Sacrococcygeal Teratoma

Sacrococcygeal Teratoma

Nicholas J. Ahn

William H. Peranteau


  • All sacrococcygeal teratomas (SCTs) involve the coccyx but are classified into four categories according to the location and extent of the tumor—the Altman Classification Scheme.5

    • Type I: primarily external with a small presacral component

    • Type II: external with intrapelvic extension

    • Type III: primarily pelvic and intra-abdominal with external component

    • Type IV: completely intrapelvic with no external component


  • SCTs are thought to originate from the primitive knot (also known as Hensen node), where the three germ cell layers start to form.

  • SCTs may be cystic, solid, or a mix of both. Solid tumors tend to be more vascular and are associated with an increased risk of high-output cardiac failure, hydrops fetalis, tumor rupture, hemorrhage, and fetal demise.


  • The majority of the lesions are now diagnosed by the time of birth as early as 18 to 19 weeks of gestation due to advancement in antenatal imaging.

  • Type I to III lesions that are not diagnosed prenatally are identified at birth by an obvious protruding mass originating from the sacral region.

  • A rectal exam must be performed to assess the degree of intrapelvic extension of the tumor, especially for tumors that were diagnosed postnatally.

  • Rarely, some type IV lesions can go undiagnosed until the child is up to 4 years of age and present with compressive symptoms of the bladder or rectum, such as urinary retention, obstruction, or constipation.


  • Most SCTs are diagnosed prenatally at the time of approximately 20-week gestation fetal anatomy ultrasound. If diagnosed, the mother and fetuses should be referred to a high-volume multidisciplinary fetal diagnosis and treatment center where a high-resolution fetal ultrasound will be performed to assess the anatomical extension of the tumor and the characteristics of the mass (solid, cystic, vascularity) (FIG 1A).

  • Ultrafast fetal MRI is used as an adjunct to ultrasonography to better assess the SCT, including the pelvic or abdominal extension of the tumor and its involvement with surrounding structures such as the colon, urinary tract, vagina, hip, and especially the spine (FIG 1B).

  • After birth, hemodynamically stable infants may undergo a CT scan or MRI to assess the extent of the tumor for preoperative planning (FIG 2).


Preoperative Planning

Feb 27, 2020 | Posted by in Pediatric plastic surgery | Comments Off on Sacrococcygeal Teratoma
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