Department of Paediatric Surgery, Our Lady's Hospital Crumlin, Cooley Rd, Crumlin, Dublin, Crumlin, Ireland
| | - Sri Paran Thambipillai
- Department of Paediatric Surgery, Our Lady's Hospital Crumlin, Cooley Rd, Crumlin, Dublin, Crumlin, Ireland
| | - Salvatore Cascio
- Department of Paediatric Surgery, Our Lady's Hospital Crumlin, Cooley Rd, Crumlin, Dublin, Crumlin, Ireland
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Elgendy A, AbouZeid AA, El-Debeiky M, Mostafa M, Takrouney MH, Abouheba M, Khairi A, Shehata S, Shehata SM. Management strategy and outcomes of sacrococcygeal teratoma - an Egyptian multicenter experience. World J Surg Oncol 2023; 21:294. [PMID: 37718391 PMCID: PMC10506197 DOI: 10.1186/s12957-023-03180-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Accepted: 09/09/2023] [Indexed: 09/19/2023] Open
Abstract
OBJECTIVES Nationwide criteria regarding patients with sacrococcygeal teratoma (SCT) are still lacking in Egypt. We aimed to present a multicenter study regarding the management and outcomes of this tumor to evaluate our national treatment strategy. METHODS A retrospective analysis including all patients with SCT who were managed at four major Egyptian centers between 2013 and 2023. Clinical data, surgical approaches, and short- and long-term outcomes were discussed. RESULTS The study included 95 patients (74 were females). Antenatal diagnosis was reported in 25% of patients. Seventy-one patients (74.7%) were classified as Altman type I/II. Surgery was performed via a perineal approach in 75 patients, whereas the remaining 20 underwent a combined abdominoperineal approach. Vertical elliptical incision with midline closure was conducted in 51.5% of patients, followed by classic or modified chevron incisions. Benign mature teratoma was detected in 82% of patients. At a median follow-up of 57 months, eight patients (8.5%) had relapsed. The 5-year overall survival (OS) and event-free survival (EFS) of all patients were 94% and 91%, respectively. In the after-care monitoring, 19 patients (20%) had urinary or bowel dysfunctions. Nine of them were managed using medications. Clean intermittent catheterization was practiced in another five patients. The remaining five underwent further surgical interventions. CONCLUSION Favorable outcomes were achieved in our country during the last decade. Diverse perineal incisions were performed for resection, and vertical elliptical with midline closure was the commonest. During follow-up, 20% of patients developed urological or bowel dysfunctions that required medical and surgical treatment modalities to improve their quality of life.
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Affiliation(s)
- Ahmed Elgendy
- Surgical Oncology Unit, Department of Surgery, Faculty of Medicine, Tanta University, Tanta, 31515, Egypt.
| | | | - Mohamed El-Debeiky
- Pediatric Surgery Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Mahmoud Mostafa
- Pediatric Surgery Unit, Department of Surgery, Faculty of Medicine, Assiut University, Assiut, Egypt
| | - Mohammed Hamada Takrouney
- Pediatric Surgery Unit, Department of Surgery, Faculty of Medicine, Assiut University, Assiut, Egypt
| | - Mohamed Abouheba
- Pediatric Surgery Unit, Department of Surgery, Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - Ahmed Khairi
- Pediatric Surgery Unit, Department of Surgery, Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - Sameh Shehata
- Pediatric Surgery Unit, Department of Surgery, Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - Sherif M Shehata
- Pediatric Surgery Unit, Department of Surgery, Faculty of Medicine, Tanta University, Tanta, Egypt
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Mosleh MM, Heo TG, Shin HB, Sohn MJ. Sacrococcygeal teratomas: a case-based review from the perspective of individual multidisciplinary experts. Childs Nerv Syst 2023; 39:57-64. [PMID: 36422695 DOI: 10.1007/s00381-022-05768-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Accepted: 11/16/2022] [Indexed: 11/27/2022]
Abstract
PURPOSE Sacrococcygeal teratoma (SCT) is a rare congenital tumor originating from a variant of extragonadal germ cell neoplasm. Herein, we present three cases of neonatal SCTs undergoing surgical resection and reconstruction. We also review the literature to discuss the importance of proper perinatal management and timely surgical intervention depending on the tumor type and maturity to prevent malignant transformation and recurrence and ensure functional outcomes. METHODS AND RESULTS Three cases of SCT were retrospectively analyzed. All infants underwent complete surgical resection of the SCT and coccygectomy during their neonatal/infancy period, followed by pelvic floor and buttock reconstruction while minimizing buttock contour deformity and undesirable skin scar. Two of the cases were histopathologically diagnosed as predominantly cystic mature teratomas of Altman types I and IV, and the third was a mature teratoma of Altman type II. There were no complications or tumor recurrence during the average follow-up period of 5.3 years. CONCLUSIONS This case-based review highlights the role of multidisciplinary team approaches, including prenatal monitoring, oncologic resection, and adequate reconstruction according to the type of tumor and anomaly. Optimal perinatal evaluation allows promising oncologic and functional outcomes in terms of timely intervention to eliminate tumor recurrence and malignant transformation. Complete oncologic surgical resection of SCTs should also include proper functional preservation strategies, such as the reconstruction of the pelvic floor, cosmetic buttock contouring, and preservation of bladder and bowel sphincter function.
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Affiliation(s)
- Mohammad Mohsen Mosleh
- Department of Neurosurgery and Neuroscience & Radiosurgery Hybrid Research Center, College of Medicine, Inje University Ilsan Paik Hospital, 170 Juhwa-ro, Ilsanseo-Gu, Goyang, Gyeonggi Province, 10380, Korea
| | - Tae Gil Heo
- Department of General Surgery, College of Medicine, Inje University Ilsan Paik Hospital, 170 Juhwa-ro, Ilsanseo-Gu, Goyang, Gyeonggi Province, 10380, Korea
| | - Hyun Beak Shin
- Division of Pediatric Surgery, Department of Surgery, Jeonbuk National University Medical School, 20, Geonjiro, Deokjin-Gu, Jeonju, Jeollabuk-do, 54907, Korea
| | - Moon-Jun Sohn
- Department of Neurosurgery and Neuroscience & Radiosurgery Hybrid Research Center, College of Medicine, Inje University Ilsan Paik Hospital, 170 Juhwa-ro, Ilsanseo-Gu, Goyang, Gyeonggi Province, 10380, Korea.
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Abstract
Sacrococcygeal teratomas (SCT) in adults are extremely rare, and most SCTs are located either mainly outside the pelvis, with a small number of intrapelvic components, or mostly in the pelvis (types III and IV). The etiology of teratomas remains unknown. Most teratomas are benign, and approximately 1 to 2% of teratomas undergo malignant transformation, including squamous cell carcinoma, adenocarcinoma, sarcoma, and other malignancies. Most SCTs grow insidiously, and their symptoms are not easily detected in the early stages. Some cases may only be discovered through physical examination or compression symptoms when the tumor reaches a detectable size. Computed tomography and magnetic resonance imaging have high detection rates for presacral space-occupying lesions and can provide imaging details with guiding significance for the selection of surgical methods. Surgical resection is the preferred treatment option for SCT and can determine the pathological type. Common sacrococcygeal malignancies are mainly immature teratomas and mature teratomas. When the presence of malignant components is confirmed, the treatment model should be adjusted according to pathological type.
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Affiliation(s)
- Jia-Xing Guo
- Department of Radiotherapy, The Affiliated Hospital of Inner Mongolia Medical University, Hohhot, China
| | - Jian-Guo Zhao
- Department of Radiotherapy, The Affiliated Hospital of Inner Mongolia Medical University, Hohhot, China
| | - Ying-Na Bao
- Department of Radiotherapy, The Affiliated Hospital of Inner Mongolia Medical University, Hohhot, China
- * Correspondence: Ying-Na Bao, Department of Radiotherapy, The Affiliated Hospital of Inner Mongolia Medical University, No.1 Tongdao North Street, Hohhot 010050, China (e-mail: )
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Zhang H, Ji L, Liu J, Li S, Chen T, Li J, Shang G. Case report: Resection of a massive primary sacrococcygeal mature teratoma in an adult using 3-dimensional reconstruction and mixed reality technology. Front Surg 2022; 9:948388. [PMID: 36338636 PMCID: PMC9632992 DOI: 10.3389/fsurg.2022.948388] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Accepted: 08/16/2022] [Indexed: 11/13/2022] Open
Abstract
Introduction Teratomas are rare neoplasms that arise from pluripotent germ cells. Sacrococcygeal teratomas are often diagnosed in infants but are rare in adults; a mature teratoma can contain hair, teeth, bony tissue, and other mature tissue types. Herein, we report for the first time a patient with a teratoma containing intact bones that formed a pseudoarthrosis. Case report A 49-year-old woman was admitted to hospital after a massive life-long sciatic tumor had begun to grow larger over the past year. A 16 cm × 25 cm solid mass with a clear boundary was palpable in the sacrococcygeal region. Radiography, computed tomography, and magnetic resonance imaging indicated a sacrococcygeal teratoma, although blood alpha-fetoprotein levels were normal. The teratoma was completely excised using 3-dimensional reconstruction mixed reality (MR) technology with no notable complications. Postoperative pathological examination of the excised lesion confirmed a mature teratoma. Interestingly, two intact irregular bones that formed a pseudoarthrosis were isolated; one was 11 cm and the other 6 cm. The patient is currently healthy and has experienced no recurrences. Conclusion Sacrococcygeal teratomas are rare, especially in adults, and often comprised lots of components, such as fat, bony tissue. However, it's first reported that formation of pseudoarthrosis in this case so far. It is difficult for surgeons to achieve complete excision without complications owing to the complex anatomic structure of the sacrum. The 3-dimensional reconstruction and mixed reality (MR) technology based on computed tomography can provide spatial visualization, which allows surgeons to examine the teratoma at different angles preoperatively. Combining 3-dimensional reconstruction and mixed reality (MR) technology in this case facilitated complete resection and prevented recurrence.
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Affiliation(s)
- He Zhang
- Department of Bone and Soft Tissue Oncology, Department of Surgery, Shengjing Hospital, China Medical University, ShenYang, China
| | - Lu Ji
- Department of Gynecology and Obstetrics, Shengjing Hospital, China Medical University, ShenYang, China
| | - Jinxin Liu
- Department of Bone and Soft Tissue Oncology, Department of Surgery, Shengjing Hospital, China Medical University, ShenYang, China
| | - Shizhe Li
- Department of Bone and Soft Tissue Oncology, Department of Surgery, Shengjing Hospital, China Medical University, ShenYang, China
| | - Ting Chen
- Department of Bone and Soft Tissue Oncology, Department of Surgery, Shengjing Hospital, China Medical University, ShenYang, China
| | - Jiatong Li
- Department of Bone and Soft Tissue Oncology, Department of Surgery, Shengjing Hospital, China Medical University, ShenYang, China
| | - Guanning Shang
- Department of Bone and Soft Tissue Oncology, Department of Surgery, Shengjing Hospital, China Medical University, ShenYang, China
- Correspondence: Guanning Shang
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Santos VDON, Coelho SDEO, Vieira AA. Sacrococcygeal teratoma: evaluation of its approach, treatment and follow-up in two reference children cancer centers in Brazil / Rio de Janeiro. Rev Col Bras Cir 2022; 49:e20223341. [PMID: 36074393 PMCID: PMC10578848 DOI: 10.1590/0100-6991e-20223341-en] [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: 04/01/2022] [Accepted: 06/06/2022] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION sacrococcygeal teratoma (TSC) is the most common tumor of the neonatal period. Alphafetoprotein is an important tumor marker and is used in the follow-up period as a marker of malignancy. The complete surgical resection of the tumor associated with coccygectomy is the standard treatment and chemotherapy in different stages are necessary. Follow-up consists of serial exam: tumor markers, imaging searching to possible metastasis sites, in addition to a complete physical examination. METHODOLOGY a descriptive, retrospective, study was carried out by analyzing a chart of 25 patients of two different reference children cancer center; with TSC in the State of Rio de Janeiro from 2004 to 2019. The clinical and epidemiological data collected were described and a comparison was made between these two centers studied. RESULTS the sociodemographic characteristics found were similar to those described in the medical literature. Data related to treatment and follow-up, such as the use of chemotherapy, use of specific imaging tests, digital rectal examination, and outpatient follow-up, differed between the two centers studied. There was a 25% loss of follow-up. CONCLUSION the characteristic of being a non-cancer center can interfere with the full application of the current protocol for the treatment of sacrococcygeal teratoma. The knowledge of the data of the studied cases can allow the optimization of the approach of the patients with this pathology and generate discussions about the integral application of the specific therapeutic protocol in the medical centers that are qualified for such treatment.
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Affiliation(s)
| | | | - Alan Araujo Vieira
- - Universidade Federal Fluminense, Saúde Materno-Infantil - Rio de Janeiro - RJ - Brasil
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Sacrococcygeal teratomas: midline reconstruction improves cosmesis without compromising outcomes. Pediatr Surg Int 2022; 38:617-621. [PMID: 35175403 DOI: 10.1007/s00383-021-05055-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/13/2021] [Indexed: 10/19/2022]
Abstract
AIM Several studies have addressed the long-term functional, psychosexual and psychosocial outcomes following sacrococcygeal teratoma (SCT) excision. It is well reported that the classical chevron incision and reconstruction can leave a cosmetically unsatisfactory result; however, there is little in the literature focussed on improving this outcome. In our institution the preference is to perform a midline reconstruction, where possible, this is felt to improve appearance without compromising the oncological or functional outcome. The aim of this study was to evaluate patient-perceived cosmetic outcomes of the midline reconstruction. METHODS All patients undergoing surgery for SCT between 2007 and 2020 were included in the study. Patient demographics, operation type, functional outcome and recurrence were all recorded. The primary outcome measure was patient/parent satisfaction with the cosmetic appearance. This was assessed using both qualitative and quantitative methodologies. Following ethical approval parents were asked questions from two existing validated patient outcome questionnaires: "Patient and Observer Scar Assessment Scale" (POSAS) v2.0 and the "Patient Scar Assessment Questionnaire". RESULTS Thirty-two patients underwent surgery at our institution for SCT during the study period. Twenty-four had a posterior approach with midline reconstruction, two laparotomy and excision (excluded from this study) and six had a combined approach. Median follow-up was 35 months (8.5-96 months). There were no recurrences. 4/30 (13%) have persistent urological symptoms, and 1/30 (3%) has constipation requiring bowel management. Questionnaires were sent to 26/30 families with a 77% return rate. Median total score was 11 (7.4-17.5) on a 60-point scale (6, as normal skin, 60, worst imaginable scar). Twenty (95%) reported that the scar never affects the child's activities and 15 (71%) said they are "not at all" conscious of the scar. CONCLUSION Scars can lead to an array of cosmetic, functional, and psychological consequences and as such consideration needs to be given to scarring following surgery for sacrococcygeal teratomas. This study demonstrates that a midline reconstruction produces a cosmetically favourable outcome. We, therefore, recommend where appropriate a midline reconstruction should be considered for SCT.
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SANTOS VANESSADONASCIMENTO, COELHO SIMONEDEOLIVEIRA, VIEIRA ALANARAUJO. Teratoma sacrococcígeo: avaliação de abordagem, tratamento e seguimento em dois centros de referência do estado do Rio de Janeiro. Rev Col Bras Cir 2022. [DOI: 10.1590/0100-6991e-20223341] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
RESUMO Introdução: teratoma sacrococcígeo é o tumor neonatal mais comum. Alfafetoproteína é um marcador tumoral importante e é utilizado no período de seguimento como um marcador de malignidade. A ressecção cirúrgica completa do tumor associado a coccigectomia é o tratamento padrão, associado a quimioterapia em determinados estadiamentos. Exames de seguimento consistem em avaliação de marcadores tumorais, investigação de sítios de metástases, além de um completo exame físico. Metodologia: foi realizado um estudo retrospectivo descritivo, através da análise de 25 pacientes em dois centros de referência em tratamento oncológico infantil, com teratoma sacrococcígeo no Estado do Rio de Janeiro, entre 2004 e 2019. Os dados clínicos e epidemiológicos foram descritos, comparando-se os dois centros. Resultados: as características socio-demográficas foram similares ao descrito na literatura médica. Os dados relativos ao tratamento e seguimento, como o uso de quimioterapia, uso de testes de imagem específicos, exame de toque e retal e seguimento ambulatorial, foi diferente entre os dois centros. Tivemos uma perda de seguimento de 25%. Conclusão: a característica de ser um centro não oncológico pode interferir com a aplicação do protocolo de tratamento de teratoma sacrococcígeo. O conhecimento dos dados estudados pode permitir a otimização da abordagem dos pacientes com esta patologia e gerar discussões sobre a aplicação integral dos protocolos terapêuticos em centros médicos que são qualificados para tal tratamento.
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Recurrent Adult Sacrococcygeal Teratoma Developing Adenocarcinoma: A Case Report and Review of Literatures. Case Rep Pathol 2021; 2021:5045250. [PMID: 34873455 PMCID: PMC8643248 DOI: 10.1155/2021/5045250] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Accepted: 10/21/2021] [Indexed: 11/19/2022] Open
Abstract
Sacrococcygeal teratomas (SCT) are most commonly seen in infants and children but are rare in adults. Most adult SCT are benign and mature with a minority of tumors having immature components or overt malignancy. Here, we report a 65-year-old female with a SCT developing adenocarcinoma. The patient was diagnosed with benign sacrococcygeal cystic teratoma on her initial hospital visit and was treated with surgical resection. She was followed up postoperatively and was noted to have a markedly elevated CA 19-9 level 13 months after the surgery. Radiological and clinical examination revealed thickening of the perirectal soft tissues, located near the inferior portion of her previous incision site. Histological evaluation of the lesion showed invasive, moderately differentiated adenocarcinoma. Immunohistochemical staining results were suggestive, but not diagnostic, of anal gland adenocarcinoma. This case report expands the knowledge regarding an adenocarcinoma arising from a previously benign, adult SCT.
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Kanburoglu MK, Okumus M. Case 2: Intergluteal Sulcus Flattening in a Newborn. Neoreviews 2021; 22:e263-e265. [PMID: 33795402 DOI: 10.1542/neo.22-4-e263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Affiliation(s)
- Mehmet Kenan Kanburoglu
- Division of Neonatology, Department of Pediatrics, Recep Tayyip Erdogan University, Medical School, Rize, Turkey
| | - Mustafa Okumus
- Department of Pediatric Surgery, Yeni Yüzyıl University, Faculty of Medicine, Istanbul, Turkey
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Masahata K, Ichikawa C, Makino K, Abe T, Kim K, Yamamichi T, Tayama A, Soh H, Usui N. Long-term functional outcome of sacrococcygeal teratoma after resection in neonates and infants: a single-center experience. Pediatr Surg Int 2020; 36:1327-1332. [PMID: 32990839 DOI: 10.1007/s00383-020-04752-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/21/2020] [Indexed: 10/23/2022]
Abstract
PURPOSE This study aimed to evaluate the incidence and factors associated with long-term functional outcomes of sacrococcygeal teratoma (SCT) after resection in neonates and infants. METHODS Twenty-nine patients with a minimum of 3 years of follow-up who underwent resection and were histologically diagnosed with SCTs between 1982 and 2017 at our institution were included. RESULTS The median age at the time of the study was 10.0 years. Functional disorders occurred after surgery in 6 (20.7%) patients. Anorectal dysfunction, urologic dysfunction, and lower-extremity motor disorders occurred in 6 (20.7%), 4 (13.8%), and 3 (10.3%) patients, respectively. One patient with all three types of functional disorders developed intestinal perforation due to ileus and died of sepsis at 13 years of age. The overall mortality rate after tumor resection was 3.4%. The patients who developed functional disorders presented a low 1-min Apgar score, larger tumors requiring abdominosacral resection, surgical injury to the pelvic organs, and immature or malignant histological findings. CONCLUSION Although the mortality rate was low, the long-term rate of functional disorders after SCT resection was approximately 20%. SCT patients with large tumors, surgical injury to the pelvic organs, and immature or malignant histological findings require thorough follow-up.
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Affiliation(s)
- Kazunori Masahata
- Department of Pediatric Surgery, Osaka Women's and Children's Hospital, Izumi, Japan. .,Department of Pediatric Surgery, Osaka University Graduate School of Medicine, Suita, Japan.
| | - Chihiro Ichikawa
- Department of Clinical Pathology, Osaka Women's and Children's Hospital, Izumi, Japan
| | - Katsutoshi Makino
- Department of Pediatric Surgery, Osaka Women's and Children's Hospital, Izumi, Japan
| | - Takatoshi Abe
- Department of Pediatric Surgery, Osaka Women's and Children's Hospital, Izumi, Japan
| | - Kiyokazu Kim
- Department of Pediatric Surgery, Osaka Women's and Children's Hospital, Izumi, Japan
| | - Taku Yamamichi
- Department of Pediatric Surgery, Osaka Women's and Children's Hospital, Izumi, Japan
| | - Ai Tayama
- Department of Pediatric Surgery, Osaka Women's and Children's Hospital, Izumi, Japan
| | - Hideki Soh
- Department of Pediatric Surgery, Osaka Women's and Children's Hospital, Izumi, Japan
| | - Noriaki Usui
- Department of Pediatric Surgery, Osaka Women's and Children's Hospital, Izumi, Japan
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Kops AL, Hulsker CC, Fiocco M, Zsiros J, Mavinkurve-Groothuis AMC, Looijenga LH, van der Steeg AF, Wijnen MH. Malignant recurrence after mature Sacrococcygeal teratoma: A meta-analysis and review of the literature. Crit Rev Oncol Hematol 2020; 156:103140. [PMID: 33142194 DOI: 10.1016/j.critrevonc.2020.103140] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2020] [Revised: 10/07/2020] [Accepted: 10/15/2020] [Indexed: 01/29/2023] Open
Abstract
BACKGROUND AND AIMS Sacrococcygeal teratoma (SCT) is a rare extragonadal germ cell tumour mostly diagnosed during infancy and early childhood. Neonatal SCTs are mostly mature, but can also contain immature and/or malignant components. Recurrence of an SCT alters prognosis, especially when it is malignant, of which its mechanism is not yet fully understood. This study is a review and meta-analysis of the literature on malignant recurrences after an initially mature SCT. METHODS A literature search was performed to identify studies describing children with SCT and presenting specific information on histology of the initial tumour as well as the recurrence. Random effect models for mature recurrence and malignant recurrence after an initially mature SCT were employed to pool study-specific percentages in order to estimate an overall percentage and its associated 95 % confidence intervals (CI). Inverse variance method, which gives more weight to larger studies, was used to pool outcomes for the different studies. RESULTS A total of 22 articles, comprising 1516 patients with SCT, were included in the meta-analysis. The pooled proportions of mature and malignant recurrences after mature SCT were 3 % (95 % CI 1-4 %) and 5% (95 % CI 3-6 %), respectively. Fifty-seven (56 %) of a total of 102 recurrences after resection of an initially mature SCT were malignant, mostly yolk sac tumour (YST). Many recurrences occurred within 1-6 years, however some occurred as long as 20 years after initial diagnosis. CONCLUSIONS A substantial number of recurrences of mature SCT present as a malignant tumour. Overlooking malignant components on initial pathological evaluation and the progression of mature SCT cells to malignant cells may play a role. Treatment of mature SCTs with resection alone requires thorough follow-up of at least 6 years. Future research is needed to determine whether SCTs with malignant microfoci should be treated or followed-up differently from mature or immature SCTs. In addition, the value of serum biomarkers in follow-up after SCT needs to be further evaluated.
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Affiliation(s)
- Aranka L Kops
- Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands
| | | | - Marta Fiocco
- Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands
| | - József Zsiros
- Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands
| | | | | | | | - Marc Hw Wijnen
- Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands
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Sacrococcygeal teratoma with intraspinal extension: A case series and review of literature. J Pediatr Surg 2020; 55:2022-2025. [PMID: 32115228 DOI: 10.1016/j.jpedsurg.2020.02.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2019] [Revised: 12/03/2019] [Accepted: 02/05/2020] [Indexed: 11/23/2022]
Abstract
BACKGROUND Sacrococcygeal teratoma (SCT) is the most common teratoma in neonates and arises from the coccyx. SCT with intraspinal invasion is extremely rare and only reported in a few cases. METHODS 37 patients with SCT were identified at our institution between 2000 and 2018. Three of these patients had SCT with intraspinal extension. A literature review for intraspinal extension associated with SCT, including mode of diagnosis, presentation, surgical approach and neurological sequelae, between 1993 and 2018 was also conducted. RESULTS The authors report three cases of infants who were antenatally and/or postnatally diagnosed with a sacrococcygeal teratoma extending into the spinal canal. We illustrate the challenges of accurate diagnosis and therapeutic management. Postnatal magnet resonance imaging (MRI) was the best method to define spinal anatomy and extension of the tumors prior to surgery. Management with a multidisciplinary team approach including neuroradiology, neurosurgery and general surgery was used in our two most recent patients. The literature review yielded 6 cases of SCT with intraspinal extension. CONCLUSION Intraspinal extension in SCT is rare but should be excluded at birth before attempting any resection. In case of positive spinal invasion on Ultrasonography (US), MRI is essential to plan for surgery and possible laminectomy to be able to perform a radical resection of this congenital tumor. We recommend this multidisciplinary approach. LEVEL OF EVIDENCE Level IV.
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van Heurn LJ, Knipscheer MM, Derikx JPM, van Heurn LWE. Diagnostic accuracy of serum alpha-fetoprotein levels in diagnosing recurrent sacrococcygeal teratoma: A systematic review. J Pediatr Surg 2020; 55:1732-1739. [PMID: 32376010 DOI: 10.1016/j.jpedsurg.2020.03.014] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2019] [Revised: 03/12/2020] [Accepted: 03/12/2020] [Indexed: 01/03/2023]
Abstract
BACKGROUND The incidence of children developing recurrent sacrococcygeal teratoma (SCT) is 2-35%. Serum alpha-fetoprotein (AFP) is often used as a tumor marker for (malignant) recurrences of SCT and could potentially be used during routine follow-up after SCT resection. However, the diagnostic accuracy of serum AFP levels during follow-up has not been well established. Therefore, we aimed to systematically review the diagnostic accuracy of serum AFP levels in recurrent SCT. METHODS We queried Search Premier, COCHRANE Library, EMCARE, EMBASE, PubMed, ScienceDirect and Web of Science databases to identify studies regarding patients with SCT with follow-up using serum AFP levels postoperative. We estimated sensitivity and specificity of serum AFP levels. RESULTS Fifteen studies (613 patients, 121 recurrences) were included and these mainly described serum AFP levels in patients with recurrent SCT (n = 111); 83 (75%) patients with recurrent SCT had elevated serum AFP levels. A subgroup analysis of articles that measured serum AFP levels in all patients (n = 6, 136 patients, 14 recurrences) showed a sensitivity and specificity of 79% and 95%, respectively. The sensitivity of AFP levels to detect malignant recurrence was 96%. CONCLUSION Diagnostic accuracy of serum AFP levels to detect recurrent SCT seems promising, though sensitivity could be overestimated since serum AFP levels are mainly described in patients with elevated AFP levels or at recurrent SCT. Furthermore, serum AFP levels could be helpful to detect malignant recurrences. TYPE OF STUDY Systematic review of level 2-4 studies. LEVEL OF EVIDENCE Level 2-4 (mostly level 2).
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Affiliation(s)
- L J van Heurn
- Emma Children's Hospital, Amsterdam UMC, University of Amsterdam & Vrije Universiteit Amsterdam, Department of P(a)ediatric Surgery, Amsterdam, The Netherlands.
| | - M M Knipscheer
- Emma Children's Hospital, Amsterdam UMC, University of Amsterdam & Vrije Universiteit Amsterdam, Department of P(a)ediatric Surgery, Amsterdam, The Netherlands
| | - J P M Derikx
- Emma Children's Hospital, Amsterdam UMC, University of Amsterdam & Vrije Universiteit Amsterdam, Department of P(a)ediatric Surgery, Amsterdam, The Netherlands
| | - L W E van Heurn
- Emma Children's Hospital, Amsterdam UMC, University of Amsterdam & Vrije Universiteit Amsterdam, Department of P(a)ediatric Surgery, Amsterdam, The Netherlands
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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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Hambraeus M, Al-Mashhadi A, Wester T, Svensson PJ, Stenström P, Lilja HE. Functional outcome and health-related quality of life in patients with sacrococcygeal teratoma - a Swedish multicenter study. J Pediatr Surg 2019; 54:1638-1643. [PMID: 30420172 DOI: 10.1016/j.jpedsurg.2018.10.044] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2018] [Revised: 08/10/2018] [Accepted: 10/07/2018] [Indexed: 11/18/2022]
Abstract
BACKGROUND/PURPOSE The aims of this study were to evaluate bowel and urinary tract function, to identify predictors for dysfunctional outcome and to evaluate health-related quality-of life (QoL) in patients treated for sacrococcygeal teratomas (SCT). METHODS Medical records of patients with SCT born between 1985 and 2015 treated at three Swedish pediatric surgical centers were reviewed. Questionnaires regarding urinary tract function, bowel function and QoL were sent to patients and parents. Different QoL instruments were used for the different age groups. RESULTS Totally 85 patients were identified. Four patients died in the neonatal period. Forty-nine patients answered the questionnaires (60%). Median age at follow-up was 8.9 years (range 3.6-28.8). Bowel dysfunction was reported by 36% and urinary tract dysfunction by 46% of the patients. Univariate analysis revealed that urinary tract dysfunction correlated with gestational age (p = 0.018) and immature histology (p = 0.008), and bowel dysfunction correlated with gestational age (p = 0.016) and tumor size (p = 0.042). Low gestational age was an independent predictor for both urinary tract and bowel dysfunction. Good or very good QoL was reported by 56% of children aged 4-7 years, 90% of children aged 8-17 years and 67% of the adults. CONCLUSION Although a considerable proportion of bowel and urinary tract dysfunction was found, the reported QoL was good in a majority of the patients with SCT. Low gestational age was found to be a predictor for bowel- and urinary tract dysfunction. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
- Mette Hambraeus
- Department of Pediatric Surgery, Skåne University Hospital, Lund and Institution of Clinical Research, Lund University, Lund, Sweden
| | - Ammar Al-Mashhadi
- Department of Women's and Children's Health, Department of Pediatric Surgery, University Children's Hospital, Uppsala, Sweden
| | - Tomas Wester
- Department of Pediatric Surgery, Karolinska University Hospital and Karolinska Institutet, Stockholm, Sweden
| | - Pär-Johan Svensson
- Department of Pediatric Surgery, Karolinska University Hospital and Karolinska Institutet, Stockholm, Sweden
| | - Pernilla Stenström
- Department of Pediatric Surgery, Skåne University Hospital, Lund and Institution of Clinical Research, Lund University, Lund, Sweden
| | - Helene Engstrand Lilja
- Department of Women's and Children's Health, Department of Pediatric Surgery, University Children's Hospital, Uppsala, Sweden.
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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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Mylonas KS, Kao CS, Levy D, Lordello L, Dal Cin P, Masiakos PT, Oliva E. Clinicopathologic Features and Chromosome 12p Status of Pediatric Sacrococcygeal Teratomas: A Multi-institutional Analysis. Pediatr Dev Pathol 2019; 22:214-220. [PMID: 30176765 DOI: 10.1177/1093526618798771] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Chromosome 12p gains are typically present in postpubertal male patients with testicular malignant germ cell tumors, including most teratomas, and absent in pure ovarian teratomas, both mature and immature. We sought to evaluate the clinicopathologic features and chromosome 12p status of pediatric patients with sacrococcygeal teratomas (SCTs) using the institutional databases of 2 tertiary medical centers. Seven mature teratomas (3 pure, 2 with yolk sac tumor, 1 with medulloepithelioma, and 1 with ependymoma) and 3 immature teratomas (2 pure: grade 2 and grade 3 and 1 mixed: grade 3 with yolk sac tumor) were identified. All patients underwent surgery and 2 received adjuvant chemotherapy. Fluorescence in situ hybridization analysis was performed to elucidate chromosome 12p gains, including isochromosome 12p. All 10 tumors analyzed lacked 12p gains regardless of the components. No patient had evidence of disease at their most recent interval follow-up (mean: 30, range: 7-91 months), irrespective of margin status or of receiving chemotherapy. Overall, our study suggests an absence of chromosome 12p abnormalities in clinically nonaggressive SCTs. Additional data are required to confirm these findings before definitive patient care recommendations can be made.
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Affiliation(s)
- Konstantinos S Mylonas
- 1 Department of Pediatric Surgery, Massachusetts General Hospital, Boston, Massachusetts
| | - Chia-Sui Kao
- 2 Department of Pathology, Stanford University School of Medicine, Stanford, California
| | - David Levy
- 2 Department of Pathology, Stanford University School of Medicine, Stanford, California
| | - Leonardo Lordello
- 3 Department of Pathology, Massachusetts General Hospital, Boston, Massachusetts
| | - Paola Dal Cin
- 4 Department of Pathology, Brigham and Women's Hospital, Boston, Massachusetts
| | - Peter T Masiakos
- 1 Department of Pediatric Surgery, Massachusetts General Hospital, Boston, Massachusetts
| | - Esther Oliva
- 3 Department of Pathology, Massachusetts General Hospital, Boston, Massachusetts
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Rahadiani N, Krisnuhoni E, Stephanie M, Handjari DR. Extragonadal yolk sac tumor following congenital buccal mature cystic teratoma. J Oral Maxillofac Pathol 2019; 23:49-53. [PMID: 30967724 PMCID: PMC6421921 DOI: 10.4103/jomfp.jomfp_127_18] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Yolk sac tumor (YST) and teratoma both categorized as germ cell tumor (GCT). YST shows preferential differentiation toward yolk sac structures, while teratoma consists of tissues that originate from at least two embryonic germinal layers. Extragonadal location of YST is rare, whereas extragonadal teratoma is majority presented in nasopharynx area. Mature teratoma tends to be benign although some malignant transformation can occur. Recurrence of teratoma was reported mostly in the case of immature teratoma. YST occurrence after removal of mature teratoma is never reported. It is extremely rare for a second GCT to occur at the same site and with a different histological type. We herein report a case of a female infant presented with YST following a congenital buccal mature teratoma.
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Affiliation(s)
- Nur Rahadiani
- Department of Anatomical Pathology, Faculty of Medicine, Universitas Indonesia, Cipto Mangunkusumo Hospital, Jakarta, Indonesia
| | - Ening Krisnuhoni
- Department of Anatomical Pathology, Faculty of Medicine, Universitas Indonesia, Cipto Mangunkusumo Hospital, Jakarta, Indonesia
| | - Marini Stephanie
- Department of Anatomical Pathology, Faculty of Medicine, Universitas Indonesia, Cipto Mangunkusumo Hospital, Jakarta, Indonesia
| | - Diah Rini Handjari
- Department of Anatomical Pathology, Faculty of Medicine, Universitas Indonesia, Cipto Mangunkusumo Hospital, Jakarta, Indonesia
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Kremer MEB, Althof JF, Derikx JPM, van Baren R, Heij HA, Wijnen MHWA, Wijnen RMH, van der Zee DC, van Heurn LWE. The incidence of associated abnormalities in patients with sacrococcygeal teratoma. J Pediatr Surg 2018; 53:1918-1922. [PMID: 29453131 DOI: 10.1016/j.jpedsurg.2018.01.013] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2017] [Revised: 01/14/2018] [Accepted: 01/16/2018] [Indexed: 10/18/2022]
Abstract
BACKGROUND Gross genetic causes for SCT are unknown; however, it might be associated with other abnormalities. We assessed the incidence of associated abnormalities in a large national cohort of neonates with SCT and aimed to identify predictive risk factors. PROCEDURE The medical records were reviewed of 235 consecutive neonates with SCT treated at the six pediatric surgical centers in the Netherlands from 1970 to 2010. Potential risk factors for associated abnormalities analyzed included sex, gestational age, tumor-volume/histology and Altman-classification. RESULTS In 76 patients (32.3%) at least one associated abnormality was diagnosed, with hydronephrosis as the most common (16.2%) and hip dysplasia in 4.3%. Multiple abnormalities were documented for 21 (9.0%). Prematurity and Altman type IV SCT were associated with an increased risk of any associated abnormality. No association between increased tumor-volume and hydronephrosis or hip dysplasia was found. Patients with type IV Altman SCT had a fourfold risk of suffering from hydronephrosis compared to Altman type I SCT. CONCLUSIONS SCT was associated with other abnormalities in one-third of children. Some were tumor-related while others were related to prematurity or occurred sporadically. In contrast to clinically obvious anomalies, hip dysplasia or hydronephrosis might be latently present with more subtle clinical presentation. We therefore suggest renal- and hip-ultrasound in all patients, certainly those with Altman type IV SCT. LEVEL OF EVIDENCE RATING Level II (retrospective study).
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Affiliation(s)
- Marijke E B Kremer
- Department of Paediatric Surgery-Maastricht University Medical Centre, The Netherlands
| | - Jessica F Althof
- Department of Paediatric Surgery-Maastricht University Medical Centre, The Netherlands
| | - Joep P M Derikx
- Department of Paediatric Surgery-Maastricht University Medical Centre, The Netherlands
| | - Robertine van Baren
- Department of Paediatric Surgery-University Medical Centre, Groningen, The Netherlands
| | - Hugo A Heij
- Pediatric Surgical Centre of Amsterdam (Emma Children's Hospital University Medical Centre and VU Medical Centre), The Netherlands
| | - Marc H W A Wijnen
- Department of Paediatric Surgery-University Medical Centre, Nijmegen, The Netherlands
| | - René M H Wijnen
- Department of Paediatric Surgery, Sophia Children's Hospital-Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - David C van der Zee
- Department of Paediatric Surgery, Wilhelmina Children's Hospital-University Medical Centre, Utrecht, The Netherlands
| | - L W Ernest van Heurn
- Department of Paediatric Surgery-Maastricht University Medical Centre, The Netherlands.
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Hambraeus M, Hagander L, Stenström P, Arnbjörnsson E, Börjesson A. Long-Term Outcome of Sacrococcygeal Teratoma: A Controlled Cohort Study of Urinary Tract and Bowel Dysfunction and Predictors of Poor Outcome. J Pediatr 2018; 198:131-136.e2. [PMID: 29656864 DOI: 10.1016/j.jpeds.2018.02.031] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2017] [Revised: 01/10/2018] [Accepted: 02/13/2018] [Indexed: 12/19/2022]
Abstract
OBJECTIVE To evaluate urinary tract and bowel function in children with sacrococcygeal teratoma, compare the findings with healthy children, and assess predictors of poor outcome. STUDY DESIGN This was a controlled cohort study of all patients operated for sacrococcygeal teratoma at a tertiary pediatric surgery center, 2000-2013. Urinary and bowel function were compared with healthy control patients matched for age and sex. Perioperative and histopathologic risk factors were analyzed. RESULTS In total, 17 patients with sacrococcygeal teratoma and 85 healthy control patients were included in the study. Patients with sacrococcygeal teratoma more often were reported to have uncontrolled voiding (12% vs 0%, P < .01), difficulty in bladder emptying (24% vs 0%, P < .001), and pyelonephritis (18% vs 1%, P < .05). Constipation was more common in patients with sacrococcygeal teratoma (47 % vs 14%, P < .05), but the overall bowel function score was equal in the 2 groups. Children with large tumors and immature histology were more likely to have a dysfunctional outcome (P < .05). CONCLUSIONS Uncontrolled voiding, difficulty in bladder emptying, pyelonephritis, and constipation were more common in patients with sacrococcygeal teratoma than in healthy children. Dysfunctional outcome was more prevalent in children with large and immature teratomas.
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Affiliation(s)
- Mette Hambraeus
- Department of Pediatric Surgery, Skåne University Hospital, Lund, Sweden; Department of Clinical Sciences Lund, Lund University, Lund, Sweden
| | - Lars Hagander
- Department of Pediatric Surgery, Skåne University Hospital, Lund, Sweden; Department of Clinical Sciences Lund, Lund University, Lund, Sweden.
| | - Pernilla Stenström
- Department of Pediatric Surgery, Skåne University Hospital, Lund, Sweden; Department of Clinical Sciences Lund, Lund University, Lund, Sweden
| | - Einar Arnbjörnsson
- Department of Pediatric Surgery, Skåne University Hospital, Lund, Sweden; Department of Clinical Sciences Lund, Lund University, Lund, Sweden
| | - Anna Börjesson
- Department of Pediatric Surgery, Skåne University Hospital, Lund, Sweden; Department of Clinical Sciences Lund, Lund University, Lund, Sweden
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Sacrococcygeal Teratoma Presenting with Vaginal Discharge and Polyp in an Infant. J Pediatr Adolesc Gynecol 2018; 31:318-320. [PMID: 29269272 DOI: 10.1016/j.jpag.2017.12.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2017] [Revised: 11/29/2017] [Accepted: 12/09/2017] [Indexed: 11/21/2022]
Abstract
BACKGROUND Sacrococcygeal teratoma accounts for the most common solid tumor in neonates. Because of improved technology, 50%-70% of cases can be diagnosed antenatally during routine ultrasound screenings. If not diagnosed antenatally, clinical findings at birth are distinct in most cases including a palpable or visible mass. CASE We report an unusual case of a 1-year-old girl who presented with persistent vaginal discharge leading to diagnosis of a mucosal polypoid lesion of the vagina, ultimately revealing a hidden sacrococcygeal teratoma. SUMMARY AND CONCLUSION We suggest thorough investigation of all infants who present with purulent discharge and recurrent vaginal mass; sacrococcygeal teratoma should routinely be considered as a differential diagnosis.
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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: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
Sacrococcygeal teratomas are the most common solid tumor in newborn infants. The diagnosis is not difficult in many cases; however, there should be additional information on imaging studies in order to manage those infants properly. Details include histology, morphologic classification, complications such as rupture, bleeding, and mass effects on the adjacent structures. Although imaging features cannot accurately predict the histologic subtypes of the tumors, thorough evaluation of the imaging features can help distinguish malignant tumors from benign tumors. In this article, pathogenesis, histological characteristics, clinical considerations, and morphologic characteristics will be discussed.
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Affiliation(s)
- Hee Mang Yoon
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea
| | - Sun-ju Byeon
- Department of Pathology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea
| | - Jae-Yeon Hwang
- Department of Radiology, Pusan National University Children's Hospital, Yangsan-Si, Republic of Korea
| | - Jeong Rye Kim
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea
| | - Ah Young Jung
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea
| | - Jin Seong Lee
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea
| | - Hye-Kyung Yoon
- Department of Radiology, Kangwon National University Hospital, Chuncheon-Si, Republic of Korea
| | - Young Ah Cho
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea
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Villamil V, Girón Vallejo O, Fernández-Ibieta M, Sánchez Sánchez Á, Reyes Ríos PY, Martínez Castaño I, Rojas-Ticona J, Ruiz Pruneda R, Ruiz Jiménez JI. [Functional and aesthetic evaluation of sacrococcygeal teratomas. Not everything ends with surgery]. An Pediatr (Barc) 2018; 88:39-46. [PMID: 28669487 DOI: 10.1016/j.anpedi.2017.03.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2016] [Revised: 02/03/2017] [Accepted: 03/16/2017] [Indexed: 11/23/2022] Open
Abstract
INTRODUCTION Sacrococcygeal teratoma is the most common solid neonatal tumour. The improvement in survival has meant that postoperative sequelae can be diagnosed and treated. The aim of this article is to evaluate the long-term outcomes of patients treated in our centre. MATERIAL AND METHODS Records of patients treated for a sacrococcygeal teratoma in our hospital from 1977 to 2014 were retrospectively reviewed. Personal data was collected and a telephone questionnaire was used to assess long-term bowel and urinary habits, as well as an aesthetic and functional self-assessment. RESULTS A total of 14 patients were treated during the study period, of whom 11 were females and 3 males, with a mean age at the time of the survey of 17 years (8 months-37 years). Eight patients completed the questionnaire (57.1%). The mean age of the 8 patients was 23 years (4-37 years), of whom 37.5% were operated on due to a sacrococcygeal teratoma type i, 25% type ii, 25% type iii, and 12.5% type iv. Two of them (25%) had constipation, and one (12.5%) had faecal incontinence. Two (25%) patients suffered from recurrent urinary tract infections, and 3 (37.5%) patients had urinary incontinence. Five patients (62.5%) had a perception of being physically impaired, with limitation of their social life. CONCLUSIONS The incidence of constipation does not differ from that found in the literature. Faecal incontinence is slightly improved compared to what has been published. However, urinary tract infections and incontinence are more prevalent in our series. Five patients out of the eight that responded suffered from psychosocial problems, according to DAS-59 questionnaire. Patients with SCT require urological, bowel, and psychological counselling, until they have a complete functional and emotional development.
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Affiliation(s)
- Vanesa Villamil
- Servicio de Cirugía Pediátrica, Hospital Clínico Universitario Virgen de la Arrixaca, El Palmar, Murcia, España.
| | - Oscar Girón Vallejo
- Servicio de Cirugía Pediátrica, Hospital Clínico Universitario Virgen de la Arrixaca, El Palmar, Murcia, España
| | - María Fernández-Ibieta
- Servicio de Cirugía Pediátrica, Hospital Clínico Universitario Virgen de la Arrixaca, El Palmar, Murcia, España
| | - Ángela Sánchez Sánchez
- Servicio de Cirugía Pediátrica, Hospital Clínico Universitario Virgen de la Arrixaca, El Palmar, Murcia, España
| | - Paulo Y Reyes Ríos
- Servicio de Cirugía Pediátrica, Hospital Clínico Universitario Virgen de la Arrixaca, El Palmar, Murcia, España
| | - Irene Martínez Castaño
- Servicio de Cirugía Pediátrica, Hospital Clínico Universitario Virgen de la Arrixaca, El Palmar, Murcia, España
| | - Javier Rojas-Ticona
- Servicio de Cirugía Pediátrica, Hospital Clínico Universitario Virgen de la Arrixaca, El Palmar, Murcia, España
| | - Ramón Ruiz Pruneda
- Servicio de Cirugía Pediátrica, Hospital Clínico Universitario Virgen de la Arrixaca, El Palmar, Murcia, España
| | - José I Ruiz Jiménez
- Servicio de Cirugía Pediátrica, Hospital Clínico Universitario Virgen de la Arrixaca, El Palmar, Murcia, España
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Villamil V, Girón Vallejo O, Fernández-Ibieta M, Sánchez Sánchez Á, Reyes Ríos PY, Martínez Castaño I, Rojas-Ticona J, Ruiz Pruneda R, Ruiz Jiménez JI. Functional and aesthetic evaluation of sacrococcygeal teratomas. Not everything ends with surgery. ANALES DE PEDIATRÍA (ENGLISH EDITION) 2018. [DOI: 10.1016/j.anpede.2017.03.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
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Padilla BE, Vu L, Lee H, MacKenzie T, Bratton B, O'Day M, Derderian S. Sacrococcygeal teratoma: late recurrence warrants long-term surveillance. Pediatr Surg Int 2017; 33:1189-1194. [PMID: 28894920 DOI: 10.1007/s00383-017-4132-1] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/01/2017] [Indexed: 11/26/2022]
Abstract
BACKGROUND Sacrococcygeal teratoma (SCT) is a rare childhood malignancy. Although overall survival is favorable, recurrent tumors are associated with poor outcomes. As most recurrences occur within 3 years of presentation, the utility of long-term surveillance is uncertain. METHODS Patients with SCTs evaluated and managed by our pediatric surgery department between 1986 and 2013 were included. Details pertaining to laboratory values, operative findings, tumor histology, management, recurrence, and outcomes were recorded and analyzed. RESULTS During the study period, 40 children with the diagnosis of SCT were managed by our practice. Five (13%) developed a recurrence. The median age at the initial resection was day of life two (range day of life 0-2.5 years). The median time to recurrence was 5 years (range 5 months-15 years). Among those with recurrences, mature teratoma was the most common histological type on the initial resection (n = 3), with yolk sac and immature teratomas comprising the other two. At the time of recurrence, three patients had mature teratomas, and all are alive and well following resection. Two patients had yolk sac tumors at the time of recurrence and both died. CONCLUSION SCT can recur many years after the initial resection. Our findings suggest that all patients with SCT should be closely followed into adulthood.
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Affiliation(s)
- Benjamin E Padilla
- University of California San Francisco School of Medicine, San Francisco, CA, USA.
| | - Lan Vu
- University of California San Francisco School of Medicine, San Francisco, CA, USA
| | - Hanmin Lee
- University of California San Francisco School of Medicine, San Francisco, CA, USA
| | - Tippi MacKenzie
- University of California San Francisco School of Medicine, San Francisco, CA, USA
| | - Barbara Bratton
- University of California San Francisco School of Medicine, San Francisco, CA, USA
| | - Maura O'Day
- University of California San Francisco School of Medicine, San Francisco, CA, USA
| | - Sarkis Derderian
- University of California San Francisco School of Medicine, San Francisco, CA, USA
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Zhelnin KE, Gebhard GM, Mirsky DM, Oliver SC, Lovell MA, Galambos C, Crombleholme TM, McCourt EA. Pediatric Intraocular Immature Teratoma Associated With Sacrococcygeal Teratoma. Pediatr Dev Pathol 2017; 20:240-244. [PMID: 28521629 DOI: 10.1177/1093526616686233] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Intraocular teratomas are rare neoplasms with only three previously reported cases. We present the fourth case of intraocular teratoma and the second associated with sacrococcygeal teratoma. While the nature of the association between intraocular teratomas and sacrococcygeal teratomas is unclear, it suggests a need for careful ophthalmologic follow-up of infants with congenital sacrococcygeal teratomas.
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Use of intraoperative lateral pelvic X-ray to localize and ensure coccyx removal during sacrococcygeal teratoma resection. Pediatr Surg Int 2017; 33:389-392. [PMID: 27858188 DOI: 10.1007/s00383-016-4025-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/14/2016] [Indexed: 10/20/2022]
Abstract
En bloc removal of the coccyx during sacrococcygeal teratoma resection is necessary to decrease the risk of recurrence. However, variable anatomy often makes the border between the coccyx and sacrum difficult to identify. We describe the use of intraoperative lateral pelvic X-ray to localize this border and ensure complete coccygectomy.
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Wang Y, Wu Y, Wang L, Yuan X, Jiang M, Li Y. Analysis of Recurrent Sacrococcygeal Teratoma in Children: Clinical Features, Relapse Risks, and Anorectal Functional Sequelae. Med Sci Monit 2017; 23:17-23. [PMID: 28042962 PMCID: PMC5223781 DOI: 10.12659/msm.900400] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Sacrococcygeal teratoma (SCT) is a relatively uncommon tumor. Recurrence with poor survival and anorectal dysfunction are the 2 leading problems for patients. Here, we would review the clinic features of patients with SCTs in our hospital to identify risk factors of recurrent SCTs and to analyze anorectal functional sequelae. MATERIAL AND METHODS A retrospective review of all patients with SCTs in our center between 2007 and 2013 was performed. We analyzed the recorded data on each patient and performed follow-up through phone calls. RESULTS Our study included 105 inpatients (78 girls and 27 boys); 104 cases underwent surgical resection, and 62.5% cases had a mature histopathology. The proportion of malignant teratomas rose with increasing age. Fifteen children developed recurrent SCTs with a median of 11.5 months, and most of them had an elevation of AFP levels. Four recurrent children experienced a second tumor relapse. We observed a statistically significant difference in survival rate through Kaplan-Meier method between relapsed (66.7%) and non-relapsed (94.4%) patients. In univariate analysis, incomplete primary resection and malignant histology were proven to increase recurrence risks. Nearly half of patients had at least 1 of the parameters reflecting abnormal bowel function (e.g., involuntary bowel movements, fecal incontinence, and constipation). For those recurrent SCTs patients, difficulty defecating was a major problem. CONCLUSIONS Tumor recurrence affected the prognosis of children with SCT. In our research, incomplete resection and malignant histology were considered risk factors. Constipation was the main problem in anorectal functional sequelae for children who had recurrence.
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Affiliation(s)
- Yi Wang
- Department of Pediatric Surgery, Xinhua Hospital Affiliated to Medicine School of Shanghai Jiaotong University, Shanghai, China (mainland)
| | - Yeming Wu
- Department of Pediatric Surgery, Xinhua Hospital Affiliated to Medicine School of Shanghai Jiaotong University, Shanghai, China (mainland)
| | - Lifeng Wang
- Department of Pathology, Xinhua Hospital Affiliated to Medicine School of Shanghai Jiaotong University, Shanghai, China (mainland)
| | - Xiaojun Yuan
- Department of Pediatric Hematology and Oncology, Xinhua Hospital Affiliated to Medicine School of Shanghai Jiaotong University, Shanghai, China (mainland)
| | - Mawei Jiang
- Department of Radiotherapy, Xinhua Hospital Affiliated to Medicine School of Shanghai Jiaotong University, Shanghai, China (mainland)
| | - Yuhua Li
- Department of Radiology, Xinhua Hospital Affiliated to Medicine School of Shanghai Jiaotong University, Shanghai, China (mainland)
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Kremer MEB, Wellens LM, Derikx JPM, van Baren R, Heij HA, Wijnen MHWA, Wijnen RMH, van der Zee DC, van Heurn LWE. Hemorrhage is the most common cause of neonatal mortality in patients with sacrococcygeal teratoma. J Pediatr Surg 2016; 51:1826-1829. [PMID: 27502009 DOI: 10.1016/j.jpedsurg.2016.07.005] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2016] [Revised: 07/10/2016] [Accepted: 07/14/2016] [Indexed: 11/17/2022]
Abstract
BACKGROUND A small percentage of neonates with sacrococcygeal teratoma die shortly after birth from hemorrhagic complications. The incidence of and risk factors associated with hemorrhagic mortality are unknown. In this multicenter study we determined the incidence of early death in neonates born with SCT and evaluated potential risk factors for hemorrhagic mortality. METHODS 235 children with SCT treated from 1970 to 2010 in the Netherlands were retrospectively included. The following candidate risk factors for hemorrhagic mortality were examined: sex, prematurity, Altman type, tumor volume, tumor histology, necessity of emergency operation and time of diagnosis. RESULTS Eighteen patients (7.7%) died at a median age of 163.5days (range 1.7-973days). Nine patients died of a malignancy. Nine others (3.8%) died postnatally (age 1-27days), six even within two days after birth. In seven of these nine patients death was related to tumor-hemorrhage and/or circulatory failure. Risk factors for hemorrhagic mortality were prematurity, tumor volume>1000cm3 and performance of an emergency operation. CONCLUSIONS Hemorrhagic mortality of neonates with SCT is relatively high (3.8%) representing almost 70% of the overall mortality in the neonatal period. High-output cardiac failure, internal tumor hemorrhage and perioperative bleeding were the most common causes of early death and were all strongly associated with larger tumor sizes. LEVEL-OF-EVIDENCE RATING II (Retrospective study).
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Affiliation(s)
- Marijke E B Kremer
- Department of Surgery-Maastricht University Medical Centre, Maastricht, the Netherlands
| | - Lianne M Wellens
- Department of Surgery-Maastricht University Medical Centre, Maastricht, the Netherlands
| | - Joep P M Derikx
- Department of Surgery-Maastricht University Medical Centre, Maastricht, the Netherlands
| | - Robertine van Baren
- Department of Paediatric Surgery-University Medical Centre Groningen, Groningen, the Netherlands
| | - Hugo A Heij
- Department of Paediatric Surgery-Surgical Centre of Amsterdam (Emma Children's Hospital AMC and VU Medical Centre), Amsterdam, the Netherlands
| | - Marc H W A Wijnen
- Department of Paediatric Surgery-Radboud University Medical Centre, Nijmegen, the Netherlands
| | - René M H Wijnen
- Department of Paediatric Surgery-Erasmus Medical Centre-Sophia Children's Hospital, Rotterdam, the Netherlands
| | - David C van der Zee
- Department of Paediatric Surgery-Wilhelmina Children's Hospital, University Medical Centre Utrecht, Utrecht, the Netherlands
| | - L W Ernest van Heurn
- Department of Surgery-Maastricht University Medical Centre, Maastricht, the Netherlands.
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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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Sarbu I, Socolov D, Socolov R, Miron I, Trandafirescu M, Diaconescu S, Ciongradi CI. Hydrocephalus secondary to chemotherapy in a case of prenatally diagnosed giant immature grade 3 sacrococcygeal teratoma: A case report and literature review. Medicine (Baltimore) 2016; 95:e5244. [PMID: 27787388 PMCID: PMC5089117 DOI: 10.1097/md.0000000000005244] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
INTRODUCTION Sacrococcygeal teratoma (SCT) is a rare tumor in the general population, arising from multipotent stem cells. Whereas most of the cases diagnosed postnatally have good prognosis, the rate of mortality and morbidities associated with prenatally diagnosed SCT remain high, with a reported mortality rate of 30% to 50%. The outcome of fetal SCT can be unpredictable, with some cases with slow growth during fetal life, whereas others grow rapidly, causing multiple complications; also, some of these tumor will develop triggering fetal (preterm delivery, high-output cardiac failure, hydrops fetalis, intrauterine death) or maternal complications (distocia, placentomegaly, maternal mirror syndrome-preeclampsia). Even if prenatal criteria seem to define tumors at risk, it can not totally predict postnatal outcome as treatment-related complications can occur.We present a case of giant prenatally detected SCT. The case was diagnosed at 24th week of gestation, and was closely monitored by serial ultrasound. The morphology of the lesion was defined by fetal MRI performed at 25th week of gestation. A baby girl with a huge sacrococcygeal tumor was born and surgery was performed 48 hours later. Pathological examination revealed a grade 3 immature teratoma. Because of the tumor size and pathological aspect, adjuvant chemotherapy was considered. The outcome was complicated by wound infection, sepsis, and subsequent hydrocephalus, induced by chemotherapy-induced immunosuppression. CONCLUSION Our case emphasizes not only the importance of prenatal monitoring of these cases but also the importance of individualized postnatal management, as unusual and unpredictable complications can occur and affect outcome.
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Affiliation(s)
- Ioan Sarbu
- Department of Pediatric and Orthopaedic Surgery, “Sf. Maria” Emergency Children Hospital
| | | | | | - Ingrith Miron
- Department of Pediatrics, “Sf. Maria” Emergency Children Hospital
| | - Mioara Trandafirescu
- Department of Morphofunctional Sciences, Discipline of Histology, “Grigore T. Popa” University of Medicine and Pharmacy, Iasi, Romania
| | | | - Carmen Iulia Ciongradi
- Department of Pediatric and Orthopaedic Surgery, “Sf. Maria” Emergency Children Hospital
- Correspondence: Carmen Iulia Ciongradi, Assistant Professor, University of Medicine and Pharmacy, Department of Pediatric Surgery, “Sf. Maria” Emergency Children's Hospital, 62 Vasile Lupu Street, Iasi, Romania (e-mail: )
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Kremer MEB, Derikx JPM, Peeters A, Ter Kuile MM, van Baren R, Heij HA, Wijnen MHWA, Wijnen RMH, van der Zee DC, van Heurn LWE. Sexual function after treatment for sacrococcygeal teratoma during childhood. J Pediatr Surg 2016; 51:534-40. [PMID: 26460155 DOI: 10.1016/j.jpedsurg.2015.09.013] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2015] [Revised: 08/29/2015] [Accepted: 09/13/2015] [Indexed: 11/19/2022]
Abstract
BACKGROUND Children treated for sacrococcygeal teratoma (SCT) may suffer from sexual dysfunction later in life because of the extended pelvic surgery performed, however, structured evaluations have not been performed yet. METHODS The Female Sexual Function Index (FSFI), the International Index of Erectile Function (IIEF) and the Body Image Questionnaire (BIQ) were sent to patients (≥18years) treated for SCT in the Dutch pediatric surgical centers after 1970. RESULTS Forty-five of 76 patients returned the questionnaires; 28 women (median age 27.3years, range 18.3-41.0) and seven men (median age 22.0years, range 19.1-36.5) were eligible for analysis. The FSFI and IIEF results were compared to healthy controls. Female patients scored significantly lower on the desire (p=0.014), arousal (p=0.013) and lubrication domain (p=0.019). FSFI total-scores of female patients were significantly lower compared to controls [median 30.5 (IQR 28.6-31.4) vs. median 32.4 (IQR 30.6-33.45) p≤0.001] but were above the threshold value for sexual dysfunction. Males reported normal erectile function and penetration ability with normal ejaculation. Females had significant lower BIQ results compared to males; BIQ-cosmesis scores were moderately correlated to the FSFI-desire score (r=-0.37, p=0.028). CONCLUSION SCT resection in girls may result in diminished sexual function at adult age with worse self-perceived body image. The possibility of sexual complaints should be integrated in the surveillance strategies for these patients.
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Affiliation(s)
- Marijke E B Kremer
- Department of Surgery, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Joep P M Derikx
- Department of Surgery, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Andrea Peeters
- Department of Clinical Epidemiology and Medical Technology Assessment, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Moniek M Ter Kuile
- Department of Psychosomatic Gynecology and Sexology, Leiden University Medical Center, Leiden, 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 AMC and VU Medical Center), Amsterdam, the Netherlands
| | - Marc H W A Wijnen
- Department of Pediatric, Radboud University Medical Center, Nijmegen, the Netherlands
| | - René M H Wijnen
- Department of Pediatric Surgery, Erasmus Medical Center-Sophia Children's Hospital, 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 Surgery, Maastricht University Medical Center, Maastricht, the Netherlands.
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Kremer MEB, Derikx JPM, van Baren R, Heij HA, Wijnen MHWA, Wijnen RMH, van der Zee DC, van Heurn ELWE. Patient-Reported Defecation and Micturition Problems Among Adults Treated for Sacrococcygeal Teratoma During Childhood--The Need for New Surveillance Strategies. Pediatr Blood Cancer 2016; 63:690-4. [PMID: 26739142 DOI: 10.1002/pbc.25857] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2015] [Accepted: 11/03/2015] [Indexed: 11/05/2022]
Abstract
BACKGROUND To evaluate defecation and micturition complaints in adults treated for sacrococcygeal teratoma (SCT) during childhood and to identify risk factors for soiling, urinary incontinence, and constipation beyond childhood. PROCEDURE Records of patients aged ≥18 treated for SCT during infancy in the Netherlands were retrospectively reviewed. Frequency and severity of soiling, constipation, and urinary incontinence were evaluated using questionnaires designed in line with the Krickenbeck classification. Problems during childhood were compared to outcomes at adult age in part of the cohort. Associations between patient- and disease-related factors with complaints beyond childhood were analyzed with the chi-square test or Fisher's exact test, when appropriate. RESULTS Of 47 included patients (mean age 26.2 years, SD ±6.5), 49% reported at least one defecation or micturition complaint. Urinary incontinence was present in 30% and had a greater negative impact than soiling (24%). Ten patients (21%) reported constipation; five found this severely bothering. Three patients reported social restrictions due to defecation or micturition complaints (6.4%). While sex and tumor histology were not identified as risk factors, a tumor diameter of >10 cm and Altman type I or type II SCT were associated with constipation during adulthood. CONCLUSIONS One-third of the patients treated for SCT during childhood reported urinary and defecation problems beyond childhood. In only a minority of cases, these led to social restrictions. A greater tumor diameter was associated with a higher risk of constipation during adulthood. Prolonged surveillance strategies are advised for all patients with SCT.
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Affiliation(s)
- Marijke E B Kremer
- Department of Pediatric Surgery, Maastricht University Medical Center, The Netherlands
| | - Joep P M Derikx
- Department of Pediatric Surgery, Maastricht University Medical Center, The Netherlands
| | - Robertine van Baren
- Department of Pediatric Surgery, University Medical Center Groningen, The Netherlands
| | - Hugo A Heij
- Pediatric Surgical Center of Amsterdam, Emma Children's Hospital University Medical Center and VU Medical Center, The Netherlands
| | - Marc H W A Wijnen
- Department of Pediatric Surgery, University Medical Center Nijmegen, The Netherlands
| | - René M H Wijnen
- Department of Pediatric Surgery, Sophia Children's Hospital, Erasmus University Medical Center Rotterdam, The Netherlands
| | - David C van der Zee
- Department of Pediatric Surgery, Wilhelmina Children's Hospital, University Medical Center Utrecht, The Netherlands
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Hambraeus M, Arnbjörnsson E, Börjesson A, Salvesen K, Hagander L. Sacrococcygeal teratoma: A population-based study of incidence and prenatal prognostic factors. J Pediatr Surg 2016; 51:481-5. [PMID: 26454470 DOI: 10.1016/j.jpedsurg.2015.09.007] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2015] [Revised: 07/23/2015] [Accepted: 09/05/2015] [Indexed: 11/19/2022]
Abstract
BACKGROUND Sacrococcygeal teratoma (SCT) is a rare congenital tumor associated with high rates of perinatal mortality and morbidity. This study evaluated the incidence, prenatal detection rate, and early predictors of a complicated outcome following diagnosis of SCT. METHODS We retrospectively identified all fetuses and newborns diagnosed with SCT in southern Sweden from 2000 to 2013. Prenatal sonograms, charts, and pathology reports were reviewed and analyzed. Each case of SCT was defined as complicated or uncomplicated based on the postnatal outcome. All cases with a fatal outcome or that required cardiac resuscitation during birth or surgery were classified as complicated. RESULTS The overall incidence of SCT was 1:13,982 (19 children in a cohort of 265,658 live births). A prenatal diagnosis was made in 74% of cases, there were no stillbirths or intrauterine deaths, and the overall mortality rate was 11%. Four cases of SCT (21%) were classified as complicated, and these cases had a significantly larger tumor size at gestational week 20 (P=0.048), had a significantly higher tumor growth rate (P=0.003), and were more often associated with polyhydramnios (P=0.01), and mainly solid/mixed morphology (P=0.001). CONCLUSIONS The incidence of SCT in southern Sweden was higher than those reported in most previous studies; however, the associated mortality rate was relatively low. Fetuses with large tumors, rapidly growing tumors, and polyhydramnios were more likely to experience a complicated outcome during the postnatal period.
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Affiliation(s)
- Mette Hambraeus
- Department of Pediatric Surgery, Skåne University Hospital, 221 85 Lund, Sweden; Department of Clinical Sciences Lund, Lund University, Box 117, 221 00 Lund, Sweden.
| | - Einar Arnbjörnsson
- Department of Pediatric Surgery, Skåne University Hospital, 221 85 Lund, Sweden; Department of Clinical Sciences Lund, Lund University, Box 117, 221 00 Lund, Sweden
| | - Anna Börjesson
- Department of Pediatric Surgery, Skåne University Hospital, 221 85 Lund, Sweden; Department of Clinical Sciences Lund, Lund University, Box 117, 221 00 Lund, Sweden
| | - Kjell Salvesen
- Department of Clinical Sciences Lund, Lund University, Box 117, 221 00 Lund, Sweden; Department of Laboratory Medicine, Children's and Women's Health, Norwegian University of Science and Technology, Trondheim, Norway
| | - Lars Hagander
- Department of Pediatric Surgery, Skåne University Hospital, 221 85 Lund, Sweden; Department of Clinical Sciences Lund, Lund University, Box 117, 221 00 Lund, Sweden
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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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Long-Term Outcomes of Sacrococcygeal Germ Cell Tumors in Infancy and Childhood. Surg Res Pract 2015; 2015:398549. [PMID: 26504900 PMCID: PMC4609489 DOI: 10.1155/2015/398549] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2015] [Accepted: 09/15/2015] [Indexed: 11/18/2022] Open
Abstract
Purpose. The aim of this study was to evaluate long-term outcomes of sacrococcygeal germ cell tumors (SC-GCTs) over a 15-year period. Materials and Methods. A retrospective review was conducted of all pediatric patients treated for SC-GCTs at our hospital from 1998 to 2012. Results. Fifty-seven patients were treated for SC-GCTs with the most common in Altman's classification type I. Age at surgery ranged from one day to 5.6 years. Tumor resection and coccygectomy were primarily performed in about 84% of the cases. Pathology revealed mature, immature, malignant sacrococcygeal teratomas (SCTs), and endodermal sinus tumors (ESTs) in 41 (72%), 4 (77%), 6 (10.5%), and 6 (10.5%), respectively. Recurrence of discase occurred in 3 of 41 patients with mature teratomas (7.3%); 2 recurrences with mature teratomas and one recurrence with EST. Five of 6 malignant SCTs and 3 of 6 ESTs responded well to the treatment. Alpha-fetoprotein (AFP) level was elevated in both malignant teratomas and ESTs. No immediate patient death was noted in any of the 57 cases, but 4 patients with malignant tumors and distant metastasis succumbed at home within 2 years of the initial treatment. Conclusion. Benign SCTs have a significant recurrence rate of approximately 7%. Close follow-up with serial AFP level monitoring should be done for 5 years after initial tumor resection and coccygectomy. The survival rate for malignant SC-GCTs with distant metastasis was unfavorable in the present study.
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Terenziani M, D'Angelo P, Inserra A, Boldrini R, Bisogno G, Babbo GL, Conte M, Dall' Igna P, De Pasquale MD, Indolfi P, Piva L, Riccipetitoni G, Siracusa F, Spreafico F, Tamaro P, Cecchetto G. Mature and immature teratoma: A report from the second Italian pediatric study. Pediatr Blood Cancer 2015; 62:1202-8. [PMID: 25631333 DOI: 10.1002/pbc.25423] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2014] [Accepted: 12/02/2014] [Indexed: 11/12/2022]
Abstract
BACKGROUND Teratomas demonstrate a benign clinical behavior, however they may recur with malignant components or as teratoma, and in a small group of patients prognosis could be fatal. After the first Italian study, we collected cases of teratoma, alongside the protocol for malignant germ cell tumors. PROCEDURE Patients with teratoma were collected from 2004 to 2014. Teratomas were classified according to the WHO classifications, as mature and immature. Patients with pathological aFP and/or bHCG, and those with a malignant germ cell component were not included. RESULTS The study enrolled 219 patients (150 mature, 69 immature teratomas) with a median age at diagnosis of 42 months. The primary sites involved were: 118 gonadal and 101 extragonadal teratomas. Two females with ovarian teratoma had a positive family history. Complete and incomplete surgeries were performed in 85% and 9% of cases. Seventeen events occurred: six females had a second metachronous tumor (5 contralateral ovarian teratoma, 1 adrenal neuroblastoma) and 11 teratomas relapsed/progressed (3 mature, 8 immature teratomas). Two patients died, one of progressive immature teratoma and one of surgical complications. At a median follow up of 68 months, the event-free, relapse-free, and overall survival rates were 90.6%, 94.3%, 98.6%, respectively. CONCLUSIONS Teratomas show a good prognosis, especially the mature ones: surgery and follow-up remain the standard approach. Incomplete surgery in immature teratoma is the group at greatest risk of relapse. Bilateral ovarian tumors are a possibility, and the rare family predisposition to ovarian mature teratoma warrants further analyses.
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Affiliation(s)
| | - Paolo D'Angelo
- ARNAS Civico, Ospedale Di Cristina e Benfratelli, Palermo, Italy
| | | | | | | | | | | | | | | | | | - Luigi Piva
- Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy
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Dirix M, van Becelaere T, Berkenbosch L, van Baren R, Wijnen RM, Wijnen MH, van der Zee DC, Heij HA, Derikx JPM, van Heurn LWE. Malignant transformation in sacrococcygeal teratoma and in presacral teratoma associated with Currarino syndrome: a comparative study. J Pediatr Surg 2015; 50:462-4. [PMID: 25746708 DOI: 10.1016/j.jpedsurg.2014.07.014] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2014] [Revised: 07/14/2014] [Accepted: 07/25/2014] [Indexed: 10/24/2022]
Abstract
BACKGROUND/PURPOSE The risk of malignant transformation of sacrococcygeal teratoma (SCT) and of presacral teratoma in Currarino syndrome (CS) may differ despite the similar position and appearance. METHODS Malignant transformation and teratoma recurrence were assessed in a national retrospective comparative analysis of 205 SCT and 16 CS patients treated in one of the six pediatric surgical centers in the Netherlands between January 1981 and December 2010. RESULTS The malignancy free survival of patients with SCT was lower than for patients with a presacral teratoma associated with CS (80% and 58% after one and two years in SCT versus 100% after two years in CS, p=0.017) CONCLUSIONS: In SCT, malignancy and recurrence risk are high. Therefore, early and complete resection is mandatory. Our data show that the risk of malignant transformation of a presacral teratoma in CS is small.
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Affiliation(s)
- Marc Dirix
- Department of Pediatric Surgery, Maastricht University Medical Centre, The Netherlands
| | - Tine van Becelaere
- Department of Pediatric Surgery, Maastricht University Medical Centre, The Netherlands
| | - Lizanne Berkenbosch
- Department of Pediatric Surgery, Maastricht University Medical Centre, The Netherlands
| | - Robertine van Baren
- Department of Pediatric Surgery, University Medical Centre Groningen, The Netherlands
| | - Rene M Wijnen
- Department of Pediatric Surgery, Erasmus Medical Centre-Sophia Children's Hospital, Rotterdam, The Netherlands
| | - Marc H Wijnen
- Department of Pediatric Surgery, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - David C van der Zee
- Department of Pediatric Surgery, Wilhelmina Children's Hospital, University Medical Centre, Utrecht, The Netherlands
| | - Hugo A Heij
- Pediatric Surgical Centre of Amsterdam (Emma Children's Hospital AMC/VU University Medical Centre), The Netherlands
| | - Joep P M Derikx
- Department of Pediatric Surgery, Maastricht University Medical Centre, The Netherlands
| | - L W Ernest van Heurn
- Department of Pediatric Surgery, Maastricht University Medical Centre, The Netherlands.
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Kremer MEB, Koeneman MM, Derikx JPM, Coumans A, van Baren R, Heij HA, Wijnen MHWA, Wijnen RMH, van der Zee DC, van Heurn ELW. Evaluation of pregnancy and delivery in 13 women who underwent resection of a sacrococcygeal teratoma during early childhood. BMC Pregnancy Childbirth 2014; 14:407. [PMID: 25495179 PMCID: PMC4271500 DOI: 10.1186/s12884-014-0407-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2014] [Accepted: 11/27/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Sacrococcygeal teratoma resection often brings changes in pelvic anatomy and physiology with possible consequences for defecation, micturition and sexual function. It is unknown, whether these changes have any gynecological and obstetric sequelae. Until now four pregnancies after sacrococcygeal teratoma resection have been described and cesarean section has been suggested to be the method of choice for delivery. We evaluated the pregnancy course and mode of delivery in women previously treated for a sacrococcygeal teratoma. METHODS The records of all patients who underwent sacrococcygeal teratoma resection after 1970 in one of the six pediatric surgical centers in the Netherlands were reviewed retrospectively. Women aged 18 years and older were eligible for participation. Patient characteristics, details about the performed operation and tumor histology were retrieved from the records. Consenting participants completed a questionnaire addressing fertility, pregnancy and delivery details. RESULTS Eighty-nine women were eligible for participation; 20 could not be traced. Informed consent was received from 41, of whom 38 returned the completed questionnaire (92.7%). Thirteen of these 38 women conceived, all but one spontaneously. In total 20 infants were born, 17 by vaginal delivery and 3 by cesarean section, in one necessitated by previous intra-abdominal surgery as a consequence of sacrococcygeal teratoma resection. Conversion to a cesarean section was never necessary. None of the 25 women without offspring reported involuntary childlessness. CONCLUSIONS There are no indications that resection of a sacrococcygeal teratoma in female patients is associated with reduced fertility: spontaneous pregnancy is possible and vaginal delivery is safe for mother and child, irrespective of the sacrococcygeal teratoma classification or tumor histology.
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Affiliation(s)
- Marijke E B Kremer
- Department of Pediatric Surgery, Maastricht University Medical Center, Maastricht, The Netherlands.
| | - Margot M Koeneman
- Department of Pediatric Surgery, Maastricht University Medical Center, Maastricht, The Netherlands. .,Department of Gynecology and Obstetrics, Maastricht University Medical Center, Maastricht, The Netherlands.
| | - Joep P M Derikx
- Department of Pediatric Surgery, Maastricht University Medical Center, Maastricht, The Netherlands.
| | - Audrey Coumans
- Department of Gynecology and Obstetrics, Maastricht University Medical Center, Maastricht, 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, 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.
| | - Ernest L W van Heurn
- Department of Pediatric Surgery, Maastricht University Medical Center, Maastricht, The Netherlands.
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Yao W, Li K, Zheng S, Dong K, Xiao X. Analysis of recurrence risks for sacrococcygeal teratoma in children. J Pediatr Surg 2014; 49:1839-42. [PMID: 25487496 DOI: 10.1016/j.jpedsurg.2014.09.036] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2014] [Accepted: 09/05/2014] [Indexed: 11/25/2022]
Abstract
BACKGROUND/PURPOSE The purpose of this study was to investigate effects of risk factors on recurrence of sacrococcygeal teratoma (SCT). METHODS A retrospective review was conducted of 107 SCTs treated between January 2003 and December 2012 in our center. Risk factors were identified by univariate and multivariate analysis. RESULTS Sixteen children had recurrence of SCT a median interval of 16.25months after primary surgery. 15.6% tumors recurrence were Altman type I, 10.5% type II, 10.0% type III, and 31.3% type IV. The recurrence of mature teratoma was observed in 8 patients, immature in 2, malignant in 5. More than half of the recurrences showed a shift towards histological immaturity or malignancy, compared with the primary tumor pathology. Risk factors for recurrence were spillage of tumor parenchyma during operation (P=0.028), incomplete resection (p=0.000), and primary immature (P=0.029) and malignant histology (P=0.026). Size, Altman classification, and age were not risk factors for recurrence. There was a statistically significant difference in OS between patients who developed relapse (64.8%) and those who did not (95.0%) (P=0.0002). CONCLUSIONS Tumor recurrence affected the outcome of children with SCT. Risk factors were tumor spillage, immature and malignant histology, or incomplete resection. Regular follow-up after surgery is mandatory to find tumor relapse earlier and to improve the outcome.
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Affiliation(s)
- Wei Yao
- Department of Pediatric Surgery, Children's Hospital of Fudan University, Shanghai
| | - Kai Li
- Department of Pediatric Surgery, Children's Hospital of Fudan University, Shanghai.
| | - Shan Zheng
- Department of Pediatric Surgery, Children's Hospital of Fudan University, Shanghai
| | - Kuiran Dong
- Department of Pediatric Surgery, Children's Hospital of Fudan University, Shanghai
| | - Xianmin Xiao
- Department of Pediatric Surgery, Children's Hospital of Fudan University, Shanghai
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Abstract
Both benign and malignant pelvic masses are encountered in the pediatric population. Although ultrasonography remains the modality of choice for initial evaluation of a pediatric pelvic mass, in selected cases magnetic resonance (MR) imaging can add important diagnostic information. MR imaging has several advantages over ultrasonography and computed tomography, including superior contrast resolution and an ability to characterize abnormalities based on unique tissue characteristics. MR evaluation assists in lesion characterization, presurgical planning, and staging when a malignancy is suspected. MR imaging also offers a nonionizing imaging modality for long-term follow-up of patients undergoing therapy for malignant pelvic masses.
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Affiliation(s)
- Deepa R Pai
- Section of Pediatric Radiology, Department of Radiology, C.S. Mott Children's Hospital, University of Michigan Health System, 1540 E. Hospital Drive, Ann Arbor, MI 48109-4252, USA
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Abstract
Currarino syndrome is a rare constellation of congenital anomalies characterized by the triad of sacral dysgenesis, presacral mass, and anorectal malformation. It is frequently associated with other congenital anomalies, often including occult spinal dysraphism. Mutations in the MNX1 gene are identified in the majority of cases. The authors report a rare case of Currarino syndrome in an infant with tethered cord syndrome and a dorsal lipomyelomeningocele continuous with a presacral intradural spinal lipoma, in addition to an imperforate anus and a scimitar sacrum. They review the literature to highlight patterns of occult spinal dysraphism in patients with Currarino syndrome and their relationship to tethered cord syndrome. Approximately 60% of the patients with Currarino syndrome reported in the literature have an occult spinal dysraphism. Published studies suggest that the risk of tethered cord syndrome may be higher among patients with a lipoma and lower among those with a teratoma or anterior meningocele.
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Bechtel AS, Gauger CA. Sacrococcygeal Teratoma With Multiple Recurrences by Intradural Extension in the Neonate: A Common Neonatal Mass With an Unusual Course. Glob Pediatr Health 2014; 1:2333794X14560820. [PMID: 27335921 PMCID: PMC4804681 DOI: 10.1177/2333794x14560820] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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Pauniaho SL, Heikinheimo O, Vettenranta K, Salonen J, Stefanovic V, Ritvanen A, Rintala R, Heikinheimo M. High prevalence of sacrococcygeal teratoma in Finland - a nationwide population-based study. Acta Paediatr 2013; 102:e251-6. [PMID: 23432104 DOI: 10.1111/apa.12211] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2013] [Revised: 02/18/2013] [Accepted: 02/19/2013] [Indexed: 11/30/2022]
Abstract
AIM The birth prevalence of sacrococcygeal teratoma (SCT) has been reported to range from 1:27 000 to 1:40 000. We assessed the population-based prevalence and clinical presentation of SCT over 22 years. METHODS We identified all cases of SCT, including live births, stillbirths and terminations of pregnancy (TOPs), in the Finnish Register of Congenital Malformations, covering 1987-2008. Data on prenatal diagnoses, pregnancy outcomes, infant deaths and associated anomalies were collected. RESULTS One hundred and twenty four SCT cases were identified among 1 331 699 pregnancies. There were 89 (72%) live births, 13 (10%) stillbirths and 22 (18%) TOPs. The total prevalence of SCT was 1:10 700. Tumours were detected in utero in 55% of the pregnancies with SCT. The proportion of perinatal deaths among all SCT births was 28%. Thirty percentage of the cases had associated abnormalities (mainly of the urinary tract and various syndromes). CONCLUSION This nationwide, population-based study on SCT shows that the total and birth prevalence of SCT in Finland is markedly higher than previously reported. This may reflect true differences between populations, but may also be explained by accurate nationwide registration of SCTs. The high perinatal mortality rate has an impact on counselling of families and planning of deliveries.
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Affiliation(s)
- Satu-Liisa Pauniaho
- Paediatric Research Centre; University of Tampere and Tampere University Hospital; Tampere Finland
- Department of Surgery; Central Hospital of Seinäjoki; Tampere Finland
| | - Oskari Heikinheimo
- Department of Obstetrics and Gynecology; University of Helsinki and Helsinki University Central Hospital; Helsinki Finland
| | - Kim Vettenranta
- Division of Hematology-Oncology and Stem Cell Transplantation; Children's Hospital; University of Helsinki and Helsinki University Central Hospital; Helsinki Finland
| | - Jonna Salonen
- Department of Obstetrics and Gynecology; University of Helsinki and Helsinki University Central Hospital; Helsinki Finland
| | - Vedran Stefanovic
- Department of Obstetrics and Gynecology; University of Helsinki and Helsinki University Central Hospital; Helsinki Finland
| | | | - Risto Rintala
- Department of Pediatric Surgery; Children's Hospital; University of Helsinki and Helsinki University Central Hospital; Helsinki Finland
| | - Markku Heikinheimo
- Department of Pediatrics; Children's Hospital; University of Helsinki and Helsinki University Central Hospital; Helsinki Finland
- Department of Pediatrics; St Louis Children's Hospital; Washington University School of Medicine; St Louis MO USA
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