Search

The presacral space is a potential space located between the rectum and the lumbosacral spine. It contains various primitive germ cell types that serve as the origin for a range of tumors. Imaging is crucial in characterizing, assessing the extent of and evaluating the treatment response to these tumors. We report a series of six cases of pediatric presacral tumors with intraspinal extension, including an immature sacrococcygeal teratoma (Altman type II), a malignant sacrococcygeal teratoma (Altman type IV), a neuroblastoma, a rhabdomyosarcoma, a clear cell sarcoma and an Ewing's sarcoma of the ilium. These tumors can be broadly categorized as tumors of germ cell, neuroblastic, mesenchymal and osteogenic origin. Despite overlapping imaging features, a review of the existing literature and careful retrospective observation revealed several distinctive features that aid in the optimal characterization of tumors. These include the tumor's epicenter, the pattern and degree of bone involvement, the status of sacral foramina and neural elements, and internal tumor characteristics such as the presence of fat, calcification, hemorrhage and necrosis. [ABSTRACT FROM AUTHOR]

Aims: The study aimed to evaluate the presentation, management, and outcome of patients of sacrococcygeal malignant germ cell tumors (SC-MGCTs) with intraspinal extension. Materials and Methods: Case records of all cases of SC-MGCT were reviewed to identify cases with intraspinal extension. They were evaluated in terms of their presentation, response to therapy, extent of surgical resection, recovery of neurological symptoms if any, and outcome. Results: Of the three cases of SC-MGT, two had intraspinal extension. One had Altman Type 3 disease and another had Altman Type 4 disease; both had Stage 4 disease. The intraspinal extension in both patients was detected on contrast computed tomography scan and magnetic resonance imaging. One patient had bladder and bowel incontinence. All the tumors responded to preoperative chemotherapy. Gross complete local resection could be achieved in all patients. Neurological recovery was complete. All were alive with no recurrence on follow-up. Conclusions: Malignant sacrococcygeal GCTs with intraspinal extension are rare and can be managed with neoadjuvant chemotherapy which obviates the need for extensive exploration for excision and has got good neurological and oncological prognosis. [ABSTRACT FROM AUTHOR]

Sacrococcygeal teratoma (SCT) with intraspinal extension is rare. There is a risk of paraplegia associated with prolonged spinal cord compression. We present the case of an infant with a prenatal diagnosis of an SCT with a large intraspinal component that was causing compression of the lower spinal cord. Ultrasound at 33 weeks showed bilateral lower extremity and foot movement without hydrops or cardiac failure. Multidisciplinary decision was made to administer betamethasone and proceed with Cesarean delivery at 34 weeks. A vigorous live-born female was delivered and a multilevel laminectomy was performed at day of life 4. The pelvic resection was performed at 4 months. Pathology revealed mature teratoma. She had an uncomplicated postoperative course, is ambulatory, continent of stool, and has no evidence of recurrence. We conclude that intraspinal extension of SCT should be evaluated prenatally with ultrasound and fetal MRI. If there is concern for spinal cord compression, early delivery and urgent decompressive laminectomy may diminish the neurologic sequelae of prolonged spinal cord compression. Since these cases are rare, risks of prematurity need to be weighed against the neurologic risks. These infants should be treated with a multidisciplinary approach. [ABSTRACT FROM AUTHOR]