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Sacrococcygeal teratomas (SCT)

Rare extracranial germ cell tumour containing tissues derived from two or more primitive germ cells.

Rare extracranial germ cell tumour containing tissues derived from two or more primitive germ cells.

  • M/C fetal neoplasm
  • Malignant transformation: 1–2%
  • Female to male ratio: 4:1

Classification

Altman classification (according to position):

  1. Type I: External mass + small presacral component
  2. Type II: External mass + intrapelvic component
  3. Type III: External mass + pelvic & abdominal component
  4. Type IV: Internal mass (intrapelvic & abdominal location)
  • Types II & III usually dumb-bell shaped

Pathophysiology

  • Abnormal migration of primordial germ cells
  • Persistence of primitive streak

Clinical presentation

  • Mass effect on the adjacent organs → Obstructive symptoms
  • Disfigurement and discomfort
  • Painful skin excoriation and ulcers
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(A): Standing view showing the mass extending down the natal cleft (B): left lateral position showing a huge mass over the lower back and upper buttocks with skin excoriations. | Shatnawi, N. J., Khammash, M. R., & Omari, A. H. (2019). A giant sacrococcygeal teratoma in adult female: A case report. International Journal of Surgery Case Reports, 54, 47–50. https://doi.org/10.1016/j.ijscr.2018.11.039

Diagnosis

MRI:

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(A): MRI of the pelvis showing cyst filled with faint calcifications with clear margins except over the lower coccyx compressing the pelvic structures anteriorly and superiorly. (B): MRI showing dimensions of the cyst and relations with pelvic structures. | Shatnawi, N. J., Khammash, M. R., & Omari, A. H. (2019). A giant sacrococcygeal teratoma in adult female: A case report. International Journal of Surgery Case Reports, 54, 47–50. https://doi.org/10.1016/j.ijscr.2018.11.039

Management

Surgical resection:

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