Intracranial growing teratoma syndrome (iGTS): an international case series and review of the literature.

PURPOSE: Intracranial growing teratoma syndrome (iGTS) is a rare phenomenon of paradoxical growth of a germ cell tumor (GCT) during treatment despite normalization of tumor markers. We sought to evaluate the frequency, clinical characteristics and outcome of iGTS in Western countries. METHODS: Pediatric patients from 22 North American and Australian institutions diagnosed with iGTS between 2000 and 2017 were retrospectively evaluated. RESULTS: From a total of 777 cases of central nervous system (CNS) GCT, 39 cases of iGTS were identified for an overall frequency of 5%. Pineal region was a more frequent location for iGTS as compared to cases of GCT without iGTS (p < 0.00001). In patients with an initial tissue diagnosis of GCT, immature teratoma was present in 50%. Serum AFP or ßhCG was detectable in 87% of patients (median values 66 ng/mL and 44 IU/L, respectively). iGTS occurred at a median of 2 months (range 0.5-32) from diagnosis, in the majority of patients. All patients underwent surgical resection, leading to gross total resection in 79%. Following surgery, all patients resumed adjuvant therapy or post treatment follow-up for GCT. At a median follow-up of 5.3 years (range 0.2-11.8), 37 (95%) of patients are alive, including 5 with stable residual mass. CONCLUSION: iGTS occurs in 5% of patients with GCT in Western countries. Tumors of the pineal region and GCT containing immature teratoma appear to be associated with a higher risk of developing iGTS. Complete surgical resection is the mainstay of treatment. Overall survival of patients developing iGTS remains favorable.

Risk Factors Associated With Abscess Formation in Children 5 Years of Age and Younger.

From 1997 to 2009, hospitalization rates have doubled for pediatric patients with soft tissue abscesses requiring incision and drainage. Despite this increasing national burden, few studies have been conducted to identify the risk factors associated with abscess formation. Our study evaluates a collection of physiological and lifestyle parameters that may serve as risk factors for abscess formation among pediatric patients 5 years of age or younger. Our results indicate family history and age 2 years and younger are associated with higher risk of abscess formation. Furthermore, methicillin-resistant Staphylococcus aureus and methicillin-susceptible Staphylococcus aureus were prevalent pathogens associated with abscess in our study group. Pediatricians may employ these novel parameters to educate parents and/or guardians of high-risk groups on preventing abscess formation to alleviate the burden of incision & dragining requiring abscess on health care costs.