The Case of an Elderly Male Patient with Unknown Primary Mucinous Adenocarcinoma within Presacral Teratoma (Teratoma with Malignant Transformation)

Abstract

Teratomas are rarely seen in adults, and presacral region is an area where they rarely settle in. Similarly, only about 1% of teratomas show malignant transformation. Malignant transformation is often associated with the area where teratoma settles in. Malignant transformation of mediastinal teratomas is more frequent than the ones located in retroperitoneal area and gonad. They most commonly show rhabdomyosarcoma, primitive neuroectodermal tumor, enteric adenocarcinoma, and leukemia transformation. In teratomas showing malignant transformation, the clinical course is aggressive; and survival of patients with metastatic disease is very low. The primary treatment of teratomas with malignant transformations is surgical. Effect of radiotherapy and chemotherapy is not clear in patients, to whom surgical operation cannot be applied, or those who are with residual tumor, even if surgical operation can be applied to them, or those who are at metastatic stage. In this paper, we presented a 76-year-old male patient due to the histologic diagnosis of mucinous adenocarcinoma within teratoma, in whom approximately 7 cm presacral mass was found during the radiographic examination made by the reason of low back pain and pelvic pain.

Recurrent Adult Sacrococcygeal Teratoma Developing Adenocarcinoma: A Case Report and Review of Literatures

“…Teratomas containing any malignant elements are considered to be malignant. In adults, there are only a few case reports noting malignant transformation from sacrococcygeal/presacral teratomas [ 3 – 9 ]: two cases being mucinous adenocarcinoma, one case being adenocarcinoma of gastrointestinal origin, and four cases being nonspecific adenocarcinoma. Cytogenetic aberrations (amplifications of 8q and 12p) have been reported to be associated with malignant transformation to an adenocarcinoma [ 4 ].…”

“…However, they are extremely rare in adults. Most of the sacrococcygeal teratomas (SCT) are benign and mature; malignant transformation within adult SCT is exceedingly rare with only several case reports documented [ 3 – 9 ]. Most of the adult SCT are located within the pelvis and may cause compressive symptoms such as lower back pain, bowel/urinary dysfunctions, and venous engorgement of the lower limbs [ 10 ].…”