Tumor metrics and morphology predict poor prognosis in prenatally diagnosed sacrococcygeal teratoma: A 25-year experience at a single institution

Shue, Eveline H.; Bolouri, Marjan S.; Jelin, Eric B.; Vu, Lan; Bratton, Barbara; Cedars, Elizabeth; Yoke, Leah M.; Byrne, Francesca A.; Hirose, Shinjiro; Feldstein, Vickie A.; Miniati, Douglas N.; Lee, Hanmin

doi:10.1016/j.jpedsurg.2013.03.016

Cited by 44 publications

(47 citation statements)

References 25 publications

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“…Moreover, all tumors sized > 4 cm at gestational week 20 and with growth rates > 8 mm/week had a complicated clinical course. Several authors have previously described the growth pattern of SCT [11,16,25], and our results are in line with those reported by Benachi et al , who showed a correlation between large, highly vascularized, fast-growing tumors and development of hydrops fetalis and/or cardiac failure. [11].…”

Section: Accepted Manuscriptsupporting

confidence: 93%

Sacrococcygeal teratoma: A population-based study of incidence and prenatal prognostic factors

Hambraeus

Arnbjörnsson

Börjesson

et al. 2016

Journal of Pediatric Surgery

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Section: Accepted Manuscriptsupporting

confidence: 93%

Sacrococcygeal teratoma: A population-based study of incidence and prenatal prognostic factors

Hambraeus

Arnbjörnsson

Börjesson

et al. 2016

Journal of Pediatric Surgery

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“…97 Other reported predictors include a ratio of tumor volume to fetal weight of 0.12 or more, tumors with mostly solid rather than cystic elements, rapid tumor growth, impaired fetal cardiac function or cardiomegaly, and the development of complications such as hydramnios or the mirror syndrome (maternal features of preeclampsia mirroring fetal hydrops). 96,98,99 The development of hydrops at a gestational age at which neonatal survival is likely usually prompts delivery, whereas impending hydrops in an immature fetus raises the possibility of fetal therapy. Current interventions include open fetal surgical debulking, shunt placement in large cystic lesions, and radiofrequency ablation, with a wide range of reported survival rates; the high rate of adverse outcomes reported by fetal treatment centers may reflect the increased severity of referred cases.…”

Section: Fetal Tumorsmentioning

confidence: 99%

Fetal Surgery

Wenstrom

Carr

2014

Obstetrics &Amp; Gynecology

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Since the first human fetal surgery was reported in 1965, several different fetal surgical procedures have been developed and perfected, resulting in significantly improved outcomes for many fetuses. The currently accepted list of fetal conditions for which antenatal surgery is considered include lower urinary tract obstruction, twin-twin transfusion syndrome, myelomeningocele, congenital diaphragmatic hernia, neck masses occluding the trachea, and tumors such as congenital cystic adenomatoid malformation or sacrococcygeal teratoma when associated with developing fetal hydrops. Until recently, it has been difficult to determine the true benefits of several fetal surgeries because outcomes were reported as uncontrolled case series. However, several prospective randomized trials have been attempted and others are ongoing, supporting a more evidence-based approach to antenatal intervention. Problems that have yet to be completely overcome include the inability to identify ideal fetal candidates for antenatal intervention, to determine the optimal timing of intervention, and to prevent preterm birth after fetal surgery. Confronting a fetal abnormality raises unique and complex issues for the family. For this reason, in addition to a maternal-fetal medicine specialist experienced in prenatal diagnosis, a pediatric surgeon, an experienced operating room team including a knowledgeable anesthesiologist, and a neonatologist, the family considering fetal surgery should have access to psychosocial support and a bioethicist.

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“…These malformations lead to hydrops, polyhydramnios, high-output cardiac failure, preterm birth, and death. Two variables suggest a greater risk for a poor prognosis: the ratio of the tumor volume to the fetal weight >0.11 determined before 32 weeks gestation and tumor morphology <60 % cystic [ 222 ].…”

Section: Sacrococcygeal Teratomamentioning

confidence: 99%