title: Sacrococcygeal malignant germ cell tumor (SC-MGCT) with intraspinal extension.
abstract: BACKGROUND
  Neurological involvement due to intraspinal extension in sacrococcygeal malignant germ cell tumors (SC-MGCTs) has rarely been reported.
  
  
  OBJECTIVE
  To evaluate the incidence, presentation, management and the outcome of patients of SC-MGCT with intraspinal extension.
  
  
  METHODS
  Case records of all cases of SC-MGCT from 2001 to 2008, were reviewed to identify cases with vertebral involvement and intraspinal extension. They were evaluated in terms of their presentation, response to therapy, extent of surgical resection, recovery of neurological symptoms and outcome.
  
  
  RESULTS
  Of the 31 cases of SC-MGCT, 5 (16%) had intraspinal extension. Age ranged from 12 to 84 months (median 24 months). Four patients had Altman type 4 disease (stage 4) and 1 had Altman type 3 (stage 3) disease. The intraspinal extension in all patients was detected on contrast CT scan. Patients presented with neurological symptoms in the form of lower limb paresis (80%), bowel and bladder (20%) incontinence. All the tumors responded to pre-operative chemotherapy. Gross complete local resection could be achieved in 4(80%). Neurological recovery was complete in all except for persisting neurogenic bladder in one. During follow up of 3-32 months, all were alive with no recurrence.
  
  
  CONCLUSIONS
  SC-MGCT presenting with neurological deficits due to intraspinal extension is usually advanced disease. These patients respond to chemotherapy and surgical resection and most have complete neurological improvement.
authors: Department of Pediatric Surgery, All India Institute of Medical Sciences, New Delhi 110029, India. Electronic address: rajangarg1985@gmail.com.
authors: Rajan
authors: R
authors: Garg
authors: Department of Pediatric Surgery, All India Institute of Medical Sciences, New Delhi 110029, India. Electronic address: sandpagr@hotmail.com.
authors: Sandeep
authors: S
authors: Agarwala
authors: Department of Medical Oncology, BRAIRCH, All India Institute of Medical Sciences, New Delhi 110029, India. Electronic address: sambakh@hotmail.com.
authors: Sameer
authors: S
authors: Bakhshi
authors: Department of Pediatric Surgery, All India Institute of Medical Sciences, New Delhi 110029, India. Electronic address: srinivasem@hotmail.com.
authors: M
authors: M
authors: Srinivas
authors: Department of Pediatric Surgery, All India Institute of Medical Sciences, New Delhi 110029, India. Electronic address: bajpai2@hotmail.com.
authors: Minu
authors: M
authors: Bajpai
authors: Department of Pediatric Surgery, All India Institute of Medical Sciences, New Delhi 110029, India. Electronic address: dkgupta@kgmcindia.edu.
authors: Devendra Kumar
authors: DK
authors: Gupta
authors: Department of Pediatric Surgery, All India Institute of Medical Sciences, New Delhi 110029, India. Electronic address: veereshwarb@hotmail.com.
authors: Veereshwar
authors: V
authors: Bhatnagar
mesh_terms: D017024:Chemotherapy, Adjuvant; D002648:Child; D002675:Child, Preschool; D003050:Coccyx / Q000473:pathology* / Q000601:surgery; D005242:Fecal Incontinence / Q000209:etiology; D006801:Humans; D007223:Infant; D008175:Lung Neoplasms / Q000556:secondary; D020360:Neoadjuvant Therapy; D009361:Neoplasm Invasiveness; D012189:Retrospective Studies; D012445:Sacrococcygeal Region / Q000473:pathology* / Q000601:surgery; D012447:Sacrum / Q000473:pathology* / Q000601:surgery; D013125:Spinal Neoplasms / Q000188:drug therapy / Q000473:pathology* / Q000601:surgery; D013724:Teratoma / Q000188:drug therapy / Q000473:pathology* / Q000556:secondary / Q000601:surgery; D016896:Treatment Outcome; D014549:Urinary Incontinence / Q000209:etiology
keywords: Intraspinal extension; Malignant germ cell tumor; Sacrococcygeal tumors