Salvage sacrococcygeal resection for yolk sac tumors after chemotherapy: report of 2 cases

Restricted access

Pediatric germ cell tumors (GCTs) are neoplasms that originate from primordial germ cells and, according to their site of presentation, are classified as gonadal or extragonadal. The most common site of extragonadal GCTs in children is the sacrococcygeal region, and the standard management is multimodal with a focus on chemotherapy. In selected instances, sacrococcygeal resection is performed. Herein, the authors report on 2 patients who presented with presacral yolk sac tumors managed with multimodal treatment. Both patients underwent salvage sacrococcygeal resection for oncological control and surgical removal of the sacral vertebral elements: a 27-month-old girl with a recurrent sacrococcygeal yolk sac tumor following chemotherapy and initial resection and a 24-month-old boy in whom a primary sacrococcygeal yolk sac tumor was resected following chemotherapy. These 2 cases illustrate the complexity in the management of these unusual tumors and will help neurosurgeons with the understanding of yolk sac tumors in the sacrococcygeal region.

ABBREVIATIONS AFP = alpha fetoprotein; BEP = bleomycin, etoposide, and cisplatin; EST = endodermal sinus tumor; GCT = germ cell tumor.
Article Information

Contributor Notes

Correspondence Guillermo Aldave: Texas Children’s Hospital, Houston, TX. gxaldave@texaschildrens.org.INCLUDE WHEN CITING Published online October 4, 2019; DOI: 10.3171/2019.7.PEDS19321.Disclosures The authors report no conflict of interest concerning the materials or methods used in this study or the findings specified in this paper.
Headings
References
  • 1

    Ablin ARKrailo MDRamsay NKMalogolowkin MHIsaacs HRaney RB: Results of treatment of malignant germ cell tumors in 93 children: a report from the Childrens Cancer Study Group. J Clin Oncol 9:178217921991

    • Search Google Scholar
    • Export Citation
  • 2

    Altman RPRandolph JGLilly JR: Sacrococcygeal teratoma: American Academy of Pediatrics Surgical Section Survey–1973. J Pediatr Surg 9:3893981974

    • Search Google Scholar
    • Export Citation
  • 3

    Ashcraft KWHolder TM: Congenital anal stenosis with presacral teratoma: case reports. Ann Surg 162:10911095 11001965

  • 4

    Baranzelli MCKramar ABouffet EQuintana ERubie HEdan C: Prognostic factors in children with localized malignant nonseminomatous germ cell tumors. J Clin Oncol 17:12121999

    • Search Google Scholar
    • Export Citation
  • 5

    Barsan VVBriceño VGandhi MJea A: Long-term follow-up and pregnancy after complete sacrectomy with lumbopelvic reconstruction: case report and literature review. BMC Pregnancy Childbirth 16:12016

    • Search Google Scholar
    • Export Citation
  • 6

    Baten MVannucci RC: Intraspinal metastatic disease in childhood cancer. J Pediatr 90:2072121977

  • 7

    Billmire DF: Germ cell tumors. Surg Clin North Am 86:489503 xi2006

  • 8

    Brown NJ: Teratomas and yolk-sac tumours. J Clin Pathol 29:102110251976

  • 9

    Colak ABenli KBerker MOnol B: Epidural metastasis of testicular yolk sac tumor: an unusual cause of spinal cord compression. Case report. Pediatr Neurosurg 17:1391411991–1992

    • Search Google Scholar
    • Export Citation
  • 10

    Cooper KBajorin DShapiro WKrol GSze GBosl GJ: Decompression of epidural metastases from germ cell tumors with chemotherapy. J Neurooncol 8:2752801990

    • Search Google Scholar
    • Export Citation
  • 11

    Dehner LP: Gonadal and extragonadal germ cell neoplasia of childhood. Hum Pathol 14:4935111983

  • 12

    den Boon JAvezaat CJvan der Gaast AKoops WHuikeshoven FJ: Conus-cauda syndrome as a presenting symptom of endodermal sinus tumor of the ovary. Gynecol Oncol 57:1211251995

    • Search Google Scholar
    • Export Citation
  • 13

    Dirix Mvan Becelaere TBerkenbosch Lvan Baren RWijnen RMWijnen MH: Malignant transformation in sacrococcygeal teratoma and in presacral teratoma associated with Currarino syndrome: a comparative study. J Pediatr Surg 50:4624642015

    • Search Google Scholar
    • Export Citation
  • 14

    Ein SHMancer KAdeyemi SD: Malignant sacrococcygeal teratoma—endodermal sinus, yolk sac tumor—in infants and children: a 32-year review. J Pediatr Surg 20:4734771985

    • Search Google Scholar
    • Export Citation
  • 15

    Flake AW: Fetal sacrococcygeal teratoma. Semin Pediatr Surg 2:1131201993

  • 16

    Friedman HMSheetz SLevine HLEverett JRHong WK: Combination chemotherapy and radiation therapy. The medical management of epidural spinal cord compression from testicular cancer. Arch Intern Med 146:5095121986

    • Search Google Scholar
    • Export Citation
  • 17

    Gale GBO’Connor DMChu JYTantana SWeber TR: Successful chemotherapeutic decompression of epidural malignant germ cell tumor. Med Pediatr Oncol 14:97991986

    • Search Google Scholar
    • Export Citation
  • 18

    Göbel USchneider DTCalaminus GHaas RJSchmidt PHarms D: Germ-cell tumors in childhood and adolescence. GPOH MAKEI and the MAHO study groups. Ann Oncol 11:2632712000

    • Search Google Scholar
    • Export Citation
  • 19

    Groff DB: Pelvic neoplasms in children. J Surg Oncol 77:65712001

  • 20

    Havránek PHedlund HRubenson AGüth DHusberg MFrykberg T: Sacrococcygeal teratoma in Sweden between 1978 and 1989: long-term functional results. J Pediatr Surg 27:9169181992

    • Search Google Scholar
    • Export Citation
  • 21

    Isaacs H Jr: Perinatal (congenital and neonatal) neoplasms: a report of 110 cases. Pediatr Pathol 3:1652161985

  • 22

    Kaste SCBridges JOMarina NM: Sacrococcygeal yolk sac carcinoma: imaging findings during treatment. Pediatr Radiol 26:2122191996

    • Search Google Scholar
    • Export Citation
  • 23

    Lewis DWPacker RJRaney BRak IWBelasco JLange B: Incidence, presentation, and outcome of spinal cord disease in children with systemic cancer. Pediatrics 78:4384431986

    • Search Google Scholar
    • Export Citation
  • 24

    Mann JStiller C: Changing pattern of incidence and survival in children with germ cell tumours (GCTs) in Jones WHarnden PAppleyard I (eds): Germ Cell Tumors III. Oxford: Elsevier Science1994 pp 152158

    • Search Google Scholar
    • Export Citation
  • 25

    Marina NFontanesi JKun LRao BJenkins JJThompson EI: Treatment of childhood germ cell tumors. Review of the St. Jude experience from 1979 to 1988. Cancer 70:256825751992

    • Search Google Scholar
    • Export Citation
  • 26

    Marsden HBBirch JMSwindell R: Germ cell tumours of childhood: a review of 137 cases. J Clin Pathol 34:8798831981

  • 27

    McKenney JKHeerema-McKenney ARouse RV: Extragonadal germ cell tumors: a review with emphasis on pathologic features, clinical prognostic variables, and differential diagnostic considerations. Adv Anat Pathol 14:69922007

    • Search Google Scholar
    • Export Citation
  • 28

    Ng EWPorcu PLoehrer PJ Sr: Sacrococcygeal teratoma in adults: case reports and a review of the literature. Cancer 86:119812021999

    • Search Google Scholar
    • Export Citation
  • 29

    Niramis RAnuntkosol MBuranakitjaroen VTongsin AMahatharadol VPoocharoen W: Long-term outcomes of sacrococcygeal germ cell tumors in infancy and childhood. Surg Res Pract 2015:3985492015

    • Search Google Scholar
    • Export Citation
  • 30

    Pashankar FDSteinbok PBlair GPritchard S: Successful chemotherapeutic decompression of primary endodermal sinus tumor presenting with severe spinal cord compression. J Pediatr Hematol Oncol 23:1701732001

    • Search Google Scholar
    • Export Citation
  • 31

    Raffel CNeave VCLavine SMcComb JG: Treatment of spinal cord compression by epidural malignancy in childhood. Neurosurgery 28:3493521991

    • Search Google Scholar
    • Export Citation
  • 32

    Rescorla FJ: Pediatric germ cell tumors. Semin Surg Oncol 16:1441581999

  • 33

    Rescorla FJBreitfeld PP: Pediatric germ cell tumors. Curr Probl Cancer 23:2573031999

  • 34

    Rescorla FJSawin RSCoran AGDillon PWAzizkhan RG: Long-term outcome for infants and children with sacrococcygeal teratoma: a report from the Children’s Cancer Group. J Pediatr Surg 33:1711761998

    • Search Google Scholar
    • Export Citation
  • 35

    Resnick DKMcLaughlin MRAlbright AL: Primary endodermal sinus tumor presenting with spinal cord compression. Case report. J Neurosurg 86:1511531997

    • Search Google Scholar
    • Export Citation
  • 36

    Rodriguez MACass DLLazar DACassady CIMoise KJJohnson A: Tumor volume to fetal weight ratio as an early prognostic classification for fetal sacrococcygeal teratoma. J Pediatr Surg 46:118211852011

    • Search Google Scholar
    • Export Citation
  • 37

    Schneider DTCalaminus GReinhard HGutjahr PKremens BHarms D: Primary mediastinal germ cell tumors in children and adolescents: results of the German cooperative protocols MAKEI 83/86, 89, and 96. J Clin Oncol 18:8328392000

    • Search Google Scholar
    • Export Citation
  • 38

    Schneider DTWessalowski RCalaminus GPape HBamberg MEngert J: Treatment of recurrent malignant sacrococcygeal germ cell tumors: analysis of 22 patients registered in the German protocols MAKEI 83/86, 89, and 96. J Clin Oncol 19:195119602001

    • Search Google Scholar
    • Export Citation
  • 39

    Schropp KPLobe TERao BMutabagani KKay GAGilchrist BF: Sacrococcygeal teratoma: the experience of four decades. J Pediatr Surg 27:107510791992

    • Search Google Scholar
    • Export Citation
  • 40

    Sears BWGramstad GGGhanayem AJ: Cauda equina syndrome in an eleven-month-old infant following sacrococcygeal teratoma tumor resection and coccyx excision: case report. Spine (Phila Pa 1976) 35:E22E242010

    • Search Google Scholar
    • Export Citation
  • 41

    Teilum G: Endodermal sinus tumors of the ovary and testis. Comparative morphogenesis of the so-called mesoephroma ovarii (Schiller) and extraembryonic (yolk sac-allantoic) structures of the rat’s placenta. Cancer 12:109211051959

    • Search Google Scholar
    • Export Citation
  • 42

    Todani TWatanabe YToki AUrushihara NSato Y: Endodermal sinus tumour of the posteroinferior mediastinum resembling dumbbell neuroblastoma in a child. Z Kinderchir 45:1201221990

    • Search Google Scholar
    • Export Citation
TrendMD
Metrics

Metrics

All Time Past Year Past 30 Days
Abstract Views 126 127 76
Full Text Views 15 15 4
PDF Downloads 3 3 0
EPUB Downloads 0 0 0
PubMed
Google Scholar