TO EVALUATE THE CLINICAL PRESENTATION, DIAGNOSIS, MANAGEMENT AND HISTOPATHOLOGICAL CORRELATION OF PATIENTS WITH SACROCOCCYGEAL TERATOMA.
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Keywords
sacrococcygeal teratoma, tumour, fecal incontinence, exploratory laparotomy, complications, malignancy
Abstract
Introduction: Sacrococcygeal teratomas (SCTs) are neoplasms, which are mostly categorized as benign at birth. If not resected short after birth, malignant transformation can occur in a timely manner. Moreover, timely resected and benign classified SCTs may reoccur years later as malignant relapse. Sacrococcygeal teratoma (SCT) is the most common tumour in the newborn. The majority is present in neonates as a sacral mass; however, some may be present late with varied clinical presentation.
Aims- The study aims to evaluate the clinical presentation, diagnosis, management and histopathological correlation of patients with sacrococcygeal teratoma.
Materials and Methods: This is an observational study of infants and children treated between May 2023 to April 2024 in the Department of Pediatric Surgery, SMS medical college, Jaipur. Data collected included antenatal diagnosis, mode of delivery, age at diagnosis, clinical presentation, Altman classification, surgical approach, histopathology and complications. Functional results were evaluated clinically and radiologically.
Results: there are 21 patients studied (M: F=1:3.2) with a median age of 40 days (range:1 day to 5.8 years) with sacrococcygeal teratoma were managed at our centre. Nearly, two-thirds of the tumors were either Altman Type 1 or 2. Yolk sac tumour was present in 2 (9.5%) patients, while the rest had either mature or immature teratoma. Tumours were removed through a posterior sagittal approach (chevron incision). In five patients, an abdominoperineal approach was used. Early complications were surgical site infection (n = 5; 23.8%), superficial wound dehiscence (n = 2; 9.5%), complete wound dehiscence (n = 1; 2.4%), and urinary tract infection (n = 1; 4.7%). Late complications were urinary dribbling or poor stream (5/21; 23.8%) and faecal soiling (n=3; 14.2%).
Conclusion: Most of the sacrococcygeal tumours are benign, and the incidence of malignancy increases with age. Morbidity due to associated malformation and treatment may persist in these patients, especially like urinary complications stream (one-fifth) and faecal incontinence (one-seventh), as seen in our series. A proper long-term follow-up is needed for the management of late complications.
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Dr. Priya Singh
Senior resident, Emergency medicine, NSCB medical college, Jabalpur
Dr. Kshama Shrivastava
Demonstrator Department of Pathology, Bundelkhand Medical College Sagar 471001
Dr. Pankaj Goyal
Senior Resident, Department of Pediatric Surgery. SMS medical college Jaipur
Dr. Tribhuvan Pratap Singh Kourav
Consultant Pathologist, Civil Hospital, Gadarwara, District Narsinghpur, M.P. 487551
Dr. Ayush Khati
Senior Resident, Department of Pediatric Surgery, Maulana Azad Medical College, New Delhi, 110002.