Sacrococcygeal teratoma type IV presenting with urine retention in infants

Giant malignant sacrococcygeal germ cell tumor in a newborn: A rare case report

“…The latter has the worst prognosis since, being devoid of external components, are difficult to diagnose, therefore, frequently malignant at the time of presentation as detected later than types I, II, and III, and sometimes less amenable to surgery. Contrary to what might have been expected, we found a type I SCT, which was cancerous [4] , [5] , [6] , [7] , [8] , 12] . Cross-sectional imaging studies such as CT and MRI play a central role in the management of SCT because, in addition to providing invaluable information that helps determine the diagnosis, define the type of mass by delineating its extension and relationship with the adjacent anatomical structures, so as to develop an appropriate surgical plan that enables complete resection of the neoplasm including coccygectomy [2 , 6 , [12] , [13] , [14] , [15] .…”

“…Contrary to what might have been expected, we found a type I SCT, which was cancerous [4] , [5] , [6] , [7] , [8] , 12] . Cross-sectional imaging studies such as CT and MRI play a central role in the management of SCT because, in addition to providing invaluable information that helps determine the diagnosis, define the type of mass by delineating its extension and relationship with the adjacent anatomical structures, so as to develop an appropriate surgical plan that enables complete resection of the neoplasm including coccygectomy [2 , 6 , [12] , [13] , [14] , [15] . CT and MRI are also very important in the evaluation of giant (>10 cm) hypervascular SCT, which is associated with a high risk of rupture and consequently severe bleeding during the operation unless the tumor is devascularized by ligation of the median sacral artery, which is considered its principal feeding vessel [5 , [7] , [8] , [16] , [17] .…”

“…Clinical presentation varies depending on the size and location of the SCTs. These neoplasms are usually asymptomatic, as in our case, but occasionally their growth within the pelvis can cause symptoms of obstruction of the rectum, colon, or bladder outlet, and/or lower limb dysfunction if the intradural spinal involvement is present [1] , [2] , [6] , [7] , 12] . The American Academy of Pediatrics Surgical Section classifies SCTs into 4 types based on the location, the ease of resection, and the malignant potential: type I (47%), predominantly external masses with a minimal presacral component, and carry the best prognosis; type II (35%), external tumors with a large intrapelvic portion; type III (10%), lesions apparent externally but predominantly pelvic and extending into the abdomen; and type IV (8%), presacral tumors only.…”

“…We adopted the “wait and watch” policy and chemotherapy will be initiated if there is evidence of reappearance of the disease based on rise in AFP and/or the presence of neoplastic tissue at MRI [1 , 20] . The recurrence rate of malignant teratoma is 0%-36% (mean, 18%) and the most important risk factors are incomplete resection of the neoplasm and/or coccyx, and/or tumor rupture/spillage during the cesarean delivery or surgical removal [4] , [5] , [6] , [7] , [8] , 10 , 12] . The probability of relapse of the disease is high in the first 3 years after surgery, but our little patient will undergo close follow-up for at least 5 years with frequent AFP level measurements alternated with diagnostic imaging examinations (abdominal ultrasound, chest x-ray, and pelvic/spinal MRI) [4 , 20] .…”