1
|
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: 2] [Impact Index Per Article: 2.0] [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.
Collapse
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
| |
Collapse
|
2
|
Abstract
Advances in prenatal screening and diagnosis, combined with an understanding of the pathophysiology of congenital anomalies, have brought incredible impetus to the field of fetal surgery. Identification of fetal anomalies can lead to counseling of the affected family so that informed decisions can be made on how to proceed with the pregnancy. Counseling may lead to pregnancy termination, changes in the timing or mode of delivery, and, in select cases, prenatal intervention. Open fetal surgery may be considered in severe cases of congenital diaphragmatic hernia, congenital chest lesions, sacrococcygeal teratoma, urinary tract obstruction, and myelomeningocele. The ex utero intrapartum treatment procedure may be lifesaving for fetuses with giant neck masses. Finally, fetoscopic surgery may be offered for select cases of twin-twin transfusion syndrome and twin reversed arterial perfusion sequence. Fetal intervention in all of these cases depends on a team approach to the patient and on the objective comparison of outcomes with and without fetal therapy. In the future, further understanding of the genetic basis of congenital diseases may enable minimally invasive treatments such as stem cell transplantation or gene therapy.
Collapse
Affiliation(s)
- Tippi C. Mackenzie
- Center for Fetal Diagnosis and Treatment, Children's Hospital of Philadelphia, Philadelphia, PA
| | - N. Scott Adzick
- Center for Fetal Diagnosis and Treatment, Children's Hospital of Philadelphia, Philadelphia, PA.
| |
Collapse
|
3
|
Dedushi K, Kabashi S, Mucaj S, Ramadani N, Hoxhaj A, Shatri J, Hasbahta G. Magnetic Resonance Imaging Verification of a Case of Sacrococcygeal Teratoma. World J Oncol 2016; 7:81-84. [PMID: 28983369 PMCID: PMC5624704 DOI: 10.14740/wjon965w] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/18/2016] [Indexed: 11/11/2022] Open
Abstract
Although rare, sacrococcygeal teratoma is the most common congenital neoplasm, occurring in 1 in 40,000 infants. Approximately 75% of affected infants are female. The aim of the present study was to correlate ultrasonography and magnetic resonance imaging (MRI) findings in patients with fetal sacrococcygeal teratoma. Three pregnant women in 27th week of gestation underwent fetal MRI after ultrasonography examination, with findings suggestive for fetal sacrococcygeal teratoma. Tumor size, location, extent and content were evaluated both by MRI and ultrasonography. Findings regarding tumor location, size and content were similar for both methods. There was a large well-circumscribed mixed, cystic/solid oval mass, originating from right sacro-gluteal region and projecting into the amniotic cavity, 132 × 110 × 76 mm in size. The mass had a heterogeneous appearance. The T1 high signal suggested fat component of the tumor, while T1 and T2 hypointense components suggested calcified/bony components. There was also T1 hypointense component consistent with cystic and fluid component. The imaging findings were characteristic for sacrococcygeal teratoma. There was not obvious lumbar or thoracic spinal involvement. There was no gross intrapelvic or abdominal extension, and even sacrum and coccyx appeared deformed. The amount of amniotic fluid was increased. MRI was superior to ultrasonography in the evaluation of the exact tumor extent, accurately demonstrating pelvic involvement in all of the three cases. Fetal MRI has shown to be a valuable adjunct to obstetric sonography in the evaluation of fetal sacrococcygeal teratoma, because of its higher accuracy in the determination of tumors extent and content, playing a significant role in the therapeutic planning and increasing the chances of cure for these fetuses.
Collapse
Affiliation(s)
- Kreshnike Dedushi
- Faculty of Medicine, Pristine University, Pristine City, 10000, Kosovo.,Department of Radiology, Diagnostic Centre, UCCK, Pristine City, 10000, Kosovo.,Diagnostic Center, International Health Center "IHC", Pristine City, 10000, Kosovo
| | - Serbeze Kabashi
- Faculty of Medicine, Pristine University, Pristine City, 10000, Kosovo.,Department of Radiology, Diagnostic Centre, UCCK, Pristine City, 10000, Kosovo
| | - Sefedin Mucaj
- Faculty of Medicine, Pristine University, Pristine City, 10000, Kosovo.,National Institute of Public Health of Kosovo, Pristine City, 10000, Kosovo
| | - Naser Ramadani
- Faculty of Medicine, Pristine University, Pristine City, 10000, Kosovo.,National Institute of Public Health of Kosovo, Pristine City, 10000, Kosovo
| | | | - Jeton Shatri
- Faculty of Medicine, Pristine University, Pristine City, 10000, Kosovo.,Department of Radiology, Diagnostic Centre, UCCK, Pristine City, 10000, Kosovo
| | - Gazmend Hasbahta
- Department of Radiology, Diagnostic Centre, UCCK, Pristine City, 10000, Kosovo
| |
Collapse
|
4
|
G R, R G, P S, G M, Lu D. Sacrococcygeal Teratoma: Mistreated With Repeated Aspirations. APSP J Case Rep 2016; 7:26. [PMID: 27398327 PMCID: PMC4921223 DOI: 10.21699/ajcr.v7i3.422] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2016] [Accepted: 05/22/2016] [Indexed: 11/29/2022] Open
Affiliation(s)
- Ramagopal G
- Department of Pediatrics, Chettinad Hospital and Research Institute, Kelambakkam, Chennai
| | - Guru R
- Department of Pediatrics, Chettinad Hospital and Research Institute, Kelambakkam, Chennai
| | - Suresh P
- Department of Pediatrics, Chettinad Hospital and Research Institute, Kelambakkam, Chennai
| | - Moorthy G
- Department of Pediatric Surgery Chettinad Hospital and Research Institute, Kelambakkam, Chennai
| | - Devi Lu
- Department of Pediatrics, Chettinad Hospital and Research Institute, Kelambakkam, Chennai
| |
Collapse
|
5
|
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: 33] [Impact Index Per Article: 4.1] [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.
Collapse
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
| |
Collapse
|
6
|
Ayed A, Tonks AM, Lander A, Kilby MD. A review of pregnancies complicated by congenital sacrococcygeal teratoma in the West Midlands region over an 18-year period: population-based, cohort study. Prenat Diagn 2015; 35:1037-47. [DOI: 10.1002/pd.4641] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2015] [Revised: 06/02/2015] [Accepted: 06/18/2015] [Indexed: 12/13/2022]
Affiliation(s)
- Amal Ayed
- The Fetal Medicine Centre; Birmingham Women's Foundation Trust; Birmingham UK
| | - Ann M. Tonks
- West Midlands Congenital Anomaly Register; Public Health England; Birmingham UK
| | | | - Mark D. Kilby
- The Fetal Medicine Centre; Birmingham Women's Foundation Trust; Birmingham UK
- Centre for Women's and Children's Health, Section Theme of Reproduction and Development, Institute of Metabolism & Allied Health Science; College of Medical and Dental Sciences; Birmingham UK
| |
Collapse
|
7
|
Adekola H, Mody S, Bronshtein E, Puder K, Abramowicz JS. The clinical relevance of fetal MRI in the diagnosis of Type IV cystic sacrococcygeal teratoma--a review. Fetal Pediatr Pathol 2015; 34:31-43. [PMID: 25183379 DOI: 10.3109/15513815.2014.949934] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
The introduction of fetal magnetic resonance imaging (MRI) has improved the prenatal evaluation of uterine, placental and fetal anatomy. However, its utilization has mostly been restricted to fetal central nervous system anomalies. We review how adjunct fetal MRI was performed and diagnosis of cystic type IV sacrococcygeal teratoma was made. We also discuss the clinical relevance of fetal MRI in differentiating this lesion from other selected abdominal/pelvic cystic malformations and lesions.
Collapse
Affiliation(s)
- Henry Adekola
- 1Department of Obstetrics and Gynecology, Hutzel Women Hospital, Wayne State University School of Medicine, Detroit Michigan
| | | | | | | | | |
Collapse
|
8
|
Abstract
Foetal counselling is best achieved by a multidisciplinary team that can favourably influence the perinatal management of prenatally diagnosed anomalies and provide this information to prospective parents. Prenatal diagnosis has remarkably improved our understanding of surgically correctable congenital malformations. It has allowed us to influence the delivery of the baby, offer prenatal surgical management and discuss the options of termination of pregnancy for seriously handicapping or lethal conditions. Antenatal diagnosis has also defined an in utero mortality for some lesions such as diaphragmatic hernia and sacrococcygeal teratoma so that true outcomes can be measured. The limitation of in-utero diagnosis cannot be ignored. The aim of prenatal counselling is to provide information to prospective parents on foetal outcomes, possible interventions, appropriate setting, time and route of delivery and expected postnatal outcomes, immediate and long term.
Collapse
Affiliation(s)
- Kokila Lakhoo
- Children's Hospital Oxford, John Radcliffe Hospital, University of Oxford, Headley Way, Headington, Oxford, United Kingdom.
| |
Collapse
|
9
|
Sacrococcygeal teratoma in infants and children. Acta Neurochir (Wien) 2011; 153:1781-6. [PMID: 21604208 DOI: 10.1007/s00701-011-1048-8] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2011] [Accepted: 05/05/2011] [Indexed: 10/18/2022]
Abstract
BACKGROUND The purpose of this study is to share our experience with extensive sacrococcygeal teratoma, paying particular attention to neurological function, intraoperative hemorrhage, rate of tumor recurrence, and the surgical procedure. METHODS Infants and children with sacrococcygeal teratoma were selected and generally examined in order to detect other associated anomalies. Patients with giant sacrococcygeal tumor and high output heart failure were managed by the abdominosacral route while patients with small sacrococcygeal tumor and normal cardiac function were managed by the sacral approach. All operated patients were observed and followed-up regularly for a period of 1-3 years after tumor excision. RESULTS This study presents 22 patients with sacrococcygeal teratoma managed over a period of 40 months; 18 patients presented in the first 2 months of life and four children aged 2-4 years. Fifteen patients were treated by sacral excision and seven patients were corrected by abdomenosacral excision and temporary colostomy. Benign teratoma presented in 17 patients, one of whom died (6%), and five patients had malignant tumor, one of whom died (20%). The fecal and urinary state was good in all patients treated by the sacral route. Patients corrected by abdominosacral excision showed varied degrees of urinary incontinence and constipation. Survival in excised malignant tumor was good following chemotherapy; three patients received chemotherapy with a 70% survival rate. CONCLUSION Benign sacrococcygeal teratoma has an excellent outcome after early surgery, but the incidences of malignancy increase if resection is delayed.
Collapse
|
10
|
Gucciardo L, Uyttebroek A, De Wever I, Renard M, Claus F, Devlieger R, Lewi L, De Catte L, Deprest J. Prenatal assessment and management of sacrococcygeal teratoma. Prenat Diagn 2011; 31:678-88. [DOI: 10.1002/pd.2781] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2011] [Revised: 04/14/2011] [Accepted: 04/20/2011] [Indexed: 11/08/2022]
|
11
|
Byrne FA, Lee H, Kipps AK, Brook MM, Moon-Grady AJ. Echocardiographic Risk Stratification of Fetuses with Sacrococcygeal Teratoma and Twin-Reversed Arterial Perfusion. Fetal Diagn Ther 2011; 30:280-8. [DOI: 10.1159/000330762] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2011] [Accepted: 07/09/2011] [Indexed: 11/19/2022]
|
12
|
Affiliation(s)
- Kokila Lakhoo
- Children's Hospital Oxford, John Radcliffe Hospital, University of Oxford, Headley Way, Headington, Oxford, OX3 9DU, UK.
| | | |
Collapse
|
13
|
Abstract
Teratomas are composed of multiple tissues foreign to the organ or site in which they arise. Their origin is postulated by 3 theories one of which is the origin from totipotent primodial germ cells. Anatomically, teratomas are divided into gonadal or extragonadal lesions and histologically they are classified as mature or immature tumors. Teratomas are mainy isolated lesions and may occur anywhere in the body. In the neonatal age group most of these tumors are benign and occur mainly in the sacrococcygeal area followed by the anterior mediastinum. Diagnosis is usually established prenatally and may require intervention in compromised fetuses. Postnatal imaging with ultrasound, CT scan or MRI provides useful information for surgical intervention. Complete surgical excision is the treatment of choice for neonatal teratomas. Alpha feto protein is the tumor marker of choice and is particularly useful for assessing the presence of residual or recurrent disease.
Collapse
Affiliation(s)
- Kokila Lakhoo
- Children's Hospital Oxford, John Radcliffe Hospital, University of Oxford, Headley Way, Headington, Oxford OX3 9DU, United Kingdom.
| |
Collapse
|
14
|
Holcroft CJ, Blakemore KJ, Gurewitsch ED, Driggers RW, Northington FJ, Fischer AC. Large fetal sacrococcygeal teratomas: could early delivery improve outcome? Fetal Diagn Ther 2008; 24:55-60. [PMID: 18504383 DOI: 10.1159/000132408] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2006] [Accepted: 04/02/2007] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To determine if gestational age (GA) at delivery or tumor size impacts outcome in neonates with very large sacrococcygeal teratomas (SCTs). METHODS Retrospective chart review from 1990 to 2006 of live-born infants with very large SCTs, defined as diameters exceeding 10 cm. Data analyzed using the independent t test and Fisher's exact test, with p values <0.05 considered significant. RESULTS Nine infants with very large SCTs were identified. Six of the 9 infants survived, 4 of whom had evidence of early hydrops. Mean GA of survivors was 32.2 +/- 3.7 versus 31.7 +/- 0.6 weeks in nonsurvivors (p = 0.85). Infants with the largest SCTs did not survive. CONCLUSION Risks of preterm delivery must be weighed against complications from further enlargement of very large SCTs and against the risks of in utero intervention.
Collapse
Affiliation(s)
- Cynthia J Holcroft
- Department of Gynecology and Obstetrics, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
| | | | | | | | | | | |
Collapse
|
15
|
Affiliation(s)
- Kokila Lakhoo
- John Radcliffe Hospital, University of Oxford, Headley Way, Headington, Oxford, OX3 9DU, UK.
| |
Collapse
|
16
|
Sy ED, Lee H, Ball R, Farrell J, Poder L, Nobuhara KK, Farmer DL, Harrison MR. Spontaneous Rupture of Fetal Sacrococcygeal Teratoma. Fetal Diagn Ther 2006; 21:424-7. [PMID: 16912491 DOI: 10.1159/000093884] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2005] [Accepted: 10/14/2005] [Indexed: 11/19/2022]
Abstract
With recent advances in technology, fetal sacrococcygeal teratoma is being diagnosed increasingly during the early prenatal period by ultrasound examination. In addition, early detection of tumor related complications such as polyhydramnios, congestive heart failure, hydrops, hemorrhage, urinary tract or bowel obstruction can be followed closely in utero. Active prenatal management can improve fetal perinatal outcome by allowing planned delivery for neonatal surgery [Chisholm, C.A. et al.: Am J Perinatol 1999;16:47-50] or in some cases, fetal intervention. Additionally, families can be counseled appropriately regarding the range of outcomes. We report a case of fetal sacrococcygeal teratoma Type I diagnosed at 20 weeks with a prominent vessel supplying the tumor mass. At 23 weeks, there was a sudden appearance of an additional lobular mass, consistent with intrauterine spontaneous ruptured of a sacrococcygeal teratoma mass.
Collapse
Affiliation(s)
- Edgar D Sy
- Fetal Treatment Center, University of California, San Francisco, Calif., USA
| | | | | | | | | | | | | | | |
Collapse
|
17
|
Ayzen M, Ball R, Nobuhara KK, Farmer DL, Harrison MR, Lee H. Monochorionic twin gestation complicated by a sacrococcygeal teratoma with hydrops--optimal timing of delivery allows for survival of the unaffected twin. J Pediatr Surg 2006; 41:e11-3. [PMID: 16863829 DOI: 10.1016/j.jpedsurg.2006.04.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Sacrococcygeal teratomas are the most common tumors found in newborns and have a favorable outcome when diagnosed late in gestation. Solid, highly vascularized tumors diagnosed early in gestation have a higher incidence of hydrops fetalis and fetal demise. The following is a case report of a monochorionic twin gestation complicated by a solid highly vascular sacrococcygeal teratoma and the development of hydrops in the affected twin. In this case, serial ultrasound evaluations and timing of delivery optimized the outcome of the unaffected twin.
Collapse
Affiliation(s)
- Marsha Ayzen
- Division of Pediatric Surgery, Department of Surgery, University of California, San Francisco, CA 94143, USA
| | | | | | | | | | | |
Collapse
|
18
|
Affiliation(s)
- Deborah F Billmire
- Section of Pediatric Surgery, JW Riley Hospital for Children, Suite 2500, Barnhill Drive, Indianapolis, IN 46202, USA.
| |
Collapse
|
19
|
Abstract
Sacrococcygeal teratoma is the most common congenital tumor of the fetus, consisting of all three germ cell layers. These layers are commonly large and vascular, causing the blood to be shunted to the tumor. This creates the vascular steal syndrome, resulting in fetal hydrops and cardiac failure. Large tumors may also cause polyhydramnios, resulting in premature labor. Treatment options include open fetal surgery and radio frequency ablation, as well as complete tumor resection following delivery. Serial sonographic examinations are important in the management of the pregnancy, from diagnosis to treatment and delivery.
Collapse
|
20
|
Abstract
BACKGROUND/PURPOSE Germ cell tumors are relatively common in the fetus and neonate and are the leading neoplasms in some perinatal reviews. The purpose of this study is to focus on the fetus and neonate in an attempt to determine the various ways germ cell tumors differ clinically and morphologically from those occurring in the older child and adult and to show that certain types of tumors have a better prognosis than others. METHODS The author conducted a retrospective review of perinatal teratomas and other germ cell tumors reported in the literature and of patients treated and followed up at Children's Hospital San Diego and Children's Hospital Los Angeles. Only fetuses and infants less than 2 months of age with adequate clinical and pathologic data were accepted for review. RESULTS Five hundred thirty-four fetuses and neonates presented with teratomas diagnosed prenatally (n = 226) and at birth (n = 309). The most common initial finding was a mass, noted either by antenatal sonography or by physical examination during the neonatal period, with signs and symptoms referable to the site of origin. Overall polyhydramnios was next followed by respiratory distress and stillbirth. The number of mature and immature teratomas was approximately the same. The incidence of teratoma with yolk sac tumor either at presentation or at recurrence was 5.8%, and the survival rate was 39%. Sacrococcygeal teratomas had the highest incidence of yolk sac tumor at 10%. Recurrent disease in the form of either teratoma or yolk sac tumor developed in 5% of patients. All individuals with teratomas who survived received surgical resection. CONCLUSIONS Some germ cell tumors of the fetus and neonate have a better prognosis than others. Neonates with gastric teratomas have the best survival rates, and those with intracranial germ cell tumors the worst. Fetuses with teratomas detected antenatally have 3 times the mortality rate compared with postnatally diagnosed neonates. Although perinatal teratomas have a relatively low recurrence rate of 5%, close follow-up with imaging studies and serum alpha-fetoprotein determinations is is strongly recommended. Surgical resection alone may be adequate therapy for teratomas with nonmetastatic, microscopic foci of yolk sac tumor. In the nonteratoma group, patients with pure yolk sac tumor and gonadoblastoma have a much better outcome than those with choriocarcinoma, which has a very low survival of rate of 12%. Currently, the use of platinum-based combination chemotherapy has significantly improved the survival rate of infants with advanced malignant germ cell tumor disease.
Collapse
Affiliation(s)
- Hart Isaacs
- Department of Pathology, Children's Hospital San Diego, San Diego, CA 92123, USA
| |
Collapse
|
21
|
Hedrick HL, Flake AW, Crombleholme TM, Howell LJ, Johnson MP, Wilson RD, Adzick NS. Sacrococcygeal teratoma: prenatal assessment, fetal intervention, and outcome. J Pediatr Surg 2004; 39:430-8; discussion 430-8. [PMID: 15017565 DOI: 10.1016/j.jpedsurg.2003.11.005] [Citation(s) in RCA: 148] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
PURPOSE To understand the natural history and define indications for fetal intervention in sacrococcygeal teratoma (SCT), the authors reviewed all cases of fetal SCT presenting for evaluation. METHODS Prenatal diagnostic studies including ultrasound scan, magnetic resonance imaging (MRI), echocardiography and pre- and postnatal outcomes were reviewed in 30 cases of SCT that presented between September 1995 and January 2003. RESULTS The mean gestational age (GA) at presentation was 23.9 weeks (range, 19 to 38.5) with 3 sets of twins (10%). Overall outcomes included 4 terminations, 5 fetal demises, 7 neonatal deaths, and 14 survivors. Significant obstetric complications occurred in 81% of the 26 continuing pregnancies: polyhydramnios (n = 7), oligohydramnios (n = 4), preterm labor (n = 13), preeclampsia (n = 4), gestational diabetes (n = 1), HELLP syndrome (n = 1), and hyperemesis (n = 1). Fetal intervention included cyst aspiration (n = 6), amnioreduction (n = 3), amnioinfusion (n = 1), and open fetal surgical resection (n = 4). Indications for cyst aspiration and amnioreduction were maternal discomfort, preterm labor, and prevention of tumor rupture at delivery. Although 15 SCTs were solid causing risk for cardiac failure, only 4 fetuses met criteria for fetal debulking based on ultrasonographic and echocardiographic evidence of impending high output failure and favorable anatomy at 21, 23.6, 25, and 26 weeks' gestation. Intraoperative events included maternal blood transfusion (n = 1), fetal blood transfusion (n = 2), chorioamniotic membrane separation (n = 2), and fetal arrest requiring successful cardiopulmonary resuscitation (CPR) (n = 1). In the fetal resection group, 3 of 4 survived with mean GA at delivery of 29 weeks (range, 27.6 to 31.7 weeks), mean birth weight of 1.3 kg, hospital stay ranging from 16 to 34 weeks, and follow-up ranging from 20 months to 6 years. Postnatal complications in the fetal surgery group included neonatal death (n = 1, secondary to premature closure of ductus arteriosus with cardiac failure), embolic event (n = 1, resulting in unilateral renal agenesis, jejunal atresia), chronic lung disease (n = 1), and tumor recurrence (n = 1). CONCLUSIONS For fetal SCT, the rapidity at which cardiac compromise can develop and the high incidence of obstetric complications warrant close prenatal surveillance. Amnioreduction, cyst aspiration, and surgical debulking are potentially life-saving interventions.
Collapse
Affiliation(s)
- Holly L Hedrick
- Center for Fetal Diagnosis and Treatment, The Children's Hospital of Philadelphia, Philadelphia, PA 19104-4399, USA
| | | | | | | | | | | | | |
Collapse
|
22
|
Abstract
An extensive analysis of the existing literature concerning sacral tumors was conducted to characterize their clinical manifestations. Although certain specific manifestations can be attributed to some of the tumor types, a more general pattern of clinical presentation of an expansive sacral lesion can be elaborated. Local pain with or without pseudoradicular or radicular radiation is the most frequent initial symptom and is usually followed by the manifestation of a lumbosacral sensorimotor deficit; bladder/bowel and/or sexual dysfunction appear throughout the natural course of disease.
Collapse
Affiliation(s)
- Michael Payer
- Department of Neurosurgery, University Hopital of Geneva, Switzerland.
| |
Collapse
|
23
|
Bonilia-Musoles F, Machado LE, Raga F, Osborne NG, Bonilla F. Prenatal diagnosis of sacrococcygeal teratomas by two- and three-dimensional ultrasound. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2002; 19:200-205. [PMID: 11876816 DOI: 10.1046/j.0960-7692.2001.00613.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
We suspected two fetuses of having sacrococcygeal teratomas following initial two-dimensional ultrasound scanning at 18 and 22 weeks' gestation. The fetuses were then scanned with three-dimensional multiplanar surface and three-dimensional orthogonal planar ultrasound to establish a definitive diagnosis. Although we made a presumptive diagnosis in both cases after initial two-dimensional scanning, with three-dimensional ultrasound we were better able to define the degree of involvement of the sacrum and other pelvic structures of prognostic importance.
Collapse
Affiliation(s)
- F Bonilia-Musoles
- Departamento de Obstetricia y Ginecología, Facultad de Medicina, Universidad de Valencia, Valencia, Spain
| | | | | | | | | |
Collapse
|
24
|
Avni FE, Guibaud L, Robert Y, Segers V, Ziereisen F, Delaet MH, Metens T. MR imaging of fetal sacrococcygeal teratoma: diagnosis and assessment. AJR Am J Roentgenol 2002; 178:179-83. [PMID: 11756117 DOI: 10.2214/ajr.178.1.1780179] [Citation(s) in RCA: 83] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE The purpose of this study was to evaluate the usefulness of MR imaging in the diagnosis and assessment of fetal sacrococcygeal teratoma and to determine if MR imaging provides information not seen on obstetric sonography. SUBJECTS AND METHODS Twelve pregnant women were referred for fetal MR imaging of sacrococcygeal teratoma seen at obstetric sonography. The presence, size, content extension, and compressive effects of each mass were determined and correlated with the sonographic findings and with postnatal studies, including surgery and pathology. The extent of each sacrococcygeal teratoma was classified according to the American Association of the Pediatrics Surgery Section (types I-IV). RESULTS There is a complete agreement of sonographic and MR imaging measurements. The sacrococcygeal teratomas appeared cystic with few septa in three fetuses, markedly septated or even microcystic in eight, and completely solid in one. The sonographic description of the content corresponded well to MR imaging findings in 10 of 12 fetuses. An agreement on the extent of each mass was observed in nine patients, whereas there is a disagreement in three, including in one fetus with an extension of the tumor within the spinal canal recognized only at MR imaging. The MR imaging findings were confirmed by postnatal studies in 10 patients. CONCLUSION Sacrococcygeal teratomas had characteristic MR imaging appearances that allowed a complete assessment in most fetuses. Because of MR imaging, the prenatal evaluation was changed in some patients and affected counseling of the parents and treatment. MR imaging is a valuable adjunct to obstetric sonography for the prenatal evaluation of sacrococcygeal teratoma.
Collapse
Affiliation(s)
- Fred E Avni
- Department of Pediatric Imaging, University Children Hospital Queen Fabiola, 15 Ave. J J Crocq, 1020 Brussels, Belgium
| | | | | | | | | | | | | |
Collapse
|
25
|
|
26
|
Affiliation(s)
- R Tuladhar
- Department of Neonatology, Kirwan Hospital for Women, Queensland 4817, Australia
| | | | | |
Collapse
|