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Varlas VN, Cloțea EM, Varlas RG, Pop A, Peneș O, Crețoiu D, Dima V, Bălănescu L. Immature Sacrococcygeal Teratoma: A Case Report and Extensive Review of the Literature. Diagnostics (Basel) 2024; 14:246. [PMID: 38337762 PMCID: PMC10854813 DOI: 10.3390/diagnostics14030246] [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: 11/07/2023] [Revised: 01/11/2024] [Accepted: 01/22/2024] [Indexed: 02/12/2024] Open
Abstract
Immature sacrococcygeal teratoma represents a histological form with rapid tumor growth, a risk of premature birth, an enhanced rate of complications, an increased risk of recurrence, and a higher mortality rate than the mature type. Thus, prenatal diagnosis of immature forms would significantly improve the prognosis of these cases. To this end, we performed an extensive literature review on the diagnosis, therapeutic management, and follow-up of immature teratomas. Regarding this medical conduct, we also presented our case. In conclusion, the early identification of immature sacrococcygeal teratomas with or without other associated structural abnormalities and their correct therapeutic approach are basic principles for a favorable evolution of these cases.
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Affiliation(s)
- Valentin Nicolae Varlas
- Faculty of Medicine, “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania; (V.N.V.); (L.B.)
- Department of Obstetrics and Gynecology, Filantropia Clinical Hospital, 011132 Bucharest, Romania
| | - Eliza Maria Cloțea
- Department of Obstetrics and Gynecology, Filantropia Clinical Hospital, 011132 Bucharest, Romania
| | - Roxana Georgiana Varlas
- Department of Obstetrics and Gynecology, Filantropia Clinical Hospital, 011132 Bucharest, Romania
| | - Anca Pop
- Faculty of Medicine, “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania; (V.N.V.); (L.B.)
- Department of Clinical Laboratory, Food Safety, “Carol Davila” University of Medicine and Pharmacy, 6 Traian Vuia Street, 020945 Bucharest, Romania
| | - Ovidiu Peneș
- Faculty of Medicine, “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania; (V.N.V.); (L.B.)
- Department of Intensive Care, University Clinical Hospital, “Carol Davila” University of Medicine and Pharmacy, 37 Dionisie Lupu St., 020021 Bucharest, Romania
| | - Dragoș Crețoiu
- Fetal Medicine Excellence Research Center, Alessandrescu-Rusescu National Institute for Mother and Child Health, 020395 Bucharest, Romania
- Department of Genetics, Carol Davila University of Medicine and Pharmacy, 8 Eroii Sanitari Blvd., 050474 Bucharest, Romania
| | - Vlad Dima
- Department of Neonatology, Filantropia Clinical Hospital, 011132 Bucharest, Romania
| | - Laura Bălănescu
- Faculty of Medicine, “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania; (V.N.V.); (L.B.)
- Department of Pediatric Surgery, Children Emergency Hospital “Grigore Alexandrescu”, 011743 Bucharest, Romania
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Creden SP, Portuondo J, Cheng LS, Halaweish I, Keswani SG, King AL, Lee TC, Sun RC. Approach and Technique for Cesarean Section to Immediate Resection for High-Risk Sacrococcygeal Teratomas. J Surg Res 2023; 292:38-43. [PMID: 37579714 DOI: 10.1016/j.jss.2023.07.021] [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: 03/13/2023] [Revised: 07/07/2023] [Accepted: 07/10/2023] [Indexed: 08/16/2023]
Abstract
INTRODUCTION Ex-utero intrapartum treatment has been established as an option for fetal and perinatal surgeons to deliver patients with sacrococcygeal teratomas (SCTs) which are causing significant fetal distress and possible in-utero fetal demise. However, ex-utero intrapartum treatment procedures carry significant maternal risk and morbidity. Herein, we report an alternative technique of Cesarean section to immediate resection (CSIR) for managing high-risk SCTs. METHODS A retrospective institutional review board-approved review was performed on all SCTs evaluated at our fetal center from May 2014 to September 2020. Demographics; prenatal imaging characteristics; prenatal interventions; and postnatal surgery data including operative time, estimated blood loss, pathology, and outcomes were collected. Outcomes of interest included surveillance serum alpha-fetoprotein levels, imaging surveillance, developmental milestones, and the presence or absence of constipation or fecal incontinence. RESULTS A total of 20 patients with prenatal diagnosis of SCT were evaluated. Mothers who transferred their care to another institution after diagnosis were excluded from this study. Twelve neonates underwent standard postnatal resection. Three neonates underwent emergent CSIR for high output cardiac failure, fetal anemia, or concerns for in-utero hemorrhagic rupture. The median (interquartile range) operative time was 231.5 (113) minutes for the standard operative group versus 156 min in the CSIR group. We present three patients who underwent immediate resection after emergent Cesarean section. We report 100% survival for the three consecutive cases. CONCLUSIONS CSIR is a safe and feasible approach for managing appropriately selected high-risk SCTs with signs of hydrops, fetal distress, or fetal anemia. Despite patient prematurity, we demonstrated 100% survival of three consecutive cases. We suggest that CSIR be considered an option in the management algorithm for high-risk SCTs.
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Affiliation(s)
- Samuel P Creden
- Division of Pediatric Surgery, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas
| | - Jorge Portuondo
- Division of Pediatric Surgery, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas
| | - Lily S Cheng
- Division of Pediatric Surgery, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas
| | - Ihab Halaweish
- Division of Pediatric Surgery, Nationwide Children's Hospital, Ohio State University, Columbus, Ohio
| | - Sundeep G Keswani
- Division of Pediatric Surgery, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas
| | - Alice L King
- Division of Pediatric Surgery, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas
| | - Timothy C Lee
- Division of Pediatric Surgery, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas
| | - Raphael C Sun
- Division of Pediatric Surgery, Doernbecher Children's Hospital, Oregon Health & Science University, Portland, Oregon.
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van Heurn LJ, Coumans A, Haak MC, van der Kaaij A, van Heurn LWE, Pajkrt E, Derikx JPM. Prognostic accuracy of factors associated with poor outcome in prenatally diagnosed sacrococcygeal teratoma: A systematic review and meta-analysis. Prenat Diagn 2023; 43:1495-1505. [PMID: 37964422 DOI: 10.1002/pd.6457] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Revised: 10/15/2023] [Accepted: 10/19/2023] [Indexed: 11/16/2023]
Abstract
Several factors associated with poor outcome in patients with prenatally diagnosed sacrococcygeal teratoma (SCT) have been found. However, the prognostic accuracy of these factors has not been well established. Therefore, we aimed to systematically review the prognostic accuracy of factors associated with poor outcome in these patients. We queried Search Premier, COCHRANE Library, EMCARE, EMBASE, PubMed, ScienceDirect, and Web of Science databases to identify studies regarding patients with prenatally diagnosed SCT. Poor outcome was defined as termination of pregnancy (TOP), intrauterine fetal death (IUFD), or perinatal death. We estimated the odds ratio of factors associated with poor outcome. Eleven studies (447 patients) were included. Overall mortality, including TOP, was 34.9%. Factors associated with poor outcome in fetuses with prenatally diagnosed SCT were cardiomegaly, hypervascular tumor, solid tumor morphology, fetal hydrops, and placentomegaly. A tumor volume to fetal weight ratio (TFR) of >0.12 before a gestational age of 24 weeks is predictive of poor outcome. The prognostic accuracy of factors associated with poor outcome in fetuses prenatally diagnosed with SCT seems promising. Factors associated with cardiac failure such as cardiomegaly, hypervascular tumor, solid tumor morphology, fetal hydrops, placentomegaly, and TFR >0.12 were found to be predictive of poor outcome.
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Affiliation(s)
- Lieke J van Heurn
- Emma Children's Hospital, University of Amsterdam & Vrije Universiteit Amsterdam, Department of P(a)ediatric Surgery, Amsterdam UMC, Amsterdam, The Netherlands
| | - Audrey Coumans
- Department of Obstetrics and Gynaecology, Maastricht UMC+, Maastricht, The Netherlands
| | - Monique C Haak
- Department Obstetrics & Gynaecology, Division of Fetal Medicine, Leiden University Medical Center, Leiden, The Netherlands
| | | | - L W Ernest van Heurn
- Emma Children's Hospital, University of Amsterdam & Vrije Universiteit Amsterdam, Department of P(a)ediatric Surgery, Amsterdam UMC, Amsterdam, The Netherlands
| | - Eva Pajkrt
- Amsterdam UMC, University of Amsterdam & Vrije Universiteit Amsterdam Department of Obstetrics, Amsterdam, The Netherlands
| | - Joep P M Derikx
- Emma Children's Hospital, University of Amsterdam & Vrije Universiteit Amsterdam, Department of P(a)ediatric Surgery, Amsterdam UMC, Amsterdam, The Netherlands
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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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Li X, Lin HH, Hu KF, Peng Y. Prenatal MRI diagnosis and outcomes of abdominal or sacrococcygeal teratomas and parasitic fetuses. Front Pediatr 2023; 11:1181110. [PMID: 37744434 PMCID: PMC10516294 DOI: 10.3389/fped.2023.1181110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Accepted: 08/22/2023] [Indexed: 09/26/2023] Open
Abstract
Objective To investigate the MRI findings of fetal abdominal or sacrococcygeal teratomas and parasitic fetuses and analyze the outcomes on the basis of follow-up assessments. Methods The MRI data of 60 cases of abdominal or sacrococcygeal masses were examined. The outcomes were followed up and compared with the prenatal MRI diagnoses. Results The 60 cases included 52 cases of sacrococcygeal teratomas and eight cases of abdominal lesions. The common types of sacrococcygeal teratomas were type I (21/52, 40.4%) and type II (20/52, 38.5%); type III sacrococcygeal teratomas were rarer (8/52, 15.4%), while type IV tumors (3/52, 5.7%) were frequently complicated with hydronephrosis. Other complications included polyhydramnios in 22 cases, placental edema in six cases, and fetal hydronephrosis in three cases (all type IV). Seven of the eight parasitic fetuses were located in the abdominal cavity, and one was located in the sacrococcygeal region. Postnatal surgery was performed in 51 cases (51/60), including 44 with teratomas and seven with parasitic fetuses. In one case with hydronephrosis, peritoneal effusion, and subcutaneous edema, treatment was discontinued after birth (1/60). Fetal induction of labor was observed in eight cases (8/60). Prenatal ultrasound yielded incorrect or ambiguous diagnoses in 11 cases, while 51 cases showed a favorable course after surgery. Conclusions MRI shows high accuracy in the diagnosis of fetal sacrococcygeal teratomas and parasitic fetuses. The prognosis in these cases is generally good. However, type IV sacrococcygeal teratomas are prone to fetal hydronephrosis and misdiagnosis and show a poorer prognosis.
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Affiliation(s)
- Xu Li
- Department of Radiology, Anhui Provincial Children’s Hospital, Hefei, China
| | - Hui hui Lin
- Department of Radiology, Anhui Provincial Children’s Hospital, Hefei, China
| | - Ke fei Hu
- Department of Radiology, Anhui Provincial Children’s Hospital, Hefei, China
| | - Yun Peng
- Department of Radiology, Beijing Children's Hospital, Capital Medical University, Beijing, China
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Fulati A, Uto K, Iwanaga M, Watanabe M, Ebara M. Smart Shape-Memory Polymeric String for the Contraction of Blood Vessels in Fetal Surgery of Sacrococcygeal Teratoma. Adv Healthc Mater 2022; 11:e2200050. [PMID: 35385611 DOI: 10.1002/adhm.202200050] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Revised: 03/01/2022] [Indexed: 12/19/2022]
Abstract
Shape-memory polymers (SMPs) are promising materials in numerous emerging biomedical applications owing to their unique shape-memory characteristics. However, simultaneous realization of high strength, toughness, stretchability while maintaining high shape fixity (Rf ) and shape recovery ratio (Rr ) remains a challenge that hinders their practical applications. Herein, a novel shape-memory polymeric string (SMP string) that is ultra-stretchable (up to 1570%), strong (up to 345 MPa), tough (up to 237.9 MJ m-3 ), and highly recoverable (Rf averagely above 99.5%, Rr averagely above 99.1%) through a facile approach fabricated solely by tetra-branched poly(ε-caprolactone) (PCL) is reported. Notably, the shape-memory contraction force (up to 7.97 N) of this SMP string is customizable with the manipulation of their energy storage capacity by adjusting the string thickness and stretchability. In addition, this SMP string displays a controllable shape-memory response time and demonstrates excellent shape-memory-induced contraction effect against both rigid silicone tubes and porcine carotids. This novel SMP string is envisioned to be applied in the contraction of blood vessels and resolves the difficulties in the restriction of blood flow in minimally invasive surgeries such as fetoscopic surgery of sacrococcygeal teratoma (SCT).
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Affiliation(s)
- Ailifeire Fulati
- Research Center for Functional Materials National Institute for Materials Science Tsukuba 3050044 Japan
- Graduate School of Science and Technology University of Tsukuba Tsukuba 3058577 Japan
| | - Koichiro Uto
- Research Center for Functional Materials National Institute for Materials Science Tsukuba 3050044 Japan
| | - Masanobu Iwanaga
- Research Center for Functional Materials National Institute for Materials Science Tsukuba 3050044 Japan
| | - Miho Watanabe
- Department of Pediatric Surgery Graduate School of Medicine Osaka University Osaka 5650871 Japan
| | - Mitsuhiro Ebara
- Research Center for Functional Materials National Institute for Materials Science Tsukuba 3050044 Japan
- Graduate School of Science and Technology University of Tsukuba Tsukuba 3058577 Japan
- Graduate School of Advanced Engineering Tokyo University of Science Tokyo 1258585 Japan
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Sun RC, Cheng LS, Shah RH, Lohmann P, Cortes-Santiago N, Ketwaroo PD, Keswani SG, King A, Lee TC. Case Report: The Medical and Surgical Management of an Infant With Extreme Prematurity and Fetus-In-Fetu. Front Surg 2022; 9:856837. [PMID: 35310432 PMCID: PMC8931197 DOI: 10.3389/fsurg.2022.856837] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Accepted: 01/31/2022] [Indexed: 11/23/2022] Open
Abstract
Fetus-in-fetu (FIF) is a rare congenital anomaly where a parasitic twin is within the body of a host twin. FIF is reported to occur in 1:500,000 live births. Herein, we report the first case of the medical and surgical treatment of a FIF patient who was born with extreme prematurity at 25-weeks gestation. With the multi-disciplinary coordination of neonatology, surgery, and interventional radiology, the patient was able to achieve a window of medical stability 4 weeks after birth. A decision was made at that time to proceed with an intra-abdominal and perineal resection of the FIF. The FIF was successfully resected and the patient was able to recover from the operation, with eventual discharge from the NICU. In conclusion, extreme prematurity and FIF may be amenable to surgical resection and a multi-disciplinary approach is crucial to achieve the desired outcome.
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Affiliation(s)
- Raphael C. Sun
- Division of Pediatric Surgery, Doernbecher Children's Hospital, Oregon Health & Science University, Portland, OR, United States
- Division of Pediatric Surgery, Texas Children's Hospital, Baylor College of Medicine, Houston, TX, United States
| | - Lily S. Cheng
- Division of Pediatric Surgery, Texas Children's Hospital, Baylor College of Medicine, Houston, TX, United States
| | - Rita H. Shah
- Division of Neonatology, Texas Children's Hospital, Baylor College of Medicine, Houston, TX, United States
| | - Pablo Lohmann
- Division of Neonatology, Texas Children's Hospital, Baylor College of Medicine, Houston, TX, United States
| | - Nahir Cortes-Santiago
- Department of Pathology & Immunology, Texas Children's Hospital, Baylor College of Medicine, Houston, TX, United States
| | - Pamela D. Ketwaroo
- Edward B. Singleton Department of Radiology, Texas Children's Hospital, Baylor College of Medicine, Houston, TX, United States
| | - Sundeep G. Keswani
- Division of Pediatric Surgery, Texas Children's Hospital, Baylor College of Medicine, Houston, TX, United States
| | - Alice King
- Division of Pediatric Surgery, Texas Children's Hospital, Baylor College of Medicine, Houston, TX, United States
| | - Timothy C. Lee
- Division of Pediatric Surgery, Texas Children's Hospital, Baylor College of Medicine, Houston, TX, United States
- *Correspondence: Timothy C. Lee
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van Heurn LJ, Coumans ABC, Derikx JPM, Bekker MN, Bilardo KM, Duin LK, Knapen MFCM, Pajkrt E, Sikkel E, van Heurn LWE, Oepkes D. Factors associated with poor outcome in fetuses prenatally diagnosed with sacrococcygeal teratoma. Prenat Diagn 2021; 41:1430-1438. [PMID: 34327722 PMCID: PMC9292788 DOI: 10.1002/pd.6026] [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: 07/04/2020] [Revised: 07/08/2021] [Accepted: 07/11/2021] [Indexed: 11/08/2022]
Abstract
AIM OF THE STUDY Outcome of fetuses, prenatally diagnosed with sacrococcygeal teratoma (SCT), is still poorly documented. This study assesses the incidence and prenatal predictors of outcome in all fetuses prenatally diagnosed with SCT. METHODS This is a retrospective study on all fetuses prenatally diagnosed with SCT from 1998 to 2018 in the Netherlands. Poor outcome was defined as terminations of pregnancy (TOP) because of expected unfavorable outcome, intrauterine fetal death, or early neonatal death. Potential risk factors for poor outcome were analyzed. MAIN RESULTS Eighty-four fetuses were included. Sixteen (19.0%) TOPs were excluded from statistical analysis. Eleven of the remaining 68 fetuses had poor outcome. Overall mortality was 32.1%, with a mortality excluding TOPs of 13.1%. Thirteen fetal interventions were performed in 11 (13.1%) fetuses. Potential risk factors for poor outcome were the presence of fetal hydrops (OR: 21.0, CI: 2.6-275.1, p = 0.012) and cardiomegaly (OR: 10.3, CI: 1.9-55.8, p = 0.011). CONCLUSIONS The overall mortality of fetuses prenatally diagnosed with SCTs including tTOP was 32.1%. This high mortality rate was mainly due to termination of pregnancy. Mortality excluding TOP was 13.1%. Potential risk factors for poor outcome were fetal hydrops and cardiomegaly.
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Affiliation(s)
- Lieke J van Heurn
- Department of P(a)ediatric Surgery, Emma Children's Hospital, Amsterdam UMC, University of Amsterdam & Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Audrey B C Coumans
- Department of Obstetrics and Gynaecology, Maastricht UMC +, Maastricht, The Netherlands
| | - Joep P M Derikx
- Department of P(a)ediatric Surgery, Emma Children's Hospital, Amsterdam UMC, University of Amsterdam & Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Mireille N Bekker
- Department of Obstetrics, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Katia M Bilardo
- Department of Obstetrics and Gynaecology, Amsterdam University Medical Centers, Amsterdam, The Netherlands
| | - Leonie K Duin
- Department of Obstetrics, Gynaecology and Prenatal Diagnosis, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Maarten F C M Knapen
- Department of Obstetrics and Fetal Medicine, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Eva Pajkrt
- Department of Obstetrics, Amsterdam UMC, University of Amsterdam & Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Esther Sikkel
- Department of Obstetrics and Gynecology, Radboud University Medical Center Nijmegen, Nijmegen, The Netherlands
| | - L W Ernest van Heurn
- Department of P(a)ediatric Surgery, Emma Children's Hospital, Amsterdam UMC, University of Amsterdam & Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Dick Oepkes
- Department of Obstetrics and Fetal Medicine, Leiden University Medical Center, Leiden, The Netherlands
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Abstract
This article reviews the contemporary diagnosis and management of the most common abdominal neoplasms and cystic lesions diagnosed in the fetus. Fetal tumors discussed include teratomas (sacrococcygeal, cervical or mediastinal), mesoblastic nephroma, nephroblastoma (Wilms' tumor), neuroblastoma, and hepatoblastoma. Fetal abdominal cystic lesions discussed include ovarian cyst, choledochal cyst, intestinal duplication cyst, mesenteric cyst, simple hepatic cyst, and meconium pseudocyst. We discuss the rare indications for fetal intervention or fetal surgery and other perinatal management, including prenatal interventions and fetal surgery for sacrococcygeal teratoma. The lesions reviewed are detected by widespread use of screening ultrasonography during pregnancy. Work-up for these abnormalities may include fetal MRI which enhances the diagnostic accuracy of abdominal tumors and cystic lesions and can aid in characterization of the lesion in relationship to surrounding anatomic structures. Accurate prenatal diagnosis of such lesions permits recommendations for optimal location and timing of delivery, and inclusion of appropriate caregivers and expertise to facilitate postnatal management. Perinatal management of the fetus with a neoplasm requires consideration of the optimal timing and mode of delivery, and pediatric oncology and surgical specialty care. The majority of tumors diagnosed antenatally have good prognosis with current multimodality treatment.
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Kramer KP, Chetty SP, Nawaytou H, Vu L, Rogers EE. Fetal Sacrococcygeal Teratoma and the Development of Hydrops. Neoreviews 2021; 22:e141-e147. [PMID: 33526646 DOI: 10.1542/neo.22-2-e141] [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)
- Katelin P Kramer
- Departments of Pediatrics.,University of California, San Francisco, Benioff Children's Hospital, San Francisco, CA
| | - Shilpa P Chetty
- Obstetrics/Gynecology and Reproductive Sciences, and.,University of California, San Francisco, Benioff Children's Hospital, San Francisco, CA
| | - Hythem Nawaytou
- Departments of Pediatrics.,University of California, San Francisco, Benioff Children's Hospital, San Francisco, CA
| | - Lan Vu
- Surgery, University of California, San Francisco, CA.,University of California, San Francisco, Benioff Children's Hospital, San Francisco, CA
| | - Elizabeth E Rogers
- Departments of Pediatrics.,University of California, San Francisco, Benioff Children's Hospital, San Francisco, CA
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11
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Sharma D, Tsibizova VI. Current perspective and scope of fetal therapy: part 1. J Matern Fetal Neonatal Med 2020; 35:3783-3811. [PMID: 33135508 DOI: 10.1080/14767058.2020.1839880] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Fetal therapy term has been described for any therapeutic intervention either invasive or noninvasive for the purpose of correcting or treating any fetal malformation or condition. Fetal therapy is a rapidly evolving specialty and has gained pace in last two decades and now fetal intervention is being tried in many malformations with rate of success varying with the type of different fetal conditions. The advances in imaging techniques have allowed fetal medicine persons to make earlier and accurate diagnosis of numerous fetal anomalies. Still many fetal anomalies are managed postnatally because the fetal outcomes have not changed significantly with the use of fetal therapy and this approach avoids unnecessary maternal risk secondary to inutero intervention. The short-term maternal risk associated with fetal surgery includes preterm labor, premature rupture of membranes, uterine wall bleeding, chorioamniotic separation, placental abruption, chorioamnionitis, and anesthesia risk. Whereas, maternal long-term complications include risk of infertility, uterine rupture, and need for cesarean section in future pregnancies. The decision for invasive fetal therapy should be taken after discussion with parents about the various aspects like postnatal fetal outcome without fetal intervention, possible outcome if the fetal intervention is done, available postnatal intervention for the fetal condition, and possible short-term and long-term maternal complications. The center where fetal intervention is done should have facility of multi-disciplinary team to manage both maternal and fetal complications. The major issues in the development of fetal surgery include selection of patient for intervention, crafting effective fetal surgical skills, requirement of regular fetal and uterine monitoring, effective tocolysis, and minimizing fetal and maternal fetal risks. This review will cover the surgical or invasive aspect of fetal therapy with available evidence and will highlight the progress made in the management of fetal malformations in last two decades.
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Affiliation(s)
- Deepak Sharma
- Department of Neonatology, National Institute of Medical Science, Jaipur, India
| | - Valentina I Tsibizova
- Almazov National Medical Research Centre, Health Ministry of Russian Federation, Saint Petersburg, Russia
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12
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Özsürmeli M, Büyükkurt S, Sucu M, Arslan E, Mısırlıoğlu S, Akçabay Ç, Kayapınar M, Demir SC, Evrüke İC. Evaluation of prenatally diagnosed fetal sacrococcygeal teratomas: A case series of seventeen pregnancies from South-central Turkey. Turk J Obstet Gynecol 2020; 17:170-174. [PMID: 33072420 PMCID: PMC7538821 DOI: 10.4274/tjod.galenos.2020.68812] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Accepted: 05/19/2020] [Indexed: 12/01/2022] Open
Abstract
Objective To evaluate sacrococcygeal teratoma (SCT) cases according to associated cardiac, extracardiac, and chromosomal anomalies in the prenatal period, and to review their outcomes. Materials and Methods Data of pregnancies with a prenatal diagnosis of SCT between 2009 and 2019 were retrospectively reviewed. Results One ongoing pregnancy was excluded. There were five medically terminated cases, three due to severe heart failure and the remaining two due to additional congenital defects. Two infants who had heart failure due to hyperdynamic flow died in the neonatal period. Nine infants are well and alive at the time of writing. Conclusion When a lesion is detected in the sacrococcygeal region during fetal sonography, the differential diagnosis should be made with an appropriate evaluation with emphasis on a possible diagnosis of fetal SCT. Tumor growth and heart failure should be monitored with serial scans when SCT has been diagnosed prenatally.
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Affiliation(s)
- Mehmet Özsürmeli
- University of Health Sciences Turkey, Kocaeli Derince Training and Research Hospital, Clinic of Obstetrics and Gynecology, Kocaeli, Turkey
| | - Selim Büyükkurt
- Çukurova University Faculty of Medicine, Department of Obstetrics and Gynecology, Perinatology Unit, Adana, Turkey
| | - Mete Sucu
- Çukurova University Faculty of Medicine, Department of Obstetrics and Gynecology, Perinatology Unit, Adana, Turkey
| | - Erol Arslan
- Çukurova University Faculty of Medicine, Department of Obstetrics and Gynecology, Perinatology Unit, Adana, Turkey
| | - Selahattin Mısırlıoğlu
- Çukurova University Faculty of Medicine, Department of Obstetrics and Gynecology, Perinatology Unit, Adana, Turkey
| | - Çiğdem Akçabay
- Çukurova University Faculty of Medicine, Department of Obstetrics and Gynecology, Perinatology Unit, Adana, Turkey
| | - Masum Kayapınar
- Çukurova University Faculty of Medicine, Department of Obstetrics and Gynecology, Perinatology Unit, Adana, Turkey
| | - Süleyman Cansun Demir
- Çukurova University Faculty of Medicine, Department of Obstetrics and Gynecology, Perinatology Unit, Adana, Turkey
| | - İsmail Cüneyt Evrüke
- Çukurova University Faculty of Medicine, Department of Obstetrics and Gynecology, Perinatology Unit, Adana, Turkey
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13
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Ulm B, Muin D, Scharrer A, Prayer D, Dovjak G, Kasprian G. Prenatal ultrasound and magnetic resonance evaluation and fetal outcome in high-risk fetal tumors: A retrospective single-center cohort study over 20 years. Acta Obstet Gynecol Scand 2020; 99:1534-1545. [PMID: 32525215 PMCID: PMC7689914 DOI: 10.1111/aogs.13933] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Revised: 05/23/2020] [Accepted: 06/01/2020] [Indexed: 12/12/2022]
Abstract
Introduction Fetal tumors are rare and usually followed by poor outcome. We describe our single‐center experience with fetal tumors evaluated by ultrasound and magnetic resonance imaging (MRI). Our aims were to evaluate mortality and morbidity including long‐term outcome and to determine which ultrasound and MRI characteristics were helpful for pre‐ and perinatal management. Material and methods We conducted a retrospective analysis on prenatally diagnosed tumors between 1998 and 2018. Poor outcome included fetal or neonatal death and survival with serious illness. MRI addressed tumor morphology (sacrococcygeal teratomas), compromise of surrounding structures (head and neck tumors) and early depiction of brain alterations specific to tuberous sclerosis (rhabdomyomas). Results Of 68 pregnancies, 15 (22%) were terminated and eight children (8/53, 15%) died pre‐ or postnatally. Of the 45 survivors (45/68, 66%), 24 (24/45, 53%) were healthy, eight (8/45, 18%) had a minor illness and 13 (13/45, 29%) a serious illness. Diffusion‐ and T1‐weighted MRI reliably predicted tumor morphology in teratomas. To detect head and neck tumors critical to airway obstruction, MRI was superior to ultrasound in delivery planning. Rhabdomyomas were frequently associated with tuberous sclerosis, regardless of their number or size in ultrasound; MRI could depict specific brain alterations from the early third trimester onwards. For several rare tumors, MRI provided critical differential diagnoses that could not be clearly displayed in ultrasound. Conclusions The rate of survivors with serious long‐term illness among fetuses with prenatal diagnosis of a tumor was high. MRI is specifically helpful for risk stratification in fetal teratomas and delivery planning in head and neck tumors.
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Affiliation(s)
- Barbara Ulm
- Division of Obstetrics and Feto-Maternal Medicine, Department of Obstetrics and Gynecology, Medical University of Vienna, Vienna, Austria
| | - Dana Muin
- Division of Obstetrics and Feto-Maternal Medicine, Department of Obstetrics and Gynecology, Medical University of Vienna, Vienna, Austria
| | - Anke Scharrer
- Clinical Institute of Pathology, Medical University of Vienna, Vienna, Austria
| | - Daniela Prayer
- Division of Neuroradiology and Musculoskeletal Radiology, Department of Radiology, Medical University of Vienna, Vienna, Austria
| | - Gregor Dovjak
- Division of Neuroradiology and Musculoskeletal Radiology, Department of Radiology, Medical University of Vienna, Vienna, Austria
| | - Gregor Kasprian
- Division of Neuroradiology and Musculoskeletal Radiology, Department of Radiology, Medical University of Vienna, Vienna, Austria
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14
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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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15
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Tedesco KT, Sarthy J, Pinto N, Boos MD. Acute enlargement of a vascular plaque and gait changes in a young girl. BMJ 2018; 363:k4679. [PMID: 30487229 DOI: 10.1136/bmj.k4679] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
| | - Jay Sarthy
- Division of Hematology-Oncology, Department of Pediatrics, University of Washington School of Medicine and Seattle Children's Hospital; Seattle, WA, USA
| | - Navin Pinto
- Division of Hematology-Oncology, Department of Pediatrics, University of Washington School of Medicine and Seattle Children's Hospital; Seattle, WA, USA
| | - Markus D Boos
- Division of Dermatology, Department of Pediatrics, University of Washington School of Medicine and Seattle Children's Hospital; Seattle, WA, USA
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16
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Chaturvedi A, Franco A, Chaturvedi A, Klionsky NB. Caudal cell mass developmental aberrations: an imaging approach. Clin Imaging 2018; 52:216-225. [PMID: 30138861 DOI: 10.1016/j.clinimag.2018.07.014] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2018] [Revised: 07/13/2018] [Accepted: 07/17/2018] [Indexed: 11/30/2022]
Abstract
The objective of this review is to describe antenatal and postnatal imaging criteria, which allow diagnosis and aid workup, prognostication and treatment of developmental anomalies of the caudal cell mass. The lower spinal cord (conus medullaris), filum terminale and inferior lumbar and sacral nerve roots develop from the caudal cell mass, a remnant of the embryologic primitive streak composed of undifferentiated pluripotential cells. Anomalous caudal cell mass development can manifest as tight filum terminale, caudal dysgenesis, terminal myelocystocele, anterior sacral meningocele or sacrococcygeal teratoma. Lower spinal cord development occurs simultaneously and in topological proximity to the developing lower gastrointestinal and genitourinary tracts, leading to coexistent malformations. We review the embryology of the caudal cell mass, describe the role of antenatal and postnatal imaging for diagnosing, staging, prognosticating and guiding intranatal or postnatal intervention for developmental anomalies of this region and briefly discuss clinical manifestations and treatment goals and strategies. An overview of antenatal imaging diagnosis of associated multisystem abnormalities will be provided where applicable.
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Affiliation(s)
| | - Arie Franco
- University of Rochester Medical Center, Rochester, NY, USA
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17
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Lee SM, Suh DH, Kim SY, Kim MK, Oh S, Song SH, Kim HY, Park CW, Park JS, Jun JK. Antenatal Prediction of Neonatal Survival in Sacrococcygeal Teratoma. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2018; 37:2003-2009. [PMID: 29399854 DOI: 10.1002/jum.14553] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/18/2017] [Revised: 11/08/2017] [Accepted: 11/09/2017] [Indexed: 06/07/2023]
Abstract
OBJECTIVES In sacrococcygeal teratoma, the presence of high-output cardiac failure resulting from arteriovenous shunting through the large tumor has been associated with an adverse outcome. The objective of this study was to determine whether the tumor size and cardiac biomarkers in cord blood can predict neonatal survival in sacrococcygeal teratoma. METHODS The study population consisted of 25 neonates with sacrococcygeal teratoma. Tumor size was calculated by the ellipsoid formula using dimensions measured by antenatal ultrasound ([length × width × depth in cm] × 0.52= volume in cm3 ). To adjust the gestational age, the tumor volume index (tumor volume/biparietal diameter) was adopted in the analysis. Cardiac biomarkers for heart failure (N-terminal pro-B-type natriuretic peptide [NT-pro-BNP] and cardiac troponin T [cTnT]) were measured in cord blood taken at the time of delivery. RESULTS The rate of neonatal death was 24% (6 of 25). The cases that resulted in neonatal death had a higher tumor volume index and higher concentrations of NT-pro-BNP and cTnT than those with survival. A tumor volume index of greater than 60 cm3 /cm, elevated NT-pro-BNP (>2000 pg/mL), and elevated cTnT (>0.08 ng/mL) had sensitivity of 100% for prediction of neonatal death. CONCLUSIONS The tumor volume index and cord blood biomarkers for heart failure can be promising prognostic markers for neonatal survival in sacrococcygeal teratoma.
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Affiliation(s)
- Seung Mi Lee
- Department of Obstetrics and Gynecology , Seoul National University College of Medicine, Seoul, Korea
| | - Dong Hoon Suh
- Department of Obstetrics and Gynecology , Seoul National University College of Medicine, Seoul, Korea
- Department of Obstetrics and Gynecology, Seoul National University Bundang Hospital, Seongnam, Korea
| | - So Yeon Kim
- Department of Obstetrics and Gynecology , Seoul National University College of Medicine, Seoul, Korea
| | - Min Kyoung Kim
- Department of Obstetrics and Gynecology , Seoul National University College of Medicine, Seoul, Korea
| | - Sohee Oh
- Department of Biostatistics, Seoul Metropolitan Government Seoul National University Boramae Medical Center, Seoul, Korea
| | - Sang Hoon Song
- Department of Laboratory Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Hyun-Young Kim
- Department of Pediatric Surgery, Seoul National University College of Medicine, Seoul, Korea
| | - Chan-Wook Park
- Department of Obstetrics and Gynecology , Seoul National University College of Medicine, Seoul, Korea
| | - Joong Shin Park
- Department of Obstetrics and Gynecology , Seoul National University College of Medicine, Seoul, Korea
| | - Jong Kwan Jun
- Department of Obstetrics and Gynecology , Seoul National University College of Medicine, Seoul, Korea
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18
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Gebb J, Khalek N, Qamar H, Johnson M, Oliver E, Coleman B, Peranteau W, Hedrick H, Flake A, Adzick N, Moldenhauer J. High Tumor Volume to Fetal Weight Ratio Is Associated with Worse Fetal Outcomes and Increased Maternal Risk in Fetuses with Sacrococcygeal Teratoma. Fetal Diagn Ther 2018; 45:94-101. [DOI: 10.1159/000486782] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2017] [Accepted: 12/29/2017] [Indexed: 11/19/2022]
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19
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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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20
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Sacrococcygeal teratoma excision. ANNALS OF PEDIATRIC SURGERY 2017. [DOI: 10.1097/01.xps.0000521797.51003.b2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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21
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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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22
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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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23
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Akinkuotu AC, Coleman A, Shue E, Sheikh F, Hirose S, Lim FY, Olutoye OO. Predictors of poor prognosis in prenatally diagnosed sacrococcygeal teratoma: A multiinstitutional review. J Pediatr Surg 2015; 50:771-4. [PMID: 25783370 DOI: 10.1016/j.jpedsurg.2015.02.034] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2015] [Accepted: 02/13/2015] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Attempts at defining predictors of poor outcome in fetal sacrococcygeal teratoma (SCT) have been hampered by small patient numbers. We sought to validate the utility of tumor volume to fetal weight ratio (TFR) as a predictor of poor prognosis and to identify other morphological outcome predictors in a multicenter series. METHODS Records of prenatally diagnosed SCT at three fetal centers from 1986 to 2011 were reviewed. Prenatal imaging characteristics including TFR, morphology, hydrops, and placentomegaly were assessed. Poor prognosis was defined as fetal demise, need for fetal intervention, or perinatal death. Receiver operating characteristic (ROC) analysis was used to select a TFR cutoff value. RESULTS Seventy-nine fetuses with SCT were evaluated. Eleven pregnancies ending in elective termination were excluded. ROC analysis revealed that TFR >0.12 prior to 24 weeks gestation was predictive of poor prognosis (AUC=0.913; Sensitivity=91.7%, Specificity=76.2%, PPV=86.8%; NPV=84.2%). Solid tumor morphology and presence of hydrops were found to be predictors of poor prognosis. None of the factors associated with poor prognosis were independent predictors on multivariate analysis. CONCLUSION This study validates TFR >0.12 prior to 24 weeks gestation as an objective predictor of outcomes in fetuses with SCT that can be easily applied in most clinical settings.
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Affiliation(s)
- Adesola C Akinkuotu
- Texas Children's Fetal Center, Baylor College of Medicine, Houston, TX, USA; Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX, USA
| | - Alan Coleman
- Department of Pediatric Surgery, Fetal Care Center, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Eveline Shue
- Department of Surgery, Division of Pediatric Surgery and Fetal Treatment Center, University of California, San Francisco, San Francisco, CA, USA
| | - Fariha Sheikh
- Texas Children's Fetal Center, Baylor College of Medicine, Houston, TX, USA; Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX, USA
| | - Shinjiro Hirose
- Department of Surgery, Division of Pediatric Surgery and Fetal Treatment Center, University of California, San Francisco, San Francisco, CA, USA
| | - Foong-Yen Lim
- Department of Pediatric Surgery, Fetal Care Center, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Oluyinka O Olutoye
- Texas Children's Fetal Center, Baylor College of Medicine, Houston, TX, USA; Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX, USA; Department of Pediatrics, Baylor College of Medicine, Houston, TX, USA; Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, TX, USA.
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24
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Carvalho E, Honjo R, Magalhães M, Yamamoto G, Rocha K, Naslavsky M, Zatz M, Passos-Bueno MR, Kim C, Bertola D. Schinzel-Giedion syndrome in two Brazilian patients: Report of a novel mutation in SETBP1 and literature review of the clinical features. Am J Med Genet A 2015; 167A:1039-46. [PMID: 25663181 DOI: 10.1002/ajmg.a.36789] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2014] [Accepted: 08/29/2014] [Indexed: 11/06/2022]
Abstract
Schinzel-Giedion syndrome is a rare autosomal dominant disorder comprising postnatal growth failure, profound developmental delay, seizures, facial dysmorphisms, genitourinary, skeletal, neurological, and cardiac defects. It was recently revealed that Schinzel-Giedion syndrome is caused by de novo mutations in SETBP1, but there are few reports of this syndrome with molecular confirmation. We describe two unrelated Brazilian patients with Schinzel-Giedion syndrome, one of them carrying a novel mutation. We also present a review of clinical manifestations of the syndrome, comparing our cases to patients reported in literature emphasizing the importance of the facial gestalt associated with neurological involvement for diagnostic suspicion of this syndrome.
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Affiliation(s)
- Ellaine Carvalho
- Genetics Unit, Instituto da Criança, Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo, Sao Paulo, Brazil
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Abstract
Since the first human fetal surgery was reported in 1965, several different fetal surgical procedures have been developed and perfected, resulting in significantly improved outcomes for many fetuses. The currently accepted list of fetal conditions for which antenatal surgery is considered include lower urinary tract obstruction, twin-twin transfusion syndrome, myelomeningocele, congenital diaphragmatic hernia, neck masses occluding the trachea, and tumors such as congenital cystic adenomatoid malformation or sacrococcygeal teratoma when associated with developing fetal hydrops. Until recently, it has been difficult to determine the true benefits of several fetal surgeries because outcomes were reported as uncontrolled case series. However, several prospective randomized trials have been attempted and others are ongoing, supporting a more evidence-based approach to antenatal intervention. Problems that have yet to be completely overcome include the inability to identify ideal fetal candidates for antenatal intervention, to determine the optimal timing of intervention, and to prevent preterm birth after fetal surgery. Confronting a fetal abnormality raises unique and complex issues for the family. For this reason, in addition to a maternal-fetal medicine specialist experienced in prenatal diagnosis, a pediatric surgeon, an experienced operating room team including a knowledgeable anesthesiologist, and a neonatologist, the family considering fetal surgery should have access to psychosocial support and a bioethicist.
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