Early intraspinal recurrence of a sacrococcygeal teratoma following oncologic resection: A case report

Abstract

Introduction: Sacrococcygeal teratoma (SCT) is the most common congenital extragonadal germ cell tumor of infancy. Post-resection recurrence is attributed to tumor spillage, incomplete resection, no coccygectomy, and immature or malignant histology. However, in the absence of these risk factors, there are few reports of early aggressive tumor recurrence with intraspinal extension. This report describes a rare early SCT recurrence with intraspinal extension after oncologic resection. Case presentation: The primary SCT was initially detected at 29-weeks gestation and demonstrated interval growth from 8.5 × 9.5 × 7.7cm on prenatal MRI to 14.1 × 11.1 × 15.6cm on postnatal MRI. The primary SCT was resected on day of life three and noted to be a grade III immature teratoma (<3 % immature elements) with negative margins and no malignant elements. On routine follow-up at 3- and 6-months post-resection, there were no signs of recurrence on physical exam and a downtrending serum AFP level. At approximately eight months post-resection, a palpable mass superior to the surgical scar prompted repeat MRI. A 2.4 × 3.5 × 2.3cm trilobed mass was discovered with invasion into the sacral canal and the patient ultimately underwent resection of this recurrence in collaboration with neurosurgery. Final pathology revealed a mature teratoma with negative margins and no immature or malignant elements. This patient will undergo active surveillance with repeat MRI imaging every three months for the first year after resection. Conclusion: This rare case highlights the potential utility of imaging in the early post-resection period, as well as the need for additional reports to elucidate factors which may predispose benign SCTs to an early aggressive recurrence.

Keywords

• Sacrococcygeal teratoma
• Intra-spinal recurrence
• Case report