Late presentation of a Type IV sacrococcygeal teratoma in a 16-year-old female: A case report

Introduction

Sacrococcygeal teratomas (SCTs) are rare germ cell tumors, predominantly diagnosed in neonates. These tumors are categorized as mature, immature, or malignant, with mature teratomas posing a lower risk for malignant transformation. While symptoms commonly arise from the mass effect, late presentation in adolescents or adults is rare.

Case presentation

A 16-year-old female with no significant past medical or surgical history presented with perianal pain, constipation, and fever. On physical exam, the rectum was collapsed by a mass. The laboratory work-up showed leukocytosis and an elevated C-reactive protein. Lactate dehydrogenase (LDH), alpha-fetoprotein (AFP), and beta-human chorionic gonadotropin (β-HCG) levels were within normal limits. A CT scan of the abdomen and pelvis revealed a 12 x 16 × 16 cm complex mass in the presacral region. Further evaluation with a pelvic MRI confirmed the presence of a multiloculated mass with mixed solid and cystic components, rim enhancement, and possible coccygeal involvement suggestive of a sacrococcygeal teratoma. Given the size and location of the mass, we decided for a combined abdomino-perineo-sacral surgical approach. The patient received Ceftriaxone and Metronidazole before the operation. We started with a midline laparotomy and detached the tumor from the intra-abdominal structures, and we continued with a posterior sagittal approach. The tumor appearance was consistent with a mature teratoma and had purulent fluid within the cystic component. We removed the mass completely and did a coccygectomy. The postoperative course was complicated by a retroperitoneal collection and a posterior wound dehiscence that required several washouts, debridement, vacuum-assisted closure therapy, and a long course of antibiotics. She was discharged home on postoperative day 32. She is being followed with yearly MRIs.

Conclusion

Superinfection of mature teratomas can lead to postoperative infectious complications. Pre-operative and postoperative antibiotics are recommended when resecting mature teratomas.