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, 2015, 398549

Long-Term Outcomes of Sacrococcygeal Germ Cell Tumors in Infancy and Childhood

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Long-Term Outcomes of Sacrococcygeal Germ Cell Tumors in Infancy and Childhood

Rangsan Niramis et al. Surg Res Pract.

Abstract

Purpose. The aim of this study was to evaluate long-term outcomes of sacrococcygeal germ cell tumors (SC-GCTs) over a 15-year period. Materials and Methods. A retrospective review was conducted of all pediatric patients treated for SC-GCTs at our hospital from 1998 to 2012. Results. Fifty-seven patients were treated for SC-GCTs with the most common in Altman's classification type I. Age at surgery ranged from one day to 5.6 years. Tumor resection and coccygectomy were primarily performed in about 84% of the cases. Pathology revealed mature, immature, malignant sacrococcygeal teratomas (SCTs), and endodermal sinus tumors (ESTs) in 41 (72%), 4 (77%), 6 (10.5%), and 6 (10.5%), respectively. Recurrence of discase occurred in 3 of 41 patients with mature teratomas (7.3%); 2 recurrences with mature teratomas and one recurrence with EST. Five of 6 malignant SCTs and 3 of 6 ESTs responded well to the treatment. Alpha-fetoprotein (AFP) level was elevated in both malignant teratomas and ESTs. No immediate patient death was noted in any of the 57 cases, but 4 patients with malignant tumors and distant metastasis succumbed at home within 2 years of the initial treatment. Conclusion. Benign SCTs have a significant recurrence rate of approximately 7%. Close follow-up with serial AFP level monitoring should be done for 5 years after initial tumor resection and coccygectomy. The survival rate for malignant SC-GCTs with distant metastasis was unfavorable in the present study.

Figures

Figure 1
Figure 1
Development of germ cell tumors.
Figure 2
Figure 2
Classification system for 57 sacrococcygeal germ cell tumors based on Altman's American Academy of Pediatrics series [7].
Figure 3
Figure 3
Resection of a type I sacrococcygeal teratoma; (a) the patient in frog-legged position (b) mobilization of the tumor, (c) exposure of the coccyx, and (d) removal of the tumor and coccyx.

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