An Analysis For Clinical Diagnosis And Therapy Of 150 Case Of Pediatric Sacrococcygeal Teratoma

Purpose:To analyze and summarize the characteristics and the clinical experience of diagnosis and treatment of pediatric sacrococcygeal teratoma retrospectively.Materials and Methods:Collected from January 2004 to December 2013 in the Surgical Oncology of Children’s Hospital affiliated to Chongqing Medical University (we call it "our department" in this paper) diagnosis with pediatric sacrococcygeal teratoma, exclude the cases without confirming by pathological examination and giving up treatment directly, a total of 150 cases,39 cases of male,111 cases of female, the sexual ratio is about 1:2.85 (39/111). The age ranged from 2 hours to 11 years and 9 months and 16 days, the the median age is 2 months. The pathological biopsy diagnosis of mature teratoma in 133 cases; Immature teratoma in 5 cases, including 3 cases of histological level II,2 cases of level III; 12 cases of malignant teratoma, including 10 cases of sacrococcygeal yolk sac tumor,1 case of embryonal carcinoma,1 case containing a large number of malignant tumour of the immature gland tissue. In clinical classification, there are 67,55,20 and 8 cases for type Ⅰ～Ⅳ。There are 138 cases of mature and immature teratom:3 cases of mature teratoma accepted the surgery again as they recurrence after the first sugery in other hospital,5 cases of immature teratoma all give up postoperative chemotherapy. There are 12 cases of malignant teratoma, according to the tumor staging standard of COG/CCG, including 1 case of period Ⅰ,4 cases of period Ⅱ,6 cases of period Ⅲ,1 case of period IV. In 12 children with malignant,4 cases (period Ⅲ) accepted comprehensive treatment including preoperative neoadjuvant chemotherapy, surgery, postoperative chemotherapy and completed the treatment, the other 8 cases who didn’t unfinished the treatment:1 case (period Ⅳ) from other hospital was recurrenced malignantly postoperative only accepted chemotherapy,3 cases interrupted chemotherapy after 1-3 courses of preoperative chemotherapy,4 cases gave up the chemotherapy after diagnosing. We analyzed the age, sex, clinical characteristics, treatment and prognosis of the 150 cases retrospectively. The follow-up data was collected by telephone and the available outpatient follow-up data, the follow-up time beginning after definite diagnosis, until December 2014 or the time of the children dead. The follow-up duration ranged from lyear to 10 years. We used SPSS 19.0 statistical software to analyzed the data, and described measurement data using mean±standard deviation(X±S). we used chi-square test to do the correlation analysis if the data meet the condition, otherwise we use Fisher chi-square test, and defined the significance test level as a=0.05.Result: ① There are more girl than boy in incidence of pediatric sacrococcygeal teratoma, the ratio is about 1’2.85.② The malignant children’s sacrococcygeal teratoma is related to pathological type, age, the property(solid or sac) of the the mass, clinical classification, serum AFP level (P< 0.05), and has nothing to do with sex (P> 0.05). ③ In 150 cases, 141 cases obtained pathological tissue by open surgery and 9 cases with sacrococcygeal tumor biopsy. The histopathologic findings as follows: mature teratoma in 133 cases; immature teratoma in 5 cases, including 3 cases of histological level II,2 cases of level III; 12 cases of malignant teratoma, including 10 cases of sacral tail yolk sac tumor,1 case of embryonal carcinoma, and 1 case including immature gland malignant tumor tissue. ④ All 138 cases of mature and immature teratoma accept primary surgical treatment, and the coccyx is completely resection intraoperative. The tumors are complete resection if possible, and if the tumor ulcerated preoperative or intraoperative, we try our best to make fully resection and careful cleaning and flushing tumor bed to avoid residual. All immature teratoma give up postoperative chemotherapy,4 cases accepted comprehensive treatment including preoperative neoadjuvant chemotherapy, surgery, postoperative chemotherapy and completed the treatment, the other 8 cases who didn’t unfinished the treatment:1 case from other hospital was recurrenced malignantly postoperative only accepted chemotherapy,3 cases interrupted chemotherapy after 1-3 courses of preoperative chemotherapy,4 cases gave up the chemotherapy after diagnosing.⑤We followed-up 1～10 years post operation, in mature teratoma. we followed-up 121 cases and 12 cases were lost. In the 121 cases, there were 2 cases benign recurrenced in situ in 4 months and 1 year and 6 months postoperative, and they are all CR(complete remission) after secondary complete resection operation.121 cases were all tumor-free survival until the follow-up deadline. In 5 immature teratoma cases,2 cases were lost to follow-up, the other followed-up 3 cases gave up chemotherapy:2 cases of level II were relapse-free survival (CR), and 1 case of level III dead after 2 years of sugery as malignant recurrence. In the 12 malignant cases,4 cases were lost to follow-up, in the other 8 cases:4 cases (all for period III) accepted neoadjuvant chemotherapy, surgery and postoperative chemotherapy and complete personalized treatment, they are all CR; 1 case (IV) with malignant recurrence in situ from other hospital only accepted 17 course of chemotherapy, and was still progression (PD); 2 cases (period II in 1 case, period III in 1) died after giving up treatment,1 case (period III) confirmed by biopsy dead for interrupting postoperative chemotherapy after 1 course and the disease was progressed.⑥ The incidence of postoperative wound infection in the 145 children who underwent a primary or second stage surgery after neoadjuvant chemotherapy was 4.14%(6/145), and after anti-infection, symptomatic and supportive treatment, they were all primary healing and without sphincter disturbances, lower limb dysfunction or other complications and sequelae.Conclusion:①The pediatric sacrococcygeal teratoma are common in children< 1 year old, more girls than boys, and ratio is about 1:2.85. ② The malignant children’s sacrococcygeal teratoma is related to pathological type, age, the property(solid or sac) of the the mass, clinical classification, serum AFP level, and they are helpful for clinical differential diagnosis of benign and malignant sacrococcygeal teratoma. ④ There are more benign than malignant sacrococcygeal teratoma, the benign teratoma has the possibility of malignant transformation, but there is no malignant recurrence case in our data, we think it’s own to completely/fully excision of the tumors during the operation. ④ The surgical treatment should be done as soon as possible after the sacrococcygeal benign teratoma was confirmed, and it is the key to make a completely/fully excision of coccyx and tumor tissue to reduce the recurrence.⑤ whether to accept chemotherapy or not in immature teratoma level I and II depends on if the tumor tissue is completely removal, if the tumor has infiltration relationship with the surrounding tissues, the imaging expression, the index of AFP and Ki67 in pathologic immunohistochemical, immature teratoma of level III should be seen as malignant tumor, and we make a suggestions for postoperative chemotherapy to improve the prognosis. ⑥ To accept normative comprehensive treatment with neoadjuvant chemotherapy, surgery, postoperative chemotherapy in children with malignant teratoma can significantly improve the prognosis reduce the incidence of relapse after surgery.