Clinical Retrospective Analysis Of 299 Cases With Teratomas In Children

Objective: To study the clinical features and experience of diagnose and treatment of children teratomas.Method: To review the clinical data of 299 cases with children teratomas retrospectively, whom were hospitalized in our hospital from October, 1991 to December, 2008. 91 Male, 208 female. Age from 3 hours to 15 years 1 month. 69.23% (207/299) were younger than 3 years old. 142 sacrococcygeal, 49 retroperitoneal, 64 ovary, 27 testicle, 6 pelvic cavity, 4 mediastinum, 3 cervical, 2 vaginal, 1 pharyngeal and 1 kidney. 132 from urban areas, 167 from rural areas. 201 mature, 9 immature and 57 malignant type. 32 clinical diagnosis. Sex, age, position, residence, pathology, clinical charater, treatment and prognosis were reviewsd respectively. Chi-square test were used as the statistical method and there was a "statistical" difference whenαwas 0.05.Result:①General characteristic: The ratio of man and woman was 1:2.29. The age was from 3 hours to 15 years 1 month old, the median age was 1 year and 4 months old. The course was from 3 hours to 10 years long, and the median course was 1 month long. 132 from urban areas, 167 from rural areas.②Position and types: The tumor usually located in sacrococcygeal region, sex gland, and retroperitoneal space, of 142 (47.49%), 91 (30.43%), and 49 (16.39%) patients respectively. 75 sacrococcygeal typeⅠ,43 typeⅡ, 12 typeⅢ, 12 typeⅣ. 201 mature, 9 immature and 57 malignant types were confirmed by pathematology. 32 other types by clinical diagnosis.③Pathogenesis of malignant teratomas: The morbidity of malignant teratomas of patients aged from 1 to 3 years, was higher than other patients aged below 1 year and above 3 years (P<0.05, P<0.05). There is no a statistical difference of the morbidity of teratomas between different sex, position and residence.④The percentage of serum alpha-fetoprotein levels elevated in patients with malignant teratomas, and the percentage in patients with immature teratomas, was higher than the number in patients with mature teratoma (P<0.05, P<0.05).⑤201 mature teratomas performed excision, 9 immature teratomas performed excision, 2 of them combined chemotherapy; 44 malignant teratomas performed excion, 28 of them combined individualization therapy, 1 of latter combined immunotherapy; 4 simple chemotherapy; 2 selective treatment; 26 gave up treatment. Patients above clinical stageⅡand grade 2 of immature teratomas combined chemotherapy. Chemotherapeutics mainly were VCR, CBP, BLM, CTX and ADR.⑥One retroperitoneal cystic teratoma of benign teratoma recurred in 3 months after excision and got excision again. Six of malignant teratoma recurred from 6 months to 3years after excision. 0.49% (1/201) patients with benign teratoma and 9.09% (4/44) patients with malignant teratoma recurred after total resection. Patients with malignant teratoma got follow up for the time from 2 months to 5 years. 3 relapse, 4 metastasis, 3 both of relapse and metastasis, 6 dead, 12 CR, 4 PR, 31 SD, and 10 PD.Conclusion:①Children teratoma occur mainly in female, infant, the median line of the body, and mostly in sacroiliac.②The morbidity of malignant teratoma had no connection with sex, residence and position, and just had connection with age. The morbidity of malignant teratoma of patients aged from 1 to 3 years, was higher than other patients aged below 1 year and above 3 years.③Serum alpha-fetoprotein determination was valuable in differential diagnosis between benign and malignant tumors, effect observation and prognosis judgment.④Resection should be taken up as soon as possible after diagnosis. Patients with Malignant teratoma need combined therapy after resection.⑤Patients with benign tumor have good prognosis and hign recovery rate. Patients with malignant tumor have poor prognosis and hign relapse rate.