Published in:
01-06-2014 | The Last Image
Heterogenous malignant presacral teratoma with a locally destructive benign intrasacral component
Published in: Techniques in Coloproctology | Issue 6/2014
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Presacral teratomas in adults have the potential for malignant degeneration. Growth is usually confined to the retrorectal space. In this 64-year-old female, there were both presacral and intrasacral components. Surgery prior to consultation at our institution consisted of removal of only the presacral component, which revealed a teratoma with neuroendocrine differentiation. Given the concern for malignancy of the intrasacral portion, an en bloc excision including the sacrum and rectum was performed. Pathology revealed benign cystic teratoma (Figs. 1, 2, 3, 4, 5).
Fig. 1
Contrast enhanced pelvic computed tomography scan. Axial images show a large 7-cm destructive lytic mass involving the inferior sacrum and presacral space. No arterial or venous encasement
Fig. 2
A Magnetic resonance imaging scan of the pelvis (sagittal T2-weighted image) with gadolinium show a nodular, heterogeneous mass extending superiorly to the second and third sacral segments. Anterior displacement of the rectum is seen
Fig. 3
A coronal/oblique T1-weighted magnetic resonance imaging scan shows the association of this mass with the S3 nerve roots (white arrow). The S4 and S5 nerve roots were not clearly distinct from the mass. The S2 nerve roots were draped over the tumor extra-foraminally
Fig. 4
A virtual three-dimensional reconstruction of the bony pelvis computed tomography scan post-resection shows the S1-2 disk level sacrectomy required to excise this lesion en bloc. A 2-cm bony margin was achieved at the time of surgery with osteotomy through the S1/2 disk space with full preservation of the lumbosacral trunk and sciatic nerve roots. The osteotomy did not violate the sacroiliac joints
Fig. 5
A sagittal section of the surgical specimen demonstrates a 6-cm mucinous cyst that destroys the mid-sacrum with extension into the piriformis and gluteus maximus muscles. All surgical resection margins were widely free of disease
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