The Irish Experience with Sacrococcygeal Teratomas: Are Type IV Lesions More Common than We Think?

Abstract

Title The Irish experience with Sacrococcygeal Teratomas- are type IV lesions more common than we think? Introduction Sacrococcygeal Teratomas (SCT) are rare tumours occurring in approximately 1 in 35,000 to 40,000 live births. The Altman classification is used to describe SCTs. There are four types, with type 1 predominantly external through to type IV which is a presacral, completely internal mass. As far as the authors are aware, this is the first study to focus on Type IV SCT lesions. Materials and Methods Using ICD-10-AM codes, we identified all patients in the Republic of Ireland with a diagnosis of Sacrococcygeal Teratoma from 2004-2020. The following information was obtained for each patient; gender, time of diagnosis, clinical presentation, method of diagnosis, Altman classification, biomarkers, age at operation, surgical technique, pathology, recurrence, age at most recent follow-up. Results There were 29 patients in total; 23 Females (79%) and 6 males (21%). 16 (55%) were diagnosed antenatally, 4 (14%) at <1 month, 4 (14%) <1 year, 3 (10%) age 2-4 years and 2(7%) were aged 5-12 years. 22 (76%) were Mature Teratomas, 2 (7%) immature teratomas and 5 (17%) were Malignant tumours. There were 6 (21%) Type I lesions, 9 (30%) Type II, 6 (21%) Type III and 8 (28%) Type IV lesions. Conclusions In Altman’s original 1974 study, type IV lesions were present in 10% of cases. As a result, this is the most frequently quoted figure. Type IV lesions were present in 28% of cases in our study. We propose that type IV lesions may be more common than the current literature suggests and consequently a higher index of suspicion of their presence should be entertained.