Infantile extragonadal germ cell tumors: Clinical characteristics, surgical outcomes, and healthcare delivery challenges at a rural tertiary care center in North India.
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BACKGROUND: Extragonadal germ cell tumors (EGCTs) in infancy are rare neoplasms with generally favorable prognosis when managed appropriately. However, outcomes in resource-limited rural settings remain poorly documented. This study analyzed clinical profiles, surgical outcomes, and healthcare delivery gaps in infantile EGCTs at a tertiary care center serving rural North India. METHODS: We retrospectively reviewed all infants (≤12 months) with histopathologically confirmed EGCTs managed between January 2019 and August 2025. Demographics, clinical presentation, imaging findings, surgical management, histopathology, complications, and follow-up outcomes were analyzed using descriptive statistics. RESULTS: Sixteen infants (female: male ratio 3:1, mean age 4.4 ± 2.3 months) were included. Antenatal diagnosis occurred in only 2 cases (12.5%), markedly lower than international benchmarks of 25-30%. Sacrococcygeal location predominated (87.5%), with Altman type I being most common (71.4%). All tumors were mature teratomas without malignant components. Complete excision with tumor-free margins was achieved universally. Postoperative complications occurred in 3 patients (18.8%), limited to superficial surgical site infections. During a median follow-up of 8 months (mean 9.1 ± 4.8 months, range 3-18 months), no recurrence or mortality occurred, yielding 100% survival . CONCLUSIONS: Infantile EGCTs demonstrate excellent surgical outcomes with complete excision, even in resource-constrained rural settings. However, the antenatal diagnosis rate of 12.5% highlights significant healthcare delivery challenges requiring systematic interventions, including enhanced antenatal screening infrastructure, a trained sonographic workforce and improved referral pathways. Extended surveillance is essential to assess long-term recurrence and functional outcomes. The 0% recurrence rate reflects short-term follow-up only (median 8 months); surveillance extending at least 3-5 years is essential given that malignant recurrence in mature teratomas typically manifests beyond this observation window .