Figure 1
Clinical image
Soft tissue lesion in the sacral region.
A case of sacrococcygeal teratoma
SectionMusculoskeletal system
Case TypeClinical Cases
AuthorsDr Sanjib Kumar Das
Connected authors
7 years, female
Clinical History
A 7-year-old girl presented with a mass in the sacral region which had been present since birth and appeared to grow with age. The mass was soft in consistency and devoid of any discharge.
Imaging Findings
A CT scan was performed and revealed a pedunculated soft tissue mass posterior of the sacrum at S4-S5 level, with inhomogeneous density (including fat and calcification). No definite presacral extension was seen.
On USG correlation, the mass appeared solid-cystic in nature.
On USG correlation, the mass appeared solid-cystic in nature.
Discussion
Sacrococcygeal teratoma is the most common solid tumour in neonates with an incidence of one in 35000 births and a F:M ratio of 4:1. It is a type of germ cell tumour arising from an early event in embryogenesis leading to abnormal primitive totipotent cells. It is most commonly benign, although malignant forms also occur. Malignant forms occur most commonly in men. [1]
It arises from the anterior portion of coccyx and grows most commonly posteroinferiorly. It can be one of 4 types: [2, 3]
Type 1: entirely external
Type 2: with little presacral extension
Type 3: largest part in pelvis or abdomen
Type 4: entirely presacral
Radiologic evaluation helps in the confirmation of the diagnosis, extension of the mass, relationship with other structures, tissue characteristics and demonstration of metastasis in malignant cases. [4] It can be solid, cystic or a combination of both. Cystic lesions have the lowest risk of malignancy while solid ones have the highest risk. USG shows solid or cystic nature of the tumour while colour Doppler in some tumours may show marked hypervascularity. MRI is the modality to rule out any colonic displacement, ureteric dilatation, associated hip dislocation and intraspinal extension.
Management of benign tumours [5] is surgical excision with coccyx to prevent recurrence while in malignant types radiotherapy and chemotherapy are performed, followed by surgical excision. The blood AFP is often the tumour marker in children with malignant teratoma.
It arises from the anterior portion of coccyx and grows most commonly posteroinferiorly. It can be one of 4 types: [2, 3]
Type 1: entirely external
Type 2: with little presacral extension
Type 3: largest part in pelvis or abdomen
Type 4: entirely presacral
Radiologic evaluation helps in the confirmation of the diagnosis, extension of the mass, relationship with other structures, tissue characteristics and demonstration of metastasis in malignant cases. [4] It can be solid, cystic or a combination of both. Cystic lesions have the lowest risk of malignancy while solid ones have the highest risk. USG shows solid or cystic nature of the tumour while colour Doppler in some tumours may show marked hypervascularity. MRI is the modality to rule out any colonic displacement, ureteric dilatation, associated hip dislocation and intraspinal extension.
Management of benign tumours [5] is surgical excision with coccyx to prevent recurrence while in malignant types radiotherapy and chemotherapy are performed, followed by surgical excision. The blood AFP is often the tumour marker in children with malignant teratoma.
Differential Diagnosis List
Sacrococcygeal teratoma (Type 1)
Sacral chordoma
Sacral meningocoele
Final Diagnosis
Sacrococcygeal teratoma (Type 1)
References
[1] Dillard BM, MayerJH, McAlisten WH, et al (1970) Sacrococcygeal teratoma in children. J Pediatr Surg 5(1):53-9 (PMID: 4907733)
[2] Schey WL, Shkolnik A, White H (1977) Clinical and radiographic considerations of sacrococcygeal teratomas: an analysis of 26 new cases and review of the literature. Radiology 125(1):189-95 (PMID: 897168)
[3] NoseworthyJ, Lack EE, Kozakewich HPW, Vawter GF, Welch KJ (1981) Sacrococcygeal germ cell tumors in childhood: an updated expenience with 118 patients. J Pediatr Surg 16(3):358-64 (PMID: 7252741)
[4] Chan FL, Cheng CS, Tam PK, Saing H (1987) Sacrococcygeal teratoma: computed tomography evaluation. J Comput Tomogr 11(2):200-4 (PMID: 3581859)
[5] Mahour GH (1988) Sacrococcygeal Teratomas. CA Cancer J Clin 38(6):362-7 (PMID: 3141009)
Case information
| URL: | https://www.eurorad.org/case/13837 |
| DOI: | 10.1594/EURORAD/CASE.13837 |
| ISSN: | 1563-4086 |
License
This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.
Figure 2
Axial view
Axial CT image at the level inferior of the sacrum, in soft tissue window showing a soft tissue dense mass lesion in the sacral region with fatty component.
Figure 3
Bone window (axial view)
Axial CT image at the level inferior to the sacrum, in bone window showing calcific foci within the mass.
Clinical image
Soft tissue lesion in the sacral region.
dept of radiology scb medical college cuttack
dept of radiology scb medical college cuttack
Axial view
Axial CT image at the level inferior of the sacrum, in soft tissue window showing a soft tissue dense mass lesion in the sacral region with fatty component.
dept of radiology scb medical college cuttack
dept of radiology scb medical college cuttack
Bone window (axial view)
Axial CT image at the level inferior to the sacrum, in bone window showing calcific foci within the mass.
dept of radiology scb medical college cuttack
dept of radiology scb medical college cuttack