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Sacrococcygeal Teratoma
Kevin R. Moore, MD; Sara M. O'Hara, MD, FAAP
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KEY FACTS

  • Terminology

    • Imaging

      • Top Differential Diagnoses

        • Pathology

          • Clinical Issues

            • Diagnostic Checklist

              TERMINOLOGY

              • Abbreviations

                • Sacrococcygeal teratoma (SCT)
              • Synonyms

                • Teratoma, germ cell tumor of coccyx
              • Definitions

                • Teratomas made up of various parenchymal cell types from > 1 germ layer, usually all 3
                  • Tumors may contain hair, teeth, cartilage, & fat, amongst other tissues
                • SCT arises from coccyx, potentially grows both internally & externally (with latter more common)
                • Both benign & malignant varieties

              IMAGING

              • General Features

                • Radiographic Findings

                  • Fluoroscopic Findings

                    • CT Findings

                      • MR Findings

                        • Ultrasonographic Findings

                          • Nuclear Medicine Findings

                            • Imaging Recommendations

                              DIFFERENTIAL DIAGNOSIS

                                PATHOLOGY

                                • General Features

                                  • Staging, Grading, & Classification

                                    • Gross Pathologic & Surgical Features

                                      • Microscopic Features

                                        CLINICAL ISSUES

                                        • Presentation

                                          • Demographics

                                            • Natural History & Prognosis

                                              • Treatment

                                                Selected References

                                                1. Hambraeus M et al: Long-term outcome of sacrococcygeal teratoma: A controlled cohort study of urinary tract and bowel dysfunction and predictors of poor outcome. J Pediatr. 198:131-136.e2, 2018
                                                2. Kremer MEB et al: The incidence of associated abnormalities in patients with sacrococcygeal teratoma. J Pediatr Surg. 53(10):1918-22, 2018
                                                3. Yoon HM et al: Sacrococcygeal teratomas in newborns: a comprehensive review for the radiologists. Acta Radiol. 59(2):236-46, 2018
                                                4. Padilla BE et al: Sacrococcygeal teratoma: late recurrence warrants long-term surveillance. Pediatr Surg Int. 33(11):1189-94, 2017
                                                5. Hambraeus M et al: Sacrococcygeal teratoma: a population-based study of incidence and prenatal prognostic factors. J Pediatr Surg. 51(3):481-5, 2016
                                                6. Kremer ME et al: Evaluation of chemotherapeutic sequelae and quality of life in survivors of malignant sacrococcygeal teratoma. Pediatr Surg Int. 32(3):261-8, 2016
                                                7. Adekola H et al: The clinical relevance of fetal MRI in the diagnosis of type IV cystic sacrococcygeal teratoma--a review. Fetal Pediatr Pathol. 34(1):31-43, 2015
                                                8. Dirix M et al: Malignant transformation in sacrococcygeal teratoma and in presacral teratoma associated with Currarino syndrome: a comparative study. J Pediatr Surg. 50(3):462-4, 2015
                                                9. Sananes N et al: Technical aspects and effectiveness of percutaneous fetal therapies for large sacrococcygeal teratomas - a cohort study and a literature review. Ultrasound Obstet Gynecol. 47(6):712-9, 2015
                                                10. Coleman A et al: Sacrococcygeal teratoma growth rate predicts adverse outcomes. J Pediatr Surg. 49(6):985-9, 2014
                                                11. Garg R et al: Sacrococcygeal malignant germ cell tumor (SC-MGCT) with intraspinal extension. J Pediatr Surg. 49(7):1113-5, 2014
                                                12. Kremer ME et al: Evaluation of pregnancy and delivery in 13 women who underwent resection of a sacrococcygeal teratoma during early childhood. BMC Pregnancy Childbirth. 14:407, 2014
                                                13. Ladino Torres MF et al: Spine ultrasound imaging in the newborn. Semin Ultrasound CT MR. 35(6):652-61, 2014
                                                14. Partridge EA et al: Urologic and anorectal complications of sacrococcygeal teratomas: prenatal and postnatal predictors. J Pediatr Surg. 49(1):139-42; discussion 142-3, 2014
                                                15. Yao W et al: Analysis of recurrence risks for sacrococcygeal teratoma in children. J Pediatr Surg. 49(12):1839-42, 2014
                                                16. Shue E et al: Tumor metrics and morphology predict poor prognosis in prenatally diagnosed sacrococcygeal teratoma: a 25-year experience at a single institution. J Pediatr Surg. 48(6):1225-31, 2013
                                                17. Yoneda A et al: Impact of the histological type on the prognosis of patients with prenatally diagnosed sacrococcygeal teratomas: the results of a nationwide Japanese survey. Pediatr Surg Int. 29(11):1119-25, 2013
                                                18. Davenport KP et al: Pediatric malignancies: neuroblastoma, Wilm's tumor, hepatoblastoma, rhabdomyosarcoma, and sacroccygeal teratoma. Surg Clin North Am. 92(3):745-67, x, 2012
                                                19. Peterson CM et al: Teratomas: a multimodality review. Curr Probl Diagn Radiol. 41(6):210-9, 2012
                                                20. Yao MS et al: Sacrococcygeal teratoma in an adolescent. JBR-BTR. 95(5):322-4, 2012
                                                21. Jan IA et al: Posterior sagittal approach for resection of sacrococcygeal teratomas. Pediatr Surg Int. 27(5):545-8, 2011
                                                22. Bartels SA et al: Presacral masses in children: presentation, etiology and risk of malignancy. Colorectal Dis. 13(8):930-4, 2011
                                                23. Shah RU et al: Imaging of pediatric pelvic neoplasms. Radiol Clin North Am. 49(4):729-48, vi, 2011
                                                24. Dancel LD et al: Sacrococcygeal teratoma presenting as perineal and periumbilical discoloration (cullen sign). J Pediatr. 157(6):1041, 2010
                                                25. Sy ED et al: Prognostic role of tumor-head volume ratio in fetal sacrococcygeal teratoma. Fetal Diagn Ther. 26(2):75-80, 2009
                                                26. Heerema-McKenney A et al: Congenital teratoma: a clinicopathologic study of 22 fetal and neonatal tumors. Am J Surg Pathol. 29(1):29-38, 2005
                                                27. Gatcombe HG et al: Primary retroperitoneal teratomas: a review of the literature. J Surg Oncol. 86(2):107-13, 2004
                                                28. Isaacs H Jr: Perinatal (fetal and neonatal) germ cell tumors. J Pediatr Surg. 39(7):1003-13, 2004
                                                29. Neubert S et al: Sonographic prognostic factors in prenatal diagnosis of SCT. Fetal Diagn Ther. 19(4):319-26, 2004
                                                30. Urioste M et al: Malignant degeneration of presacral teratoma in the Currarino anomaly. Am J Med Genet A. 128(3):299-304, 2004
                                                31. Zaccara A et al: Gait analysis in patients operated on for sacrococcygeal teratoma. J Pediatr Surg. 39(6):947-52; discussion 947-52, 2004
                                                32. Graf JL et al: Fetal sacrococcygeal teratoma. World J Surg. 27(1):84-6, 2003
                                                33. Hirose S et al: Fetal surgery for sacrococcygeal teratoma. Clin Perinatol. 30(3):493-506, 2003
                                                34. Huddart SN et al: Sacrococcygeal teratomas: the UK Children's Cancer Study Group's experience. I. Neonatal. Pediatr Surg Int. 19(1-2):47-51, 2003
                                                35. Avni FE et al: MR imaging of fetal sacrococcygeal teratoma: diagnosis and assessment. AJR Am J Roentgenol. 178(1):179-83, 2002
                                                36. Lam YH et al: Thermocoagulation of fetal sacrococcygeal teratoma. Prenat Diagn. 22(2):99-101, 2002
                                                37. O'Hara SM: Tumors of the pediatric genitourinary system. In Bragg et al: Oncologic Imaging. 2nd ed. Philadelphia: W. B. Saunders. 779-811, 2002
                                                38. Wakhlu A et al: Sacrococcygeal teratoma. Pediatr Surg Int. 18(5-6):384-7, 2002
                                                39. Kamata S et al: Operative management for sacrococcygeal teratoma diagnosed in utero. J Pediatr Surg. 36(4):545-8, 2001
                                                40. Singh SJ et al: Familial presacral masses: Screening pitfalls. J Pediatr Surg. 36(12):1841-4, 2001
                                                41. Wells RG et al: Imaging of sacrococcygeal germ cell tumors. Radiographics. 10(4):701-13, 1990
                                                Related Anatomy
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                                                Related Differential Diagnoses
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                                                References
                                                Tables

                                                Tables

                                                KEY FACTS

                                                • Terminology

                                                  • Imaging

                                                    • Top Differential Diagnoses

                                                      • Pathology

                                                        • Clinical Issues

                                                          • Diagnostic Checklist

                                                            TERMINOLOGY

                                                            • Abbreviations

                                                              • Sacrococcygeal teratoma (SCT)
                                                            • Synonyms

                                                              • Teratoma, germ cell tumor of coccyx
                                                            • Definitions

                                                              • Teratomas made up of various parenchymal cell types from > 1 germ layer, usually all 3
                                                                • Tumors may contain hair, teeth, cartilage, & fat, amongst other tissues
                                                              • SCT arises from coccyx, potentially grows both internally & externally (with latter more common)
                                                              • Both benign & malignant varieties

                                                            IMAGING

                                                            • General Features

                                                              • Radiographic Findings

                                                                • Fluoroscopic Findings

                                                                  • CT Findings

                                                                    • MR Findings

                                                                      • Ultrasonographic Findings

                                                                        • Nuclear Medicine Findings

                                                                          • Imaging Recommendations

                                                                            DIFFERENTIAL DIAGNOSIS

                                                                              PATHOLOGY

                                                                              • General Features

                                                                                • Staging, Grading, & Classification

                                                                                  • Gross Pathologic & Surgical Features

                                                                                    • Microscopic Features

                                                                                      CLINICAL ISSUES

                                                                                      • Presentation

                                                                                        • Demographics

                                                                                          • Natural History & Prognosis

                                                                                            • Treatment

                                                                                              Selected References

                                                                                              1. Hambraeus M et al: Long-term outcome of sacrococcygeal teratoma: A controlled cohort study of urinary tract and bowel dysfunction and predictors of poor outcome. J Pediatr. 198:131-136.e2, 2018
                                                                                              2. Kremer MEB et al: The incidence of associated abnormalities in patients with sacrococcygeal teratoma. J Pediatr Surg. 53(10):1918-22, 2018
                                                                                              3. Yoon HM et al: Sacrococcygeal teratomas in newborns: a comprehensive review for the radiologists. Acta Radiol. 59(2):236-46, 2018
                                                                                              4. Padilla BE et al: Sacrococcygeal teratoma: late recurrence warrants long-term surveillance. Pediatr Surg Int. 33(11):1189-94, 2017
                                                                                              5. Hambraeus M et al: Sacrococcygeal teratoma: a population-based study of incidence and prenatal prognostic factors. J Pediatr Surg. 51(3):481-5, 2016
                                                                                              6. Kremer ME et al: Evaluation of chemotherapeutic sequelae and quality of life in survivors of malignant sacrococcygeal teratoma. Pediatr Surg Int. 32(3):261-8, 2016
                                                                                              7. Adekola H et al: The clinical relevance of fetal MRI in the diagnosis of type IV cystic sacrococcygeal teratoma--a review. Fetal Pediatr Pathol. 34(1):31-43, 2015
                                                                                              8. Dirix M et al: Malignant transformation in sacrococcygeal teratoma and in presacral teratoma associated with Currarino syndrome: a comparative study. J Pediatr Surg. 50(3):462-4, 2015
                                                                                              9. Sananes N et al: Technical aspects and effectiveness of percutaneous fetal therapies for large sacrococcygeal teratomas - a cohort study and a literature review. Ultrasound Obstet Gynecol. 47(6):712-9, 2015
                                                                                              10. Coleman A et al: Sacrococcygeal teratoma growth rate predicts adverse outcomes. J Pediatr Surg. 49(6):985-9, 2014
                                                                                              11. Garg R et al: Sacrococcygeal malignant germ cell tumor (SC-MGCT) with intraspinal extension. J Pediatr Surg. 49(7):1113-5, 2014
                                                                                              12. Kremer ME et al: Evaluation of pregnancy and delivery in 13 women who underwent resection of a sacrococcygeal teratoma during early childhood. BMC Pregnancy Childbirth. 14:407, 2014
                                                                                              13. Ladino Torres MF et al: Spine ultrasound imaging in the newborn. Semin Ultrasound CT MR. 35(6):652-61, 2014
                                                                                              14. Partridge EA et al: Urologic and anorectal complications of sacrococcygeal teratomas: prenatal and postnatal predictors. J Pediatr Surg. 49(1):139-42; discussion 142-3, 2014
                                                                                              15. Yao W et al: Analysis of recurrence risks for sacrococcygeal teratoma in children. J Pediatr Surg. 49(12):1839-42, 2014
                                                                                              16. Shue E et al: Tumor metrics and morphology predict poor prognosis in prenatally diagnosed sacrococcygeal teratoma: a 25-year experience at a single institution. J Pediatr Surg. 48(6):1225-31, 2013
                                                                                              17. Yoneda A et al: Impact of the histological type on the prognosis of patients with prenatally diagnosed sacrococcygeal teratomas: the results of a nationwide Japanese survey. Pediatr Surg Int. 29(11):1119-25, 2013
                                                                                              18. Davenport KP et al: Pediatric malignancies: neuroblastoma, Wilm's tumor, hepatoblastoma, rhabdomyosarcoma, and sacroccygeal teratoma. Surg Clin North Am. 92(3):745-67, x, 2012
                                                                                              19. Peterson CM et al: Teratomas: a multimodality review. Curr Probl Diagn Radiol. 41(6):210-9, 2012
                                                                                              20. Yao MS et al: Sacrococcygeal teratoma in an adolescent. JBR-BTR. 95(5):322-4, 2012
                                                                                              21. Jan IA et al: Posterior sagittal approach for resection of sacrococcygeal teratomas. Pediatr Surg Int. 27(5):545-8, 2011
                                                                                              22. Bartels SA et al: Presacral masses in children: presentation, etiology and risk of malignancy. Colorectal Dis. 13(8):930-4, 2011
                                                                                              23. Shah RU et al: Imaging of pediatric pelvic neoplasms. Radiol Clin North Am. 49(4):729-48, vi, 2011
                                                                                              24. Dancel LD et al: Sacrococcygeal teratoma presenting as perineal and periumbilical discoloration (cullen sign). J Pediatr. 157(6):1041, 2010
                                                                                              25. Sy ED et al: Prognostic role of tumor-head volume ratio in fetal sacrococcygeal teratoma. Fetal Diagn Ther. 26(2):75-80, 2009
                                                                                              26. Heerema-McKenney A et al: Congenital teratoma: a clinicopathologic study of 22 fetal and neonatal tumors. Am J Surg Pathol. 29(1):29-38, 2005
                                                                                              27. Gatcombe HG et al: Primary retroperitoneal teratomas: a review of the literature. J Surg Oncol. 86(2):107-13, 2004
                                                                                              28. Isaacs H Jr: Perinatal (fetal and neonatal) germ cell tumors. J Pediatr Surg. 39(7):1003-13, 2004
                                                                                              29. Neubert S et al: Sonographic prognostic factors in prenatal diagnosis of SCT. Fetal Diagn Ther. 19(4):319-26, 2004
                                                                                              30. Urioste M et al: Malignant degeneration of presacral teratoma in the Currarino anomaly. Am J Med Genet A. 128(3):299-304, 2004
                                                                                              31. Zaccara A et al: Gait analysis in patients operated on for sacrococcygeal teratoma. J Pediatr Surg. 39(6):947-52; discussion 947-52, 2004
                                                                                              32. Graf JL et al: Fetal sacrococcygeal teratoma. World J Surg. 27(1):84-6, 2003
                                                                                              33. Hirose S et al: Fetal surgery for sacrococcygeal teratoma. Clin Perinatol. 30(3):493-506, 2003
                                                                                              34. Huddart SN et al: Sacrococcygeal teratomas: the UK Children's Cancer Study Group's experience. I. Neonatal. Pediatr Surg Int. 19(1-2):47-51, 2003
                                                                                              35. Avni FE et al: MR imaging of fetal sacrococcygeal teratoma: diagnosis and assessment. AJR Am J Roentgenol. 178(1):179-83, 2002
                                                                                              36. Lam YH et al: Thermocoagulation of fetal sacrococcygeal teratoma. Prenat Diagn. 22(2):99-101, 2002
                                                                                              37. O'Hara SM: Tumors of the pediatric genitourinary system. In Bragg et al: Oncologic Imaging. 2nd ed. Philadelphia: W. B. Saunders. 779-811, 2002
                                                                                              38. Wakhlu A et al: Sacrococcygeal teratoma. Pediatr Surg Int. 18(5-6):384-7, 2002
                                                                                              39. Kamata S et al: Operative management for sacrococcygeal teratoma diagnosed in utero. J Pediatr Surg. 36(4):545-8, 2001
                                                                                              40. Singh SJ et al: Familial presacral masses: Screening pitfalls. J Pediatr Surg. 36(12):1841-4, 2001
                                                                                              41. Wells RG et al: Imaging of sacrococcygeal germ cell tumors. Radiographics. 10(4):701-13, 1990