Sacrococcygeal teratoma surgery: Difference between revisions

Jump to navigation Jump to search
VisualWikitext
(Created page with "'''For patient information click here''' {{Sacrococcygeal teratoma}} {{CMG}} ==Overview== '''Sacrococcygeal teratoma''' (SC...")
 
No edit summary
 
(20 intermediate revisions by 5 users not shown)
Line 1: Line 1:
'''For patient information click [[Sacrococcygeal teratoma (patient information)|here]]'''
__NOTOC__
 
{{Sacrococcygeal teratoma}}
{{Sacrococcygeal teratoma}}
{{CMG}}
{{CMG}}{{AE}}{{MGS}}


==Overview==
==Overview==
'''Sacrococcygeal teratoma''' (SCT) is a [[teratoma]] (a kind of tumor) located at the base of the [[coccyx]] (tailbone). It is thought to be a derivative of the [[primitive streak]].
[[Perinatal period|Perinatal]] [[Surgery|surgical]] intervention is used to decrease [[cardiovascular]] [[Complication (medicine)|complications]] caused by the large sacrococcygeal teratoma. Early complete [[resection]] is the mainstay of management of [[benign tumor]]. Complete [[Surgery|surgical]] [[excision]] in [[malignant]] sacrococcygeal teratoma is followed by [[Chemotherapy|platinum based chemotherapy]].
Management of most fetal SCTs involves [[watch and wait]], also known as [[expectant management]].  An often used [[decision tree]] is as follows:


*Perform detailed ultrasound exam including fetal [[echocardiogram]] and [[Doppler]] [[Data-flow analysis|flow analysis]]
==Surgery==
**If fetal high output failure, placentomegaly, or [[hydrops]]
===Perinatal Management===
***If fetus not mature, perform [[pregnancy termination]] or [[fetal intervention]]
[[Perinatal period|Perinatal]] intervention is only used to decrease [[cardiovascular]] [[Complication (medicine)|complications]] caused by the parasitic mass.<ref name="tt">{{cite journal |vauthors=Roybal JL, Moldenhauer JS, Khalek N, Bebbington MW, Johnson MP, Hedrick HL, Adzick NS, Flake AW |title=Early delivery as an alternative management strategy for selected high-risk fetal sacrococcygeal teratomas |journal=J. Pediatr. Surg. |volume=46 |issue=7 |pages=1325–32 |year=2011 |pmid=21763829 |doi=10.1016/j.jpedsurg.2010.10.020 |url=}}</ref>
***Else fetus mature, perform emergency [[Cesarean section]]
====Open Fetal Surgery====
**Else no emergent problems, perform serial [[non-stress test]]s and ultrasound [[biophysical profile]]s and plan delivery
*Open [[Fetus|fetal]] [[surgery]] is the option at some specialized centers.
***If emergent problems develop, return to top of decision tree
*[[Contraindication]] to open [[Fetus|fetal]] [[surgery]]:
***Else if SCT over 5–10cm or [[polyhydramnios]], perform early (37 weeks gestation) [[Caesarean delivery on maternal request|elective Cesarean]] section
:*Type III or IV Altman type [[Tumor|tumors]]
***Else SCT small and no complications, permit term [[spontaneous vaginal delivery]]
:*Severe [[placentomegaly]]
:*[[Cervix|Cervical]] shortening
:*Maternal [[medical conditions]]
====Minimally Invasive in Utero Procedures====
*[[Laser ablation]]<ref>{{cite journal |vauthors=Makin EC, Hyett J, Ade-Ajayi N, Patel S, Nicolaides K, Davenport M |title=Outcome of antenatally diagnosed sacrococcygeal teratomas: single-center experience (1993-2004) |journal=J. Pediatr. Surg. |volume=41 |issue=2 |pages=388–93 |year=2006 |pmid=16481257 |doi=10.1016/j.jpedsurg.2005.11.017 |url=}}</ref><ref>{{cite journal |vauthors=Hecher K, Hackelöer BJ |title=Intrauterine endoscopic laser surgery for fetal sacrococcygeal teratoma |journal=Lancet |volume=347 |issue=8999 |pages=470 |year=1996 |pmid=8618503 |doi= |url=}}</ref>
*[[Radiofrequency ablation]]<ref>{{cite journal |vauthors=Lam YH, Tang MH, Shek TW |title=Thermocoagulation of fetal sacrococcygeal teratoma |journal=Prenat. Diagn. |volume=22 |issue=2 |pages=99–101 |year=2002 |pmid=11857611 |doi= |url=}}</ref><ref>{{cite journal |vauthors=Paek BW, Jennings RW, Harrison MR, Filly RA, Tacy TA, Farmer DL, Albanese CT |title=Radiofrequency ablation of human fetal sacrococcygeal teratoma |journal=Am. J. Obstet. Gynecol. |volume=184 |issue=3 |pages=503–7 |year=2001 |pmid=11228510 |doi=10.1067/mob.2001.110446 |url=}}</ref>
*[[Urinary bladder|Bladder]] drainage for [[obstructive uropathy]]<ref>{{cite journal |vauthors=Wilson RD, Hedrick H, Flake AW, Johnson MP, Bebbington MW, Mann S, Rychik J, Liechty K, Adzick NS |title=Sacrococcygeal teratomas: prenatal surveillance, growth and pregnancy outcome |journal=Fetal. Diagn. Ther. |volume=25 |issue=1 |pages=15–20 |year=2009 |pmid=19122459 |doi=10.1159/000188056 |url=}}</ref><ref>{{cite journal |vauthors=Scrimgeour EM, Brown P |title=BSE and potential risks to slaughtermen |journal=Vet. Rec. |volume=129 |issue=17 |pages=390–1 |year=1991 |pmid=1746122 |doi= |url=}}</ref>
*[[Cyst]] [[aspiration]]<ref>{{cite journal |vauthors=Lee MY, Won HS, Hyun MK, Lee HY, Shim JY, Lee PR, Kim A |title=Perinatal outcome of sacrococcygeal teratoma |journal=Prenat. Diagn. |volume=31 |issue=13 |pages=1217–21 |year=2011 |pmid=22024911 |doi=10.1002/pd.2865 |url=}}</ref>
===Delivery Option===
'''Fetus with High-risk Sacrococcygeal Teratoma'''<ref name="tt">{{cite journal |vauthors=Roybal JL, Moldenhauer JS, Khalek N, Bebbington MW, Johnson MP, Hedrick HL, Adzick NS, Flake AW |title=Early delivery as an alternative management strategy for selected high-risk fetal sacrococcygeal teratomas |journal=J. Pediatr. Surg. |volume=46 |issue=7 |pages=1325–32 |year=2011 |pmid=21763829 |doi=10.1016/j.jpedsurg.2010.10.020 |url=}}</ref>
*Early [[Childbirth|delivery]] by [[Caesarean section|cesarean section]] after 28 weeks of [[gestation]]
'''Fetus with Low-risk Sacrococcygeal Teratoma'''<ref name="tt">{{cite journal |vauthors=Roybal JL, Moldenhauer JS, Khalek N, Bebbington MW, Johnson MP, Hedrick HL, Adzick NS, Flake AW |title=Early delivery as an alternative management strategy for selected high-risk fetal sacrococcygeal teratomas |journal=J. Pediatr. Surg. |volume=46 |issue=7 |pages=1325–32 |year=2011 |pmid=21763829 |doi=10.1016/j.jpedsurg.2010.10.020 |url=}}</ref>
*[[Childbirth|Delivery]] by [[Caesarean section|cesarean section]] after 36 weeks of [[gestation]]
'''Fetus with Small Tumor''' '''(< 5cm)'''<ref>{{cite journal |vauthors=Okada T, Sasaki F, Cho K, Honda S, Naito S, Hirokata G, Todo S |title=Management and outcome in prenatally diagnosed sacrococcygeal teratomas |journal=Pediatr Int |volume=50 |issue=4 |pages=576–80 |year=2008 |pmid=18937757 |doi=10.1111/j.1442-200X.2008.02703.x |url=}}</ref>
*[[Vagina|Vaginal]] [[Childbirth|delivery]]


Emergent problems include maternal [[mirror syndrome]], [[polyhydramnios]], and [[preterm labor]].  Poor management decisions, including interventions that are either premature or delayed, can have dire consequences.<ref name="pmid11965727">{{cite journal
===Postnatal Management===
| author = Mazneĭkova V, Dimitrova V
====Benign Sacrococcygeal Teratoma====
| title = [Prenatal ultrasonographic diagnosis of four cases of sacrococcygeal teratoma]
Early complete [[resection]] is the mainstay of management of [[benign tumor]].<ref name="txchemo">{{cite journal |vauthors=Marina NM, Cushing B, Giller R, Cohen L, Lauer SJ, Ablin A, Weetman R, Cullen J, Rogers P, Vinocur C, Stolar C, Rescorla F, Hawkins E, Heifetz S, Rao PV, Krailo M, Castleberry RP |title=Complete surgical excision is effective treatment for children with immature teratomas with or without malignant elements: A Pediatric Oncology Group/Children's Cancer Group Intergroup Study |journal=J. Clin. Oncol. |volume=17 |issue=7 |pages=2137–43 |year=1999 |pmid=10561269 |doi= |url=}}</ref>
| language = Bulgarian
*Complete [[excision]] must include removal of [[coccyx]] and early ligation of [[Sacrum|sacral]] [[Blood vessel|blood vessels]].<ref>{{cite journal |vauthors=Ein SH, Mancer K, Adeyemi SD |title=Malignant sacrococcygeal teratoma--endodermal sinus, yolk sac tumor--in infants and children: a 32-year review |journal=J. Pediatr. Surg. |volume=20 |issue=5 |pages=473–7 |year=1985 |pmid=3903096 |doi= |url=}}</ref>
| journal = Akusherstvo i ginekologii͡a
*If complete [[resection]] can not be achieved with first [[surgery]], a second [[surgery]] must be performed.<ref>{{cite journal |vauthors=Calaminus G, Schneider DT, Bökkerink JP, Gadner H, Harms D, Willers R, Göbel U |title=Prognostic value of tumor size, metastases, extension into bone, and increased tumor marker in children with malignant sacrococcygeal germ cell tumors: a prospective evaluation of 71 patients treated in the German cooperative protocols Maligne Keimzelltumoren (MAKEI) 83/86 and MAKEI 89 |journal=J. Clin. Oncol. |volume=21 |issue=5 |pages=781–6 |year=2003 |pmid=12610174 |doi= |url=}}</ref>
| volume = 38
| issue = 1
| pages = 64-9
| year = 1999
| pmid = 11965727
| doi =  
| issn =  
}}</ref><ref name="pmid17525561">{{cite journal
| author = Sheil AT, Collins KA
| title = Fatal birth trauma due to an undiagnosed abdominal teratoma: case report and review of the literature
| journal = The American journal of forensic medicine and pathology : official publication of the National Association of Medical Examiners
| volume = 28
| issue = 2
| pages = 121-7
| year = 2007
| pmid = 17525561
| doi = 10.1097/01.paf.0000257373.91126.0d
| issn =  
}}</ref>


In many cases, a fetus with a small SCT (under 5 or 10 cm) may be delivered vaginally.<ref name="pmid12475573">{{cite journal
====Malignant Sacrococcygeal Teratoma====
| author = Anteby EY, Yagel S
*Complete [[Surgery|surgical]] [[excision]] in [[malignant]] sacrococcygeal teratoma is followed by [[Chemotherapy|platinum based chemotherapy]].
| title = Route of delivery of fetuses with structural anomalies
*Most widely used combination of [[chemotherapy]] is [[Bleomycin]], [[etoposide]], [[cisplatin]] or [[carboplatin]].
| journal = Eur. J. Obstet. Gynecol. Reprod. Biol.
| volume = 106
| issue = 1
| pages = 5-9
| year = 2003
| pmid = 12475573
| doi =
| issn =
}}</ref><ref name="pmid11336088">{{cite journal
| author = Ruangtrakool R, Nitipon A, Laohapensang M, ''et al''
| title = Sacrococcygeal teratoma: 25 year experience
| journal = Journal of the Medical Association of Thailand = Chotmaihet thangphaet
| volume = 84
| issue = 2
| pages = 265-73
| year = 2001
| pmid = 11336088
| doi =
| issn =
}}</ref><ref name="pmid8458172">{{cite journal
| author = McCurdy CM, Seeds JW
| title = Route of delivery of infants with congenital anomalies
| journal = Clinics in perinatology
| volume = 20
| issue = 1
| pages = 81-106
| year = 1993
| pmid = 8458172
| doi =
| issn =
}}</ref><ref name="pmid2205995">{{cite journal
| author = Kainer F, Winter R, Hofmann HM, Karpf EF
| title = [Sacrococcygeal teratoma. Prenatal diagnosis and prognosis]
| language = German
| journal = Zentralblatt für Gynäkologie
| volume = 112
| issue = 10
| pages = 609-16
| year = 1990
| pmid = 2205995
| doi =
| issn =
}}</ref>


==References==
==References==
{{reflist|2}}
{{reflist|2}}
{{Congenital malformations and deformations of nervous system|state=collapsed}}
{{Tumors|state=collapsed}}
{{Epithelial neoplasms}}
{{Pathology|state=collapsed}}
{{Joints of torso|state=collapsed}}


[[Category:Congenital disorders]]
[[Category:Congenital disorders]]
Line 103: Line 46:
[[Category:Pediatrics]]
[[Category:Pediatrics]]
[[Category:Types of cancer]]
[[Category:Types of cancer]]
[[Category:Oncology]]
[[Category:Rare diseases]]
[[Category:Rare diseases]]
[[Category:Pediatric cancers]]
[[Category:Pediatric cancers]]
[[Category:Mature chapter]]
[[Category:Mature chapter]]
[[de:Steißbeinteratom]]
[[es:Teratoma sacrococcígeo]]
[[fr:Tératome sacro-coccygien]]
[[it:Teratoma sacro-coccigeo]]
{{WikiDoc Help Menu}}
{{WikiDoc Help Menu}}
{{WikiDoc Sources}}
{{WikiDoc Sources}}
[[Category:Up-To-Date]]
[[Category:Oncology]]
[[Category:Medicine]]
[[Category:Orthopedics]]

Latest revision as of 21:16, 7 May 2019

Sacrococcygeal teratoma Microchapters

Home

Patient Information

Overview

Historical perspective

Classification

Pathophysiology

Causes

Differentiating Sacrococcygeal teratoma from other Diseases

Epidemiology and Demographics

Risk Factors

Screening

Natural history, Complications and Prognosis

Diagnosis

Diagnostic Study of Choice

History & Symptoms

Physical Examination

Laboratory Findings

Electrocardiogram

X-ray

Echocardiography and Ultrasound

CT scan

MRI

Other Imaging Findings

Other Diagnostic Studies

Treatment

Medical Therapy

Surgery

Primary Prevention

Secondary Prevention

Cost-Effectiveness of Therapy

Future or Investigational Therapies

Case Studies

Case #1

Sacrococcygeal teratoma surgery On the Web

Most recent articles

Most cited articles

Review articles

CME Programs

Powerpoint slides

Images

American Roentgen Ray Society Images of Sacrococcygeal teratoma surgery

All Images
X-rays
Echo & Ultrasound
CT Images
MRI

Ongoing Trials at Clinical Trials.gov

US National Guidelines Clearinghouse

NICE Guidance

FDA on Sacrococcygeal teratoma surgery

CDC on Sacrococcygeal teratoma surgery

Sacrococcygeal teratoma surgery in the news

Blogs on Sacrococcygeal teratoma surgery

Directions to Hospitals Treating Sacrococcygeal teratoma

Risk calculators and risk factors for Sacrococcygeal teratoma surgery

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]Associate Editor(s)-in-Chief: Mirdula Sharma, MBBS [2]

Overview

Perinatal surgical intervention is used to decrease cardiovascular complications caused by the large sacrococcygeal teratoma. Early complete resection is the mainstay of management of benign tumor. Complete surgical excision in malignant sacrococcygeal teratoma is followed by platinum based chemotherapy.

Surgery

Perinatal Management

Perinatal intervention is only used to decrease cardiovascular complications caused by the parasitic mass.[1]

Open Fetal Surgery

Minimally Invasive in Utero Procedures

Delivery Option

Fetus with High-risk Sacrococcygeal Teratoma[1]

Fetus with Low-risk Sacrococcygeal Teratoma[1]

Fetus with Small Tumor (< 5cm)[9]

Postnatal Management

Benign Sacrococcygeal Teratoma

Early complete resection is the mainstay of management of benign tumor.[10]

Malignant Sacrococcygeal Teratoma

References

  1. ↑ 1.0 1.1 1.2 Roybal JL, Moldenhauer JS, Khalek N, Bebbington MW, Johnson MP, Hedrick HL, Adzick NS, Flake AW (2011). "Early delivery as an alternative management strategy for selected high-risk fetal sacrococcygeal teratomas". J. Pediatr. Surg. 46 (7): 1325–32. doi:10.1016/j.jpedsurg.2010.10.020. PMID 21763829.
  2. ↑ Makin EC, Hyett J, Ade-Ajayi N, Patel S, Nicolaides K, Davenport M (2006). "Outcome of antenatally diagnosed sacrococcygeal teratomas: single-center experience (1993-2004)". J. Pediatr. Surg. 41 (2): 388–93. doi:10.1016/j.jpedsurg.2005.11.017. PMID 16481257.
  3. ↑ Hecher K, Hackelöer BJ (1996). "Intrauterine endoscopic laser surgery for fetal sacrococcygeal teratoma". Lancet. 347 (8999): 470. PMID 8618503.
  4. ↑ Lam YH, Tang MH, Shek TW (2002). "Thermocoagulation of fetal sacrococcygeal teratoma". Prenat. Diagn. 22 (2): 99–101. PMID 11857611.
  5. ↑ Paek BW, Jennings RW, Harrison MR, Filly RA, Tacy TA, Farmer DL, Albanese CT (2001). "Radiofrequency ablation of human fetal sacrococcygeal teratoma". Am. J. Obstet. Gynecol. 184 (3): 503–7. doi:10.1067/mob.2001.110446. PMID 11228510.
  6. ↑ Wilson RD, Hedrick H, Flake AW, Johnson MP, Bebbington MW, Mann S, Rychik J, Liechty K, Adzick NS (2009). "Sacrococcygeal teratomas: prenatal surveillance, growth and pregnancy outcome". Fetal. Diagn. Ther. 25 (1): 15–20. doi:10.1159/000188056. PMID 19122459.
  7. ↑ Scrimgeour EM, Brown P (1991). "BSE and potential risks to slaughtermen". Vet. Rec. 129 (17): 390–1. PMID 1746122.
  8. ↑ Lee MY, Won HS, Hyun MK, Lee HY, Shim JY, Lee PR, Kim A (2011). "Perinatal outcome of sacrococcygeal teratoma". Prenat. Diagn. 31 (13): 1217–21. doi:10.1002/pd.2865. PMID 22024911.
  9. ↑ Okada T, Sasaki F, Cho K, Honda S, Naito S, Hirokata G, Todo S (2008). "Management and outcome in prenatally diagnosed sacrococcygeal teratomas". Pediatr Int. 50 (4): 576–80. doi:10.1111/j.1442-200X.2008.02703.x. PMID 18937757.
  10. ↑ Marina NM, Cushing B, Giller R, Cohen L, Lauer SJ, Ablin A, Weetman R, Cullen J, Rogers P, Vinocur C, Stolar C, Rescorla F, Hawkins E, Heifetz S, Rao PV, Krailo M, Castleberry RP (1999). "Complete surgical excision is effective treatment for children with immature teratomas with or without malignant elements: A Pediatric Oncology Group/Children's Cancer Group Intergroup Study". J. Clin. Oncol. 17 (7): 2137–43. PMID 10561269.
  11. ↑ Ein SH, Mancer K, Adeyemi SD (1985). "Malignant sacrococcygeal teratoma--endodermal sinus, yolk sac tumor--in infants and children: a 32-year review". J. Pediatr. Surg. 20 (5): 473–7. PMID 3903096.
  12. ↑ Calaminus G, Schneider DT, Bökkerink JP, Gadner H, Harms D, Willers R, Göbel U (2003). "Prognostic value of tumor size, metastases, extension into bone, and increased tumor marker in children with malignant sacrococcygeal germ cell tumors: a prospective evaluation of 71 patients treated in the German cooperative protocols Maligne Keimzelltumoren (MAKEI) 83/86 and MAKEI 89". J. Clin. Oncol. 21 (5): 781–6. PMID 12610174.

Template:WikiDoc Sources

Retrieved from "https://www.wikidoc.org/index.php?title=Sacrococcygeal_teratoma_surgery&oldid=1567263"