The Outcomes of Treatment for Sacrococcygeal Teratoma: The 24-year Experiences

CS Gong; SC Kim; DY Kim; IK Kim; JM Namgung; JH Hwang; JJ Kim

doi:10.13029/jkaps.2013.19.2.81

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The Outcomes of Treatment for Sacrococcygeal Teratoma: The 24-year Experiences

CS Gong, M.D., SC Kim, M.D., DY Kim, M.D., IK Kim, M.D.¹, JM Namgung, M.D., JH Hwang, M.D., JJ Kim, M.D.²

Journal of the Korean Association of Pediatric Surgeons 2013;19(2):81-89.
Published online: December 24, 2013

DOI: https://doi.org/10.13029/jkaps.2013.19.2.81

Pediatric Surgery, University of Ulsan College of Medicine and Asan Medical Center, Seoul, Korea.

¹Department of Surgery, University of Ulsan College of Medicine and GangNeung Asan Medical Center, GangNeung, Korea.

²Department of Pathology, University of Ulsan College of Medicine and Asan Medical Center, Seoul, Korea.

Correspondence: Seong-Chul Kim, M.D., Division of Pediatric surgery, Asan Medical Center, Asanbyeongwon-gil 86, Sonpa-gu, Seoul 138-736, Korea. Tel: 02)3010-3498, Fax: 02)474-6701, sckim@amc.seoul.kr

• Received: August 28, 2013 • Accepted: November 21, 2013

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ABSTRACT
REFERENCES

ABSTRACT

The purposes of this study was to describe the clinical correlation of mass size and gestational age, prognostic factors in sacrococcygeal teratoma (SCT) at a tertiary pediatric surgery, University of Ulsan College of Medicine and Asan Medical Center (AMC), Seoul, Korea. Fifty five patients admitted to the AMC with a SCT between May 1989 and April 2013 were included in this retrospective review. Mean follow up was 861 days. Mean maternal age at delivery was 30 ± 2.7 year, mean gestational age (GA) was 36.9 ± 3.6wks, and preterm delivery was 21.8%. Birth body weight was 3182 ± 644 g and male vs. female ratio was 1:2.05. We can't find significant difference between Caesarean section and maternal age at delivery (p = 0.817). But, caesarean section was favored by gestational age (p = 0.002), larger tumor size (p = 0.029) or higher tumor weight fraction rate to birth body weight (p = 0.024). Type I was 13, II 21, III 17, and IV 3 according to Altman et al. classification. The tumor component was predominantly cystic(>50%) in 73.1%. And the majority histological classification of tumors were mature teratoma (70.3%). The motality rate was 5.5%. Three patients expired because of postpartum bleeding, post-op bleeding related complication such as DIC. SCT recurred in four patients. The interval between first and second operation was 206.2 ± 111.0 d (range 53~325 d). In two patients, serum AFP levels were elevated at a regular checkup without any symptom, and subsequent imaging studies revealed SCT. The most common cause of death was bleeding and bleeding related complication. So Caesarean section and active peripartum and perioperative management will be needed for huge solid SCT. In the case of Yolk sac tumor or huge immature teratoma, possibility of recurrence have to be always considered, so follow up by serial AFP and MRI is important for SCT management.
Keywords: Sacrococcygeal teratoma; Teratoma; Delivery; Preterm

REFERENCES

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16. Yoshida M, Matsuoka K, Nakazawa A, et al. Sacrococcygeal yolk sac tumor developing after teratoma: A clinicopathological study of pediatric sacrococcygeal germ cell tumors and a proposal of the pathogenesis of sacrococcygeal yolk sac tumors. J Pediatr Surg 2013;48(4):776-781.

Fig. 1

Histological classification

MT; Mature teratoma, IMT; Immature teratoma, YST; York sac tumor, Gr;Grade ^* Three patients with mixed type consisting of YST and mature and immature teratoma are included in this group

Fig. 2

Duration of operation and Mass size by univariate linear regression analyses

Table 1

Demographics of the Patients

Values are presentated mean ± SD (range) or number (%)

Table 2

Route of Delivery (Vaginal vs. Cesarean delivery)

Values are presentated mean ± SD

Statistical significances were tested by Oneway analysis among group

Table 3

Gestational Age and Mass Size (P<0.001)

M; Mass size

Values are presentated number (%)

Table 4

Types and Tumor Component and Duration of Operation

Values are presentated mean ± SD or number

Statistical significances were tested by Oneway analysis among group

Table 5

Postoperative Morbidity and Mortality Cases of Sacrococcygeal Teratoma Patients

GA; Gestational Age, B.Wt; Birth Body Weight, V/D; Vaginal delivery, C/S; Caesarean section, AS; Apgar Score, Bx.; Biopsy (histological classification), IMT; Immature teratoma, MT; Mature teratoma, Gr; Grade, DIC; Disseminated Intravascular Coagulation

Table 6

Recurrence Cases of Sacrococcygeal Teratoma Patients

1^st op. ; Age at 1^st operation, Interval; The interval between first and second operation, Bx.; Biopsy(histological classification), 2^nd Bx; The biopsy result of recurred tumor, MT; Mature teratoma, IMT; Immature teratoma, YST; York sac tumor, Gr; Grade

^* IMT Gr3 40 %, MT 50 %, YST < 10 %

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The Outcomes of Treatment for Sacrococcygeal Teratoma: The 24-year Experiences

J Korean Assoc Pediatr Surg. 2013;19(2):81-89. Published online December 24, 2013

DOI: https://doi.org/10.13029/jkaps.2013.19.2.81

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The Outcomes of Treatment for Sacrococcygeal Teratoma: The 24-year Experiences

J Korean Assoc Pediatr Surg. 2013;19(2):81-89. Published online December 24, 2013

DOI: https://doi.org/10.13029/jkaps.2013.19.2.81

Figure

The Outcomes of Treatment for Sacrococcygeal Teratoma: The 24-year Experiences

Fig. 1 Histological classification MT; Mature teratoma, IMT; Immature teratoma, YST; York sac tumor, Gr;Grade * Three patients with mixed type consisting of YST and mature and immature teratoma are included in this group

Fig. 2 Duration of operation and Mass size by univariate linear regression analyses

Fig. 1

Fig. 2

The Outcomes of Treatment for Sacrococcygeal Teratoma: The 24-year Experiences

Table 1

Demographics of the Patients

Values are presentated mean ± SD (range) or number (%)

Table 2

Route of Delivery (Vaginal vs. Cesarean delivery)

Values are presentated mean ± SD

Statistical significances were tested by Oneway analysis among group

Table 3

Gestational Age and Mass Size (P<0.001)

M; Mass size

Values are presentated number (%)

Table 4

Types and Tumor Component and Duration of Operation

Values are presentated mean ± SD or number

Statistical significances were tested by Oneway analysis among group

Table 5

Postoperative Morbidity and Mortality Cases of Sacrococcygeal Teratoma Patients

Table 6

Recurrence Cases of Sacrococcygeal Teratoma Patients

^* IMT Gr3 40 %, MT 50 %, YST < 10 %

Table 1 Demographics of the Patients

Values are presentated mean ± SD (range) or number (%)

Table 2 Route of Delivery (Vaginal vs. Cesarean delivery)

Values are presentated mean ± SD

Statistical significances were tested by Oneway analysis among group

Table 3 Gestational Age and Mass Size (P<0.001)

M; Mass size

Values are presentated number (%)

Table 4 Types and Tumor Component and Duration of Operation

Values are presentated mean ± SD or number

Statistical significances were tested by Oneway analysis among group

Table 5 Postoperative Morbidity and Mortality Cases of Sacrococcygeal Teratoma Patients

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