Pure yolk sac tumor of sacrococcygeal region

The sacrococcygeal region is the most common site for the extragonadal germ cell tumors comprising seminomatous and non-seminomatous tumors. Seminomatous tumors are seminomas, and non-seminomatous tumors comprise mainly teratoma (mature and immature), yolk sac tumor (YST), embryonal carcinoma (EC), and choriocarcinoma. These tumors occur in newborns, infants, and adolescents. Other common sites for extragonadal germ cell tumors are the brain and mediastinum, although they may occur anywhere in the body. These tumors may occur in mixed as well as pure form. So, sectioning from different areas should be done before labeling them as pure germ cell tumors. YST, in its pure form, is rare and therefore should not be missed as it is chemosensitive. The patient should be thoroughly assessed clinically. Imaging also becomes necessary while evaluating swelling in the sacrococcygeal region and can aid in differentials. When the clinical and imaging suspicion of either Sacrococcygeal teratoma or other germ cell tumor is high, serum biomarkers as alfa-fetoprotein should be requested. The serum levels are necessary and should be done preoperatively, postoperatively, and during the course of chemotherapy as follow-up. However, the final diagnosis rests on the histopathological diagnosis. We report one such case of pure YST in the sacrococcygeal region in a 9-month-old female child. The imaging suggested sacrococcygeal teratoma type 4, and high alfa-fetoprotein levels were determined postoperatively.

Controversies in presacral tumors management / Controvérsias no tratamento de tumores pré-sacrais

ABSTRACT Presacral tumors are rare lesions of the retrorectal space that can present diagnostic and therapeutic difficulty because of their anatomic location and the different tissue types and etiology. Although the diagnosis and management of these tumors has evolved in recent years, several points still to be addressed in order to improve perioperative diagnosis and treatment. In the upcoming we will try to highlight some controversial points; the pre-operative biopsies, neoadjuvant therapy, the necessity of surgery and the role of minimally invasive surgeries of presacral tumors.

RESUMO Tumores pré-sacrais são lesões raras do espaço retrorretal que podem trazer dificuldades diagnósticas e terapêuticas por causa de sua localização anatômica e também pelos diferentes tipos de tecidos e etiologia. Embora nos últimos anos o diagnóstico e tratamento desses tumores tenham evoluído, diversos pontos ainda devem ser estudados com vistas à melhora do diagnóstico e tratamento no perioperatório. Mais adiante, tentaremos esclarecer alguns pontos controversos; biópsias pré-operatórias, terapia neoadjuvante, a necessidade de cirurgia e o papel das cirurgias minimamente invasivas para os tumores pré-sacrais.

Umbilical Pilonidal Sinus: A Rare Presentation.

Pilonidal sinus is common in the sacrococcygeal region. It is rare at the umbilicus. Incidence being 0.6%, we report a case of umbilical pilonidal sinus treated in our hospital. A 20-year-old male patient was admitted to our hospital with complaints of purulent discharge from the umbilicus since 3 months. Patient was posted for omphalectomy. Intraoperatively, a tuft of hair was found in a sinus tract communicating with the umbilicus. Histopathological evaluation was compatible with pilonidal sinus disease. There are only a few reports of the umbilical pilonidal sinus in the literature. Umbilical sinus tract differs from the sacrococcygeal variety in the absence of multiple tracts and low recurrence rates. Treatment options and differential diagnosis are discussed in the article.

comparative study of excision with laying open and modified bascom's technique in sacro-coccygeal pilonidal sinus

The study aimed to compare the results of excision and laying open to achieve primary healing method to those of lateral approach [modified Bascom's procedure] in the treatment of sacro-coccygeal pilonidal sinus in regard to the hospital stay, time required for complete healing, time required to return to daily job or activity, early complications [bleeding, infection, wound hematoma or seroma] and late complications [scar and recurrence]. Methods: Eighty patients underwent elective surgery for there pilonidal sinus, 62 males, 18 females at Al-Karama Teaching Hospital [Baghdad, Iraq], between June 2009 and June 2014. Two surgical procedures were carried out, excision and laying open [40 patients, group A] and modified Bascom's procedure [lateral approach] [40 patients, group B]. Five patients omitted from further follow up, two cases related to excision and packing and three of modified Bascom's procedure. Results: It has been found that the third decade of life is the most frequent age group at which patients presenting. It has been concluded that there was no significant difference in the occurrence of the early complications [bleeding, infection, seroma/hematoma], 25% for group A and 37.5% group B, and recurrence rate 10.5% for group A and 16.2% for group B, but patients in group B provided a significantly quicker healing time [mean 49 days for group A and 28 days for group B]. Shorter time-work [mean 47.8 days for group A and 28 days for group B] with better patient convenience [more pain free period], needs only simple oral analgesia, no patient needed hospital admission for pain control, no dressing required and less risk of wound breakdown. Conclusions: The study showed that modified Bascom's procedure for pilonidal sinus is an attractive, safe, easily performed operation with minimal morbidity and feasible as day-care surgery

Dedifferentiated chordoma: a case report

Sarcomatous transformation [dedifferentiated chordoma] in chordoma is a very rare condition and has been emphasized as a distinct entity because of its more aggressive clinical course. Here we describe a case of dedifferentiated chordoma arising from the sacrococcygeal region of a 60-year-old man, in third tumor recurrence. This tumor showed features of sarcoma with areas more typical of chordoma The chordoma-like areas expressed cytokeratin, epithelial membrane antigen and S-100 protein in all tumor cells and the spindle-cell component exhibited vimentin positivity in all of them but negative for other markers. The results showed that the sarcomatous areas as seen in the recurrent chordoma lack epithelial cell features of chordoma and suggest the possibility of altered differentiation pathway of the tumor stem cell or emergence of a new malignant cell population within the recurrent tumor

Extra-ordinary sacrococcygeal teratoma. a case report and review of the literature

Sacrococcygeal teratoma is the most common congenital neoplasm in neonates. It is more common in females and is associated with a higher incidence of congenital anomalies. This tumour is often large, vascular, and carries malignant potentials. Management consists of complete tumour excision and removal of the coccyx. We report a one day old female newborn, part of twin born prematurely at 34 weeks of gestation as a product of caesarean section due to pre labor rupture of membranes at king Hussein Medical Center, presented with a very large soft, cystic, pendulous mass over the sacrococcygeal area, with a circumference of about 30 cm. No neurological deficit was elicited and radiography showed no involvement of the underlying bone. Surgery was performed three days after delivery. The tumour was completely excised enblock with coccyx and sent for histopathological examination. Post-operative period was uneventful and the child was discharged in a good health, and is followed up till now, 4 years after surgery and no any signs of recurrence

Extragonadal teratomas presenting at birth and originating from 3 different sites--a report of 3 cases.

Three cases of extragonadal teratomas presented at birth and all the cases arisen from three separate sites are reported in the present study. A huge sacrococcygeal teratoma is being reported and the other two retroperitoneal and nasopharyngeal teratomas, are reported for the rarity of their location in neonatal period. Teratomas of all three babies were mature benign on histopathology and surgical removal sufficed as mode of treatment. No recurrence was noted on follow-up.

Coccigodínias: diagnóstico por imagem / Coccygodynia: diagnostic imaging

Coccigodínia é uma síndrome dolorosa de difícil abordagem diagnóstica e terapêutica, ainda mal compreendida por clínicos, ortopedistas e radiologistas. No intuito de entender e diferenciar as anormalidades clínico-radiológicas encontradas nas coccigodínias, revisamos a anatomia normal do sacro-cóccix e das demais estruturas pélvicas, suas variações e alterações anatômicas, além doselementos biomecânicos e fisiopatológicos implicados na etiologia da dor. O estudo radiológico funcional do cóccix consiste na obtenção de incidências de perfil nas posições ortostática e sentada, que permite a determinação da mobilidade coccígea. Este método pode demonstrar lesãocausal em 70% dos casos de coccigodínia. A classificação radiológica segundo as alterações da dinâmica do cóccix pode orientar tratamentos e comparar respostas terapêuticas por subgrupos.

Coccygodynia is a painful syndrome still misunderstood by physicians. To understand the radiological abnormalities that may accompanythis syndrome we have revised sacro-coccygeal normal anatomy and its variants and biomechanical elements that may produce pain. Functional radiologic studies of the coccyx consistin lateral projection in upright and sitted positions. Such projections provide clues for the evaluation of coccygeal mobility and may disclose the causal lesion producing coccygodynia in about 70%of the patients. Radiologic classification of the dynamic dysfunctions of coccygeal mobility may orient treatments and compare outcomes in subgroups.

Correlação entre os achados ultra-sonográficos e de ressonância magnética no teratoma sacrococcígeo fetal / Correlation between ultrasonographic and magnetic resonance imaging findings in fetal sacrococcygeal teratoma

OBJETIVO: Correlacionar os achados ultra-sonográficos e de ressonância magnética no teratoma sacrococcígeo fetal. MATERIAIS E MÉTODOS: Três pacientes com idade gestacional entre 30 e 35 semanas, com diagnóstico ultra-sonográfico suspeito de teratoma sacrococcígeo fetal, foram submetidas a ressonância magnética e, posteriormente, a ultra-sonografia para correlação dos achados. Tanto na ressonância magnética quanto na ultra-sonografia foram avaliadas as dimensões, a localização, a extensão e os conteúdos dos tumores. RESULTADOS: A ultra-sonografia e a ressonância magnética obtiveram resultados semelhantes em relação à localização, ao tamanho e ao conteúdo dos tumores. Todas as lesões localizavam-se na região sacrococcígea, com dimensões médias de 6,0 cm x 9,0 cm. Quanto ao conteúdo dos tumores, um dos casos era completamente cístico e dois eram sólidos e císticos. A extensão exata das lesões foi mais bem avaliada pela ressonância magnética do que pela ultra-sonografia, mostrando de forma adequada o acometimento pélvico nos três casos. CONCLUSÃO: A ressonância magnética fetal é capaz de complementar os achados ultra-sonográficos do teratoma sacrococcígeo fetal, uma vez que determina com melhor precisão o conteúdo e a extensão do tumor, auxiliando na conduta terapêutica e aumentando as chances de cura desses fetos.

OBJECTIVE: The present study was aimed at correlating ultrasonographic and magnetic resonance imaging findings in patients with fetal sacrococcygeal teratoma. MATERIALS AND METHODS: Three pregnant women between the 30th and 35th weeks of gestation were submitted to fetal magnetic resonance imaging because of previous ultrasonographic findings suggestive of fetal sacrococcygeal teratoma. Subsequently, they were submitted to ultrasonography for correlation of the imaging findings. Tumors size, location, extent and content were evaluated both at magnetic resonance imaging and ultrasonography. RESULTS: Findings regarding tumor location, size and content were similar for both methods. All the lesions were found in the sacrococcygeal region, with a mean size of 6.0 cm x 9.0 cm. As regards the tumors content, two of them were mixed solid-cystic, and one, entirely cystic. Magnetic resonance imaging was superior to ultrasonography in the evaluation of the exact tumor extent, accurately demonstrating pelvic involvement in all of the three cases. CONCLUSION: Fetal magnetic resonance imaging has showed to be a valuable adjunct to obstetric sonography in the evaluation of fetal sacrococcygeal teratoma, because of its higher accuracy in the determination of these tumors extent and content, playing a significant role in the therapeutic planning and increasing the chances of cure for these fetuses.

Obesidad e hirsutismo como factores predisponentes de la enfermedad pilonidal sacrococcígea / Obesity and hirsutism as risk factors for sacrococcygeal pilonidal sinus disease

Antecedentes: La enfermedad pilonidal sacrococcígea (EPSC) se ha asociado con la obesidad y el hirsutismo. El objetivo de este estudio es investigar la relevancia de estas dos características como factores de riesgo de una EPSC. Material y Método: Estudio prospectivo que incluye todos los pacientes intervenidos por una EPSC en forma consecutiva en forma electiva. Se usó el índice de masa corporal (IMC) para medir el grado de obesidad y se comparó el IMC, la morbilidad y la recidiva con un grupo control de pacientes operados por patología benigna distinta de la obesidad. El hirsutismo se define como la presencia de pelo abundante y grueso en la región lumbar y espalda. Resultados: Se trata de 74 pacientes (51% varones) con una edad promedio de 22,6 años para las mujeres y 27,8 para los hombres (p=0,02). El IMC promedio fue 28,6 para los varones versus 26,4 para las mujeres (p=0,03). Los pacientes con sobrepeso y obesidad tuvieron un promedio de edad superior que los pacientes con IMC normal (p<0,0001). El 54% de los pacientes fue catalogado como hirsutos, sin diferencias en el promedio de edad ni del IMC. El grado de hirsutismo fue significativamente mayor en los varones que en la mujeres (p=0,014). Al comparar con el grupo control (n=62), no hubo diferencias en cuanto al promedio del IMC (p=0,31) ni el grado de hirsutismo (p=0,56) entre ambos grupos. Tampoco hubo diferencias significativas en cuanto a la morbilidad postoperatoria y la recidiva de la enfermedad en pacientes con obesidad y/o hirsutismo. Conclusión: La obesidad y el hirsutismo no son factores de riesgo de desarrollar una EPSC, no aumentan la morbilidad postoperatoria ni la recidiva.

Background: Sacrococcygeal pilonidal sinus disease may be associated to obesity and hirsutism. Aim: To study the association between sacrococcygeal pilonidal sinus disease and obesity and hirsutism. Material and Methods: Prospective study that includes 38 males aged 28 ± 12 years and 36 women aged 23 ± 11 years, subjected to elective surgery for a sacrococcygeal pilonidal sinus disease. Body mass index was used to define obesity. Hirsutism was defined as abundant and tick hair in the back and lumbar region. Results: Mean body mass index was 28.6 ± 5.3 and 26.4 ± 4.6 kg/m² in men and women, respectively (p= 0.03). Overweight and obese patients were significantly older than those with a normal body mass index. Fifty four percent was defined as hirsute, without differences in age or body mass index between hirsute and non hirsute subjects. The degree of hirsutism was higher among males. No differences in the rate of complications or disease relapse was observed between obese or hirsute patients. Conclusions: In this series, obesity and hirsutism were not a risk factor for sacrococcygeal pilonidal sinus disease and did not increase the risk of complications or relapse.

A Case of Pulmonary Vein Tumor Presenting as a Left Atrial Mass

Primary cardiac tumors are extremely rare and can originate within the heart or be the result of tumor spread from other sites. We report a female patient with a pulmonary vein tumor extending into the left atrium that had a suspicious primary malignant origin with a sacral metastatic carcinoma. The patient was admitted complaining of pain in her buttock area as a result of a sacral tumor. It was believed that the sacral tumor was a metastasis from the imaging study and clinical manifestation. The primary malignant origin was evaluated. The chest CT showed a left atrium thrombus-like lesion without a pulmonary abnormality. After a transesophageal echocardiogram, the patient was diagnosed with a pulmonary vein tumor extending to the left atrium. The patient was given palliative radiotherapy for the sacral pain. Initially, the clinical impression was a metastatic sacral tumor with a thromboembolism of the left atrium. However, this patient was finally diagnosed with a pulmonary vein tumor with a left atrium extension by a transesophageal echocardiogram.

Pilonidal disease simple pathogenesis but complex management

Retrospective study. The study was conducted on 75 patients suffering PND with a male to female ratio 59 to 16 done between May 2004 to June 2007 with a follow up range 8-13 and a median of 10.7 months. Sixty four patients had sacrococcygeal disease, 9 patients had umbilical disease, and 1 patient had suprapubic while 1 patient had axillary disease. For sacrococcygeal disease Limberg operation was done in 26.5% [n=17], abscess drainage and curettage in 31.2% [n=20], Bascom operation in 23% [n=15] while conservative treatment in 31.2% [n=20].For umbilical disease, omphalectomy was done in all cases [n=9]. Conservative treatment was done for suprapubic disease while excision followed by primary closure was done in axillary disease [n=1] after failure of conservation. To evaluate different modalities in treating pilonidal disease [PND]. For sacrococcygeal disease, patients who received Limberg procedure [n=17] showed complete resolution in 88.2% [n=15] with recurrence rate 11.8% [n=2]. Those who received Bascom operation showed complete resolution after all procedures with no recurrence during the follow up period. Patients who received conservative treatment [n=20] showed a success rate of 70% [n=14] with recurrence rate of 30% [n=6] who received Bascom procedure later for their recurrence. For umbilical, suprapubic and axillary disease; omphalectomy, conservative treatment and excision with primary closure were used respectively with no complications encountered. For sacrococcygeal disease, Bascom operation was found to be superior over other modalities with respect to smooth postoperative period and early healing while in umbilical disease conservation shows higher success rate

Surgical treatment of chronic sacrococcygeal pilonidal sinus. Open method versus primary closure

To study the comparison between the primary closure and open technique after excision of chronic sacrococcygeal pilonidal sinus. A randomized study was designed and 77 patients with chronic sacrococcygeal pilonidal sinus were included in this study. This study took place in Rizgary Teaching Hospital, Erbil, Kurdistan, Iraq, from January 1997 to August 2003. The patients were separated into 2 groups; Group A [37 patients] were treated by open method [excision and healing by secondary intention] and Group B [40 patients] for whom primary midline suturing was performed after excision of the pilonidal sinus. The follow up ranged from 1.5-5.5 years [mean 4.16] was through outpatient visits. The Student t test was applied for statistical analysis for the operating time, hospital-stay, time off from work and wound healing time; and the results show extremely significant differences between the 2 groups [p<0.0001]. The statistical analysis of the total number of postoperative complications of both techniques showed a significant difference [p=0.0401], while the differences were insignificant for each complication when analyzed separately. Excision and primary closure for chronic sacrococcygeal pilonidal sinus is superior to excision and healing by secondary intention. We believe that primary midline suturing is a useful method for management of chronic sacrococcygeal pilonidal sinus

Sacrococcygeal teratoma in infants and children review of 17 cases

Sacrococcygeal teratoma a congenital tumor, may present at birth or at later in childhood. Altman's type 1 and 2 are most commonly seen while type 3 and 4 are rare. Sacrococcygeal teratoma may be benign with mature tissue and malignant with immature elements. Apart from surgery, adjuvant chemotherapy and radiotherapy may be needed in few cases. This Study conducted retrospectively to examine spectrum of 17 cases of sacrococcygeal teratoma received in infancy and childhood in the dept: of pediatric surgery People's Medical College Nawabshah from 2001 to 2005. Female predominance found. Most of patients underwent through classical inverted chevron incision except two, which require abdomino-sacral approach. Benign histology found in 15 cases and two had malignant pathology, which required chemotherapy. In 2 years follow-up no recurrence found. From our study we found most of lesions were benign. Combined approach usually required in Altman's type 3, and early presentation always revealed benign pathology

FNAC diagnosis of a pre-sacral chordoma: a case report.

Chordoma is a malignant tumour that arises from the remnants of the fetal notochord. A case of a 46 year old man presenting with a pre-sacral mass diagnosed as a chordoma on FNAC is described.

Adult sacrococcygeal teratomas

Sacrococcygeal SCT teratoma are rare in adults with an incidence of 1:87,000 and a female to male ratio of 10:1. Most of SCT are cystic and benign. Our patient was born with this mass that increased in size as she grew older. Being a precious child she was kept away from seeking medical advice by her parents. Initial work up included plain x-ray pelvis, computerized tomography scan and magnetic resonance imaging. At operation the mass was seen arising from sacrococcygeal region. It was excised completely along with coccyx. Pathologically, the specimen contained differentiated tissue from all 3 germ layers

Quiste pilonidal. Técnica de Buie / Pilonidal cyst. Buie's technique

Introducción: la técnica de marsupialización tiene múltiples ventajas para el tratamiento del quiste pilonidal. El objetivo es analizar la experiencia en el tratamiento quirúrgico de esta patología con la técnica de Buie. Diseño: evaluación retrospectiva. Método: se evaluaron 31 pacientes portadores de quistes pilonidales operados con la técnica de marsupialización, 26 hombres y 5 mujeres con un promedio de edad de 28,4 años (rango 15 a 49 años). Resultados: se observó en mayor proporción en individuos jóvenes del sexo masculino. La técnica de Buie requirió una breve hospitalización, con mínimo dolor postoperatorio, bajo índice de morbilidad y rápida reinserción laboral. Conclusiones: este procedimiento es simple, con bajo índice de complicaciones y es un excelente método para el tratamiento quirúrgico de la enfermedad pilonidal no complicada.