Gonzalez-Crussi et al classified teratomas arising in the sacrococcygeal region of infants and children based on the histologic components seen during microscopic examination. The histologic grade corresponds with the patient's prognosis. The authors are from Riley Hospital for Children in Indianapolis.
Parameters:
(1) presence of immature embryonal tissue
(2) amount of immature embryonal tissue
(3) nuclear pleomorphism
Mature elements may include:
(1) glia
(2) intestine
(3) pancreas
(4) cartilage
(5) bronchial mucosa
(6) cystic structures
(7) choroid-plexus like papillary structures
|
Immature Embryonal Tissue |
Amount of Immature Embryonal Tissue |
Nuclear Atypia |
Grade |
|
absent (all mature) |
NA |
none |
0 |
|
present |
rare foci |
none to minimal |
1 |
|
present |
moderate |
moderate |
2 |
|
present |
large |
marked with abundant mitoses |
3 |
|
Amount |
Microscopic Equivalent |
|
rare |
<= 1 low power microscopic field per slide |
|
moderate |
1 - 3 low power microscopic fields per slide |
|
large |
> 3 low power microscopic fields per slide |
where:
• The magnification for a low power microscopic field or the microscopic field area were not specified. I assume they are using a 4x objective and a 10x ocular (40x overall).
|
Clinical Appearance |
Stage |
|
locally confined with an intact capsule, with removal of coccyx |
I |
|
break in capsule and/or coccyx left in place |
II |
|
distant metastases or invasion into adjacent structures |
III |
Risk factors for recurrence and metastases:
(1) higher grade (Grades 2 and 3)
(2) incomplete surgical excision
(3) presence of vitelline differentiation (yolk sac = endodermal sinus components, which correlates with elevated serum alpha-fetoprotein levels)
(4) delay in diagnosis (> 6 months of age)
Size of the tumor did not have a bearing on prognosis.
Specialty: Hematology Oncology, Surgery, general, Surgery, orthopedic
ICD-10: ,
