Recurrent retrorectal teratoma

Abstract

Retrorectal tumors are a rare group of neoplasms that occur most commonly in the neonatal and infant population. They vary in presentation, but teratomas are the most common and often present as a protruding mass from the sacrococcygeal region. Immediate surgical resection is indicated when found and coccygectomy is performed to prevent recurrence. When teratomas recur, the patients most often have vague symptoms and the tumors usually have malignant transformation. Here, we present the case of a young woman who underwent surgical resection of a sacrococcygeal teratoma at 3 days of age where the coccyx was not removed. She presented at 31 years of age with lower extremity paresthesias and radiography revealed a cystic mass extending from the sacrum. After resection, pathology revealed a recurrent teratoma with nests of adenocarcinoma.

Figure 1

Original photograph of patient with congenital sacrococcygeal teratoma at 3 days of age before primary surgery.

Figure 2

MRI pelvis with recurrent teratoma extending from the retrorectal space and precoccygeal area across midline to the region of right piriformis and deep to right gluteus muscles.

Figure 3

Histologic sections showing pools of mucin associated with an invasive adenocarcinoma and residual teratoma with portion of gut wall and pancreatic parenchyma. (H&E 20x).