F' the large solid tumors which may be encountered in newborn infants, the sacrococcygeal teratoma is by far the most common. This tumor is usually benign when treated early; otherwise it often undergoes malignant degeneration. Our experience and review of the literature indicate that many of these are still incorrectly diagnosed and are not treated early.Presented here is a brief survey of the subject including pertinent points in diagnosis and treatment, and three case histories of patients with this lesion recently treated in our hospital. Our purpose is to emphasize to pediatricians the presentation, prognosis, and treatment of this tumor in order to improve the survival rate of the infants.
Case ReportsCase 1. C. S. This patient was first admitted to UMMC September 3, 1965 at nine months of age, with a chief complaint of a large sacral mass evi-dent since birth and now rapidly increasing in size.This essentially normal and active 7-lb. infant was delivered at home of a 15-year-old Negro mother after a fullterm uncomplicated pregnancy, labor and delivery. The only noted abnormality was a 50-cent-sized raised lesion on the right buttock, described as a &dquo;bump.&dquo; The infant developed normally until eight months of age when he fell on the raised area. This then increased in size and became tender, and fever, lethargy, decreased appetite, and diarrhea developed.Physical examination on admission revealed an emaciated, alert, slightly irritable Negro female, with a 10-cm. non-erythematous, non-edematous, movable skin-covered mass in the midline sacral area. Deep tendon reflexes were absent in the lower extremities and the Babinski response was positive bilaterally. No abdominal masses were felt. The rectum was pushed anteriorly by the tumor.Intravenous pyelogram, myelogram, and barium enema all showed a 9 X 9 X 9 czxa. mass displacing the urinary bladder, coccyx and rectum and having no connection with the spinal cord. The diagnosis of probable sacral teratoma was made.The operative procedure performed on the I 1 tla hospital day revealed mass involvement not only of the sacrum and coccyx but also of' the lower lumbar vertebrae and the posterior pelvic cav:~y. The tumor could be only partially -emoved. Postoperatively the child had no dimculties.The tissue removed contained large sheets of highly anaplastie eells forming papillary projections and sworls, as well as other tissue elements from all germinal layers. The diagnosis was malignant sacrococcygeal teratoma.
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