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Pediatric presacral tumors with intraspinal extension: a rare entity with diagnostic challenges
Ebinesh A1, Anjali Prakash1, Aanchal Ashta1
1Department of Radiodiagnosis, Maulana Azad Medical College and associated Lok Nayak Hospital, Jawahar Lal Nehru Marg, New Delhi, India.
Insights
Pediatric presacral tumors require advanced imaging for accurate diagnosis and treatment planning. Key imaging features help differentiate various tumor types, including germ cell, neuroblastic, and mesenchymal origins, aiding in optimal characterization.
Area of Science:
- Radiology
- Pediatric Oncology
- Pathology
Background:
- The presacral space, situated between the rectum and lumbosacral spine, harbors primitive germ cells that can develop into diverse tumors.
- Imaging plays a critical role in the diagnosis, staging, and treatment monitoring of these pediatric presacral tumors.
Purpose of the Study:
- To report six cases of pediatric presacral tumors with intraspinal extension.
- To identify distinctive imaging features that aid in the optimal characterization of these tumors.
Main Methods:
- Retrospective review of six pediatric cases with presacral tumors and intraspinal extension.
- Analysis of imaging characteristics including epicenter, bone involvement, sacral foramina status, and internal tumor composition (fat, calcification, hemorrhage, necrosis).
Main Results:
- The cases included immature and malignant sacrococcygeal teratomas, neuroblastoma, rhabdomyosarcoma, clear cell sarcoma, and Ewing's sarcoma.
- Distinctive imaging features were identified to aid in differentiating tumor origins (germ cell, neuroblastic, mesenchymal, osteogenic).
Conclusions:
- Accurate characterization of pediatric presacral tumors relies on a comprehensive analysis of specific imaging findings.
- Understanding these features is essential for effective management and treatment planning in pediatric oncology.
Abstract:
The presacral space is a potential space located between the rectum and the lumbosacral spine. It contains various primitive germ cell types that serve as the origin for a range of tumors. Imaging is crucial in characterizing, assessing the extent of and evaluating the treatment response to these tumors. We report a series of six cases of pediatric presacral tumors with intraspinal extension, including an immature sacrococcygeal teratoma (Altman type II), a malignant sacrococcygeal teratoma (Altman type IV), a neuroblastoma, a rhabdomyosarcoma, a clear cell sarcoma and an Ewing's sarcoma of the ilium. These tumors can be broadly categorized as tumors of germ cell, neuroblastic, mesenchymal and osteogenic origin. Despite overlapping imaging features, a review of the existing literature and careful retrospective observation revealed several distinctive features that aid in the optimal characterization of tumors. These include the tumor's epicenter, the pattern and degree of bone involvement, the status of sacral foramina and neural elements, and internal tumor characteristics such as the presence of fat, calcification, hemorrhage and necrosis.
