Abstract. This report describes a case of sacrococcygeal teratoma with adenocarcinomatous transformation in a 45-year-old woman. This is an infrequent location for teratoma in adults and malignant transformation has rarely been described. Prognosis depends on complete excision. Clinical manifestations, imaging aspects and histological findings of this case are presented. CT and MRI adequately document the mixed cystic and solid nature of the tumour, its extension and relations with adjacent structures, allowing accurate pre-operative planning.Sacrococcygeal teratoma is the most common solid neoplasm in neonates, with an estimated prevalence of 1 in 35 000-40 000 live births. They can be diagnosed prenatally by fetal ultrasound and 50-70% are found during the first few days of life. 80% are diagnosed by the sixth month and fewer than 10% beyond the age of 2 years [1,2]. Reported cases of sacrococcygeal teratomas in adults are rare. Treatment consists of complete surgical resection. Long-term survival is possible for malignant tumours, but incomplete surgical removal carries a poor prognosis. If the tumour invades adjacent structures, neoadjuvant pre-operative combination chemotherapy should be given [7].We report an unusual case of a 45-year-old woman with intestinal and urinary obstructive symptoms due to a large sacrococcygeal teratoma with adenocarcinomatous transformation. CT and MRI appropriately demonstrated the combined cystic and solid nature of the tumour, its extension and relations with adjacent structures, allowing accurate pre-operative planning.
Case reportA 45-year-old woman with a 1-year history of gradually increasing lower back and pelvic pain, presented with constipation, dysuria and urinary frequency that had progressively developed over 2 months. There was an obstetrical history of dystocic forceps deliveries at ages 21 and 27. On gynaecological and rectal examination a large palpable mass was found in the right pelvis, posterior to the rectum. Neurological examination was unremarkable. Alpha-fetoprotein, carcinoembryonic antigen and human chorionic gonadotropin levels were normal. On pelvic CT (Figure 1) a regularly marginated thin walled cystic mass measuring 15 cm611.5 cm610.5 cm was identified, anterior to the sacrum and coccyx and extending inferiorly into the left ischiorectal fossa, compressing the urinary bladder and sigmoid colon and anteriorly displacing the rectum and vagina. Its content had homogeneous density near to that of water (10 Hounsfield Units), with a discrete amount of floating fat. At the coccyx bone level, a contrast enhancing 2.5 cm solid nodule was also evident as vegetation from the posterior wall. No evidence of bone destruction or invasion of the adjacent structures was found. Hysterectomy, bilateral adnexectomy and biopsies of the tumour were performed at laparotomy. Histopathological evaluation showed the wall of the cystic portion to be composed of a fibrous capsule with an inner lining of respiratory epithelium and areas of squamous epithelium. The described ...
Benign metastasising leiomyoma (BML) is a rare entity characterised by uterine leiomyoma that, later on, develops slow-growing metastasis mainly to the lung. In general, these lung metastases are incidentally discovered, but sometimes can become symptomatic with dyspnoea, cough and chest pain. The expression of oestrogen and progesterone receptors by these tumours supports the idea that they respond to hormone therapy (chemical, with oestrogen receptor modulators, aromatase inhibitors or luteinising hormone releasing hormone analogues and surgical, with bilateral adnexectomy). The authors present a case report of BML with two peculiarities: a less common pattern of metastisation (soft tissue), in addition to lung; and disease progression despite treatment with chemical and surgical castration.
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