Yenidoğan Dönemindeki Kitlesel Lezyonlarda Ayırıcı Tanı Ve Yönetim: On Yıllık Tek Merkez Deneyimi

Öz

Giriş: Yenidoğan tümörleri nadirdir ve bu hastalıklara standart bir yaklaşım bulunmamaktadır. Ayrıca kanser, perinatal morbidite ve mortalitenin önemli bir nedenidir. Bu çalışmanın amacı, merkezimizde izlediğimiz bu istisnai tümörlerin insidansını, klinik özelliklerini ve yönetimini analiz etmektir. Gereç-Yöntem: Hastanemizde 2007-2018 yılları arasında takip ettiğimiz solid kitlesi olan bebekleri retrospektif olarak değerlendirdik. Yaş, cinsiyet dağılımı, doğum ağırlığı ve gebelik yaşı, lezyon tipi, vakaların yönetimi ve sonuçlar incelendi. Bulgular: 10 yıllık süre içinde toplam 62 vaka tespit edilmiş olup en sık görülen solid neonatal tümör germ hücreli tümör idi (%30.6). Kırk iki lezyon karında yerleşmekteydi. Olguların büyük çoğunluğuna (%48.3) tedavi olarak sadece cerrahi uygulandı. Sonuç: Tüm dünyada olduğu gibi ülkemizde de yenidoğan tümörleri için sınırlı yönetim deneyimine rağmen, doğum öncesi tanı yöntemlerindeki yenilikler ve yeterli perinatal bakım sayesinde, uzmanlaşmış multidisipliner merkezlerde bu hastaların sağkalımı artırılabilir.

Anahtar Kelimeler

• antenatal tanı
• Neonatal kitleler
• Prematür
• Sağkalım
• Tedavi

Differential Diagnosis And Management In Neonatal Mass Lesions: Ten Years Experience

Abstract

Introduction: Neonatal tumors are rare and there is no standard approach to these diseases. Besides, cancer is an important cause of perinatal morbidity and mortality. The aim of this study is to analyze the incidence, clinical features and management of these exceptional tumors which were followed up at our center. Material and Method: We assessed all babies with solid masses admitted to our hospital between 2007-2018 retrospectively. The age, sex distribution, birth weight and gestational age, type of lesion, management and outcome were studied. Results: Of total; there were 62 cases over 10 years in which the most common solid neonatal tumor was germ cell tumor (30.6%). Forty two lesions were located in the abdomen. The majority of cases (48.3%) underwent only surgery for treatment strategy. Conclusion: In spite of limited management experience for newborn tumors, thanks to renovations in prenatal diagnostic methods and sufficient perinatal care, survival can be improved in specialised multidisciplinary centers.

Keywords

• antenatal diagnosis
• neonatal tumors
• premature
• survival
• treatment

Kaynakça

1. 1.Escudero A, Ruz-Caracuel B, Bueno D, Martinez M, Rubio P, Regojo RM, Antolin E, Ybarra M, Martinez L, Pozo-Kreilinger JJ, Elorza MD, Pellicer A, Omenaca F, Perez-Martinez. Genetic predisposition of fetal and neonatal cancer. Clin Transl Oncol 2021; 23:1179-84.
2. 2. Moore SW, Satge D, Sasco AJ, Zimmermann A, Plaschkes J. The epidemiology of neonatal tumors. Report of an international working group. Pediatr Surg Int 2003; 19:509-519.
3. 3. Lopez Almaraz R, Villafruela Alvarez C, Rodriguez Luis J, Domenech Martinez E. Neonatal neoplasms: a single-center experience. An Pediatr 2006; 65(6):529-35.
4. 4. Alfaar AS, Hassan WH, Bakry MS, Qaaddoumi I. Neonates with cancer and cause of death; lessons from 615 cases in the SEER databases. Cancer Med 2017; 6(7):1817-26.
5. 5. Desandes E, Guissou S, Ducassou S, Lacour B. Neonatal solid tumors: incidence and survival in France. Pediatr Blood Cancer 2016; 63:1375-80.
6. 6. Raciborska A, Bilska K, Weclawek-Tompol, Ussowicz M, Pogorzala M, Janowska J, Rychlowska-Pruszynska M, Rodriguez-Galindo C, Helwich E. Solid cancers in the premature and the newborn: Report of three national referral centers. Pediatr Neonatol 2016; 57:295-301.
7. 7. Okada T, Sasaki F, Cho K, Honda S, Naito S, Hirokata G, Todo S. Management and outcome in prenatally diagnosed sacrococcygeal teratomas. Pediatr Int 2008; 50(4):576-80.
8. 8. Baro AM, Perez SP, Costa MM, Heredia CL, Azuara LS, Juanos JL, Lapiedra MZ. Sacrococcygeal teratoma with preterm delivery: a case report. J Med Case Rep 2020; 14:72.

9. 9. Hambraeus M, Arnbjörnsson E, Börjesson A, Salvesen K, Hagander L. Sacrococcygeal teratoma: A population-based study of incidence and prenatal prognostic factors. J Pediatr Surg 2016; 51:481-5.
10. 10. Zheng XQ, Yan JY, Xu RL, Wang XC, Chen X, Huang KH. A clinical analysis of the diagnosis and treatment of fetal sacrococcygeal teratomas. Cancer Manag Res 2020; 12:13185-93.
11. 11. Holcroft CJ, Blakemore KJ, Gurewitsch ED, Driggers RW, Northington FJ, Fischer AC. Large fetal sacrococcygeal teratomas: could early delivery improve outcome? Fetal Diagn Ther 2008; 24:55-60.
12. 12. Heck JE, Meyers TJ, Lombardi C, Park AS, Cockburn M, Reynolds P, Ritz B. Case-control study of birth characteristics and the risk hepatoblastoma. Cancer Epidemiol 2013; 37(4):390-95.
13. 13. Zhelnin KE, Gebhard GM, Mirsky DM, Oliver SC, Lovell MA, Galambos C, Crombleholme TM, McCourt EA. Pediatric intraocular immature teratoma associated with sacrococcygeal teratoma: case report and review of the literature. Pediatr Dev Pathol 2017; 20(3):240-44.
14. 14. Orbach D, Sarnacki S, Brisse HJ, Gauthier-Villars M, Jarreau PH, Tsatsaris V, Baruchel A, Zerah M, Seigneur E, Peuchmaur M, Doz F. Neonatal cancer. Lancet Oncol 2013; 14:609-20.
15. 15. Mandal B, Chatterjee G, Bhattacharya K, Roy D, Das RN, Chatterjee U. Sacrococcygeal teratoma with complete adrenal gland. J Can Res Ther 2015; 11(4):1040.
16. 16. Nam SH, Kim DY, Kim SC, Seo JJ. Neonatal neuroblastoma needs the aggressive treatment? World J Surg 2012; 36:2102-7.
17. 17. Chaturvedi A, Katzman PJ, Franco A. Neonatal neuroblastoma 4S with diffuse liver metastases (Pepper syndrome) without an adrenal/extraadrenal primary identified on imaging. J Radiol Case Rep 2018; 12(3):18-27.
18. 18. Marcenaro ML, Varas JMC, Solis JFV, Bombardiere SG, Silva JCP. Differential diagnosis and minimally invasive surgery of an antenatal adrenal mass. Rev Chil Pediatr 2019; 90(3):321-7.
19. 19. Fisher JPH, Tweddle DA. Neonatal neuroblastoma. Semin Fetal Neonatal Med 2012; 17:207-15.