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Management of preterm giant sacrococcygeal teratoma (GSCT) with an excellent outcome.

Gangadharan M, Panda S, Almond PS, Agrawal V, Bhandari A, Koska AJ - J Surg Case Rep (2014)

Bottom Line: Infants born with a giant sacrococcygeal teratoma (GSCT; >10 cm) have high mortality.Risk factors for mortality include increased tumor vascularity, high cardiac output, rapid growth, diagnosis before 20-week gestation, delivery before 30-week gestation, hydrops, low birth weight, Apgar less than 7 at 5 min and polyhydramnios.We present the case of a 28-week infant born with a GSCT (15 × 12 × 16 cm) and all of these risk factors.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Anesthesiology, Driscoll Children's Hospital, Corpus Christi, TX, USA meera.gangadharan@dchstx.org.

No MeSH data available.


Related in: MedlinePlus

(A) At Day 0, a GSCT (15 × 12 × 16 cm) is noted with skin necrosis on the left decubitus position. (B) Irregular multinodular contour noted on GSCT on the right decubitus position. (C) Infant on post operative day 0 after GCST resection. (D) Infant at 15 month follow up.
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RJU132F1: (A) At Day 0, a GSCT (15 × 12 × 16 cm) is noted with skin necrosis on the left decubitus position. (B) Irregular multinodular contour noted on GSCT on the right decubitus position. (C) Infant on post operative day 0 after GCST resection. (D) Infant at 15 month follow up.

Mentions: A 28-year-old, G3P2 mother delivered a 28-week gestation, 2.7 kg (including the weight of the tumor) male infant via emergency cesarean section due to fetal distress and a rapidly increasing GSCT (an increase of 3 cm from 27 to 28th week gestation). At 26-week and 4-day gestation, removal of 3700 ml of amniotic fluid was conducted and 90 ml of packed red blood cells (PRBCs) transfused to treat fetal anemia and congestive heart failure, respectively. At delivery, the GSCT measured 15 × 12 × 16 cm (Fig. 1A and B). The arterial blood pH, base deficit and alpha-fetoprotein (AFP) were 7.15, 9.9 mmol/l, and 864 998 ng/ml, respectively. He was intubated and transferred to Driscoll Children's Hospital (DCH). On evaluation, he had pulmonary hypertension, hydrops, thrombocytopenia, hypoglycemia, respiratory failure, ascites and metabolic acidosis. He was placed on high frequency oscillatory ventilation, and fentanyl, vecuronium and dopamine (5 μg/kg/min) infusions. From day of life (DOL)2–7, he received multiple PRBC, fresh frozen plasma (FFP) and platelet transfusions. His neutropenia was treated with intravenous immunoglobulin and Neupogen. Nitric oxide (1–20 ppm) was used to treat his pulmonary hypertension. By DOL5, nitric oxide was weaned off and he was transitioned to conventional ventilation. His coagulopathy stabilized, and the pulmonary pressures decreased to 75% of systemic. He was deemed optimized for tumor resection by neonatology, cardiology, anesthesiology and surgery.Figure 1:


Management of preterm giant sacrococcygeal teratoma (GSCT) with an excellent outcome.

Gangadharan M, Panda S, Almond PS, Agrawal V, Bhandari A, Koska AJ - J Surg Case Rep (2014)

(A) At Day 0, a GSCT (15 × 12 × 16 cm) is noted with skin necrosis on the left decubitus position. (B) Irregular multinodular contour noted on GSCT on the right decubitus position. (C) Infant on post operative day 0 after GCST resection. (D) Infant at 15 month follow up.
© Copyright Policy - creative-commons
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4256527&req=5

RJU132F1: (A) At Day 0, a GSCT (15 × 12 × 16 cm) is noted with skin necrosis on the left decubitus position. (B) Irregular multinodular contour noted on GSCT on the right decubitus position. (C) Infant on post operative day 0 after GCST resection. (D) Infant at 15 month follow up.
Mentions: A 28-year-old, G3P2 mother delivered a 28-week gestation, 2.7 kg (including the weight of the tumor) male infant via emergency cesarean section due to fetal distress and a rapidly increasing GSCT (an increase of 3 cm from 27 to 28th week gestation). At 26-week and 4-day gestation, removal of 3700 ml of amniotic fluid was conducted and 90 ml of packed red blood cells (PRBCs) transfused to treat fetal anemia and congestive heart failure, respectively. At delivery, the GSCT measured 15 × 12 × 16 cm (Fig. 1A and B). The arterial blood pH, base deficit and alpha-fetoprotein (AFP) were 7.15, 9.9 mmol/l, and 864 998 ng/ml, respectively. He was intubated and transferred to Driscoll Children's Hospital (DCH). On evaluation, he had pulmonary hypertension, hydrops, thrombocytopenia, hypoglycemia, respiratory failure, ascites and metabolic acidosis. He was placed on high frequency oscillatory ventilation, and fentanyl, vecuronium and dopamine (5 μg/kg/min) infusions. From day of life (DOL)2–7, he received multiple PRBC, fresh frozen plasma (FFP) and platelet transfusions. His neutropenia was treated with intravenous immunoglobulin and Neupogen. Nitric oxide (1–20 ppm) was used to treat his pulmonary hypertension. By DOL5, nitric oxide was weaned off and he was transitioned to conventional ventilation. His coagulopathy stabilized, and the pulmonary pressures decreased to 75% of systemic. He was deemed optimized for tumor resection by neonatology, cardiology, anesthesiology and surgery.Figure 1:

Bottom Line: Infants born with a giant sacrococcygeal teratoma (GSCT; >10 cm) have high mortality.Risk factors for mortality include increased tumor vascularity, high cardiac output, rapid growth, diagnosis before 20-week gestation, delivery before 30-week gestation, hydrops, low birth weight, Apgar less than 7 at 5 min and polyhydramnios.We present the case of a 28-week infant born with a GSCT (15 × 12 × 16 cm) and all of these risk factors.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Anesthesiology, Driscoll Children's Hospital, Corpus Christi, TX, USA meera.gangadharan@dchstx.org.

No MeSH data available.


Related in: MedlinePlus