Teratomas in children : an institutional retrospective study

Aim and Objectives: The aim is to study the clinical presentation, malignant potential of teratomas and their management in pediatric age group. Materials and Methods: This is a retrospective study done in 52 cases of teratomas in children . All the cases were evaluated clinically, investigated , treated and were on regular follow up. Results: In our series 52 cases of teratomas were studied retrospectively. 43% of teratomas are sacrococcygeal teratomas and by far the commonest. There is a relatively high incidence of retroperitoneal tumors occupying second place ,constituting 25% (13 cases) of teratomas as against the other series which range between 5-10%. The ovarian teratomas has an unusually lower incidence at 15.3%. There are 12 cases of malignant tumors out of 52 cases (23%), Immature teratomas being 9.6% and mature teratomas 67.4%. Though retroperitoneal teratomas constitute 25% of paediatric teratomas , the malignant potential is equivalent to that of sacrococcygeal teratomas. Malignant teratomas in the extragonadal site is seen in children below 5 years whereas in the gonadal site they are seen in children above 5 years. In sacrococcygeal teratoma there is no evidence of malignancy below one month of age whereas in three cases reported in infancy, malignant changes were seen. Incidence of malignancy related to the sex of pt F = 8 M = 4 (RP-3,Testicular-1). More cases of malignant variety were present in Altman type III & IV. Of 12 malignant teratomas, 9 cases were endodermal sinus tumours (Yolk sac tumour). There were 4 deaths recorded in this series representing a mortality rate of 7.76%, one death occurred due to postoperative bleeding, whereas in other 3 cases it was due to malignancy related complications. The 5year survival rate for benign tumours is 97.5% and of malignant teratomas is 75% . Conclusion: There is a high malignant potential in the retroperitoneal tumours and it increases with the age. The female incidence of sacrococcygeal teratomas is more than 90%. The levels of AFP correlates with the progress of the tumours. All the malignant changes seen in sacrococcygeal teratomas and retroperitoneal teratomas are between infancy and 5 yrs age.