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Sacrococcygeal Teratoma
Sara M. O'Hara, MD, FAAP
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KEY FACTS

  • Terminology

    • Imaging

      • Pathology

        • Clinical Issues

          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: Sacrococcygeal teratoma: a population-based study of incidence and prenatal prognostic factors. J Pediatr Surg. 51(3):481-5, 2016
                                            2. 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
                                            3. 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
                                            4. 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
                                            5. 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
                                            6. Coleman A et al: Sacrococcygeal teratoma growth rate predicts adverse outcomes. J Pediatr Surg. 49(6):985-9, 2014
                                            7. Garg R et al: Sacrococcygeal malignant germ cell tumor (SC-MGCT) with intraspinal extension. J Pediatr Surg. 49(7):1113-5, 2014
                                            8. 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
                                            9. Ladino Torres MF et al: Spine ultrasound imaging in the newborn. Semin Ultrasound CT MR. 35(6):652-61, 2014
                                            10. 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
                                            11. Yao W et al: Analysis of recurrence risks for sacrococcygeal teratoma in children. J Pediatr Surg. 49(12):1839-42, 2014
                                            12. 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
                                            13. 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
                                            14. 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
                                            15. Peterson CM et al: Teratomas: a multimodality review. Curr Probl Diagn Radiol. 41(6):210-9, 2012
                                            16. Yao MS et al: Sacrococcygeal teratoma in an adolescent. JBR-BTR. 95(5):322-4, 2012
                                            17. Jan IA et al: Posterior sagittal approach for resection of sacrococcygeal teratomas. Pediatr Surg Int. 27(5):545-8, 2011
                                            18. Bartels SA et al: Presacral masses in children: presentation, etiology and risk of malignancy. Colorectal Dis. 13(8):930-4, 2011
                                            19. Shah RU et al: Imaging of pediatric pelvic neoplasms. Radiol Clin North Am. 49(4):729-48, vi, 2011
                                            20. Dancel LD et al: Sacrococcygeal teratoma presenting as perineal and periumbilical discoloration (cullen sign). J Pediatr. 157(6):1041, 2010
                                            21. Sy ED et al: Prognostic role of tumor-head volume ratio in fetal sacrococcygeal teratoma. Fetal Diagn Ther. 26(2):75-80, 2009
                                            22. 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
                                            23. Gatcombe HG et al: Primary retroperitoneal teratomas: a review of the literature. J Surg Oncol. 86(2):107-13, 2004
                                            24. Isaacs H Jr: Perinatal (fetal and neonatal) germ cell tumors. J Pediatr Surg. 39(7):1003-13, 2004
                                            25. Neubert S et al: Sonographic prognostic factors in prenatal diagnosis of SCT. Fetal Diagn Ther. 19(4):319-26, 2004
                                            26. Urioste M et al: Malignant degeneration of presacral teratoma in the Currarino anomaly. Am J Med Genet A. 128(3):299-304, 2004
                                            27. Zaccara A et al: Gait analysis in patients operated on for sacrococcygeal teratoma. J Pediatr Surg. 39(6):947-52; discussion 947-52, 2004
                                            28. Graf JL et al: Fetal sacrococcygeal teratoma. World J Surg. 27(1):84-6, 2003
                                            29. Hirose S et al: Fetal surgery for sacrococcygeal teratoma. Clin Perinatol. 30(3):493-506, 2003
                                            30. 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
                                            31. Avni FE et al: MR imaging of fetal sacrococcygeal teratoma: diagnosis and assessment. AJR Am J Roentgenol. 178(1):179-83, 2002
                                            32. Lam YH et al: Thermocoagulation of fetal sacrococcygeal teratoma. Prenat Diagn. 22(2):99-101, 2002
                                            33. O'Hara SM: Tumors of the pediatric genitourinary system. In Bragg et al: Oncologic Imaging. 2nd ed. Philadelphia: W. B. Saunders. 779-811, 2002
                                            34. Wakhlu A et al: Sacrococcygeal teratoma. Pediatr Surg Int. 18(5-6):384-7, 2002
                                            35. Kamata S et al: Operative management for sacrococcygeal teratoma diagnosed in utero. J Pediatr Surg. 36(4):545-8, 2001
                                            36. Singh SJ et al: Familial presacral masses: Screening pitfalls. J Pediatr Surg. 36(12):1841-4, 2001
                                            37. 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

                                                • Pathology

                                                  • Clinical Issues

                                                    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: Sacrococcygeal teratoma: a population-based study of incidence and prenatal prognostic factors. J Pediatr Surg. 51(3):481-5, 2016
                                                                                      2. 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
                                                                                      3. 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
                                                                                      4. 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
                                                                                      5. 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
                                                                                      6. Coleman A et al: Sacrococcygeal teratoma growth rate predicts adverse outcomes. J Pediatr Surg. 49(6):985-9, 2014
                                                                                      7. Garg R et al: Sacrococcygeal malignant germ cell tumor (SC-MGCT) with intraspinal extension. J Pediatr Surg. 49(7):1113-5, 2014
                                                                                      8. 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
                                                                                      9. Ladino Torres MF et al: Spine ultrasound imaging in the newborn. Semin Ultrasound CT MR. 35(6):652-61, 2014
                                                                                      10. 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
                                                                                      11. Yao W et al: Analysis of recurrence risks for sacrococcygeal teratoma in children. J Pediatr Surg. 49(12):1839-42, 2014
                                                                                      12. 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
                                                                                      13. 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
                                                                                      14. 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
                                                                                      15. Peterson CM et al: Teratomas: a multimodality review. Curr Probl Diagn Radiol. 41(6):210-9, 2012
                                                                                      16. Yao MS et al: Sacrococcygeal teratoma in an adolescent. JBR-BTR. 95(5):322-4, 2012
                                                                                      17. Jan IA et al: Posterior sagittal approach for resection of sacrococcygeal teratomas. Pediatr Surg Int. 27(5):545-8, 2011
                                                                                      18. Bartels SA et al: Presacral masses in children: presentation, etiology and risk of malignancy. Colorectal Dis. 13(8):930-4, 2011
                                                                                      19. Shah RU et al: Imaging of pediatric pelvic neoplasms. Radiol Clin North Am. 49(4):729-48, vi, 2011
                                                                                      20. Dancel LD et al: Sacrococcygeal teratoma presenting as perineal and periumbilical discoloration (cullen sign). J Pediatr. 157(6):1041, 2010
                                                                                      21. Sy ED et al: Prognostic role of tumor-head volume ratio in fetal sacrococcygeal teratoma. Fetal Diagn Ther. 26(2):75-80, 2009
                                                                                      22. 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
                                                                                      23. Gatcombe HG et al: Primary retroperitoneal teratomas: a review of the literature. J Surg Oncol. 86(2):107-13, 2004
                                                                                      24. Isaacs H Jr: Perinatal (fetal and neonatal) germ cell tumors. J Pediatr Surg. 39(7):1003-13, 2004
                                                                                      25. Neubert S et al: Sonographic prognostic factors in prenatal diagnosis of SCT. Fetal Diagn Ther. 19(4):319-26, 2004
                                                                                      26. Urioste M et al: Malignant degeneration of presacral teratoma in the Currarino anomaly. Am J Med Genet A. 128(3):299-304, 2004
                                                                                      27. Zaccara A et al: Gait analysis in patients operated on for sacrococcygeal teratoma. J Pediatr Surg. 39(6):947-52; discussion 947-52, 2004
                                                                                      28. Graf JL et al: Fetal sacrococcygeal teratoma. World J Surg. 27(1):84-6, 2003
                                                                                      29. Hirose S et al: Fetal surgery for sacrococcygeal teratoma. Clin Perinatol. 30(3):493-506, 2003
                                                                                      30. 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
                                                                                      31. Avni FE et al: MR imaging of fetal sacrococcygeal teratoma: diagnosis and assessment. AJR Am J Roentgenol. 178(1):179-83, 2002
                                                                                      32. Lam YH et al: Thermocoagulation of fetal sacrococcygeal teratoma. Prenat Diagn. 22(2):99-101, 2002
                                                                                      33. O'Hara SM: Tumors of the pediatric genitourinary system. In Bragg et al: Oncologic Imaging. 2nd ed. Philadelphia: W. B. Saunders. 779-811, 2002
                                                                                      34. Wakhlu A et al: Sacrococcygeal teratoma. Pediatr Surg Int. 18(5-6):384-7, 2002
                                                                                      35. Kamata S et al: Operative management for sacrococcygeal teratoma diagnosed in utero. J Pediatr Surg. 36(4):545-8, 2001
                                                                                      36. Singh SJ et al: Familial presacral masses: Screening pitfalls. J Pediatr Surg. 36(12):1841-4, 2001
                                                                                      37. Wells RG et al: Imaging of sacrococcygeal germ cell tumors. Radiographics. 10(4):701-13, 1990