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Description
A 67-year-old woman was admitted to our hospital with severe low back/radicular pain and gait disturbance, and presenting a giant extraperineal mass (figure 1).
A preoperative CT scan documented a mixed fluid/solid mass measuring 35×19×18 cm dislocating the rectum and protruding outside the perineum in the infragluteal space, which was also associated with a sacrococcygeal malformation consistent with a coccyx's cleft, as confirmed by MRI.
The patient reported the presence of a smaller sacrococcygeal mass since childhood, which increased in size over the past 3 years; she did not consider a medical consultation, however, due to a major depressive disorder.
The patient was scheduled for a surgical procedure and the tumour was completely removed via a posterior approach. The pathological examination documented a teratoma with focal areas of malignant transformation.
Sacrococcygeal teratomas (SCTs) are germ cell tumours, with an incidence of 1/40 000 live-births, affecting females 4 times more often than males.1 ,2
SCTs are the most common presacral germ cell tumours in children and neonates. Up to 27% of SCTs are malignant, and the probability of malignancy increases with the age of presentation.1
SCTs are classified according to Altman classification into: type I, predominantly external masses with a small presacral component; type II, external masses with a significant intrapelvic component; type III, external masses with a pelvic and abdominal component; and type IV, internal masses with an intrapelvic and abdominal location; types II and III are dumbbell shaped.3
Learning points
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Because the clinical manifestations of presacral masses are often non-specific, imaging plays an important role in the detection and differentiation of these masses and might be crucial for their surgical management.
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Sacro-coccygeal teratomas affect females more often than males.
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Up to one-fourth of the SCT might be malignant and the risk is increased in adult patients.
Footnotes
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Contributors All authors contributed to writing the manuscript; and reviewed and approved the manuscript in its final form.
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Competing interests None.
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Patient consent Obtained.
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Provenance and peer review Not commissioned; externally peer reviewed.