Abstract:
Introduction: Sacrococcygeal teratoma (SCT) is commonly observed in neonates but is extremely uncommon in adults, with an estimated incidence of 1 in 40,000–63,000 and a marked female predominance(1,2,8). In adults, SCTs are generally intrapelvic (Altman Types III/IV), exhibit slow growth, and are often diagnosed at a late stage due to the presentation of nonspecific symptoms(1).
Case Presentation: A 24-year-old Filipina from Butuan City presented with chronic pelvic pressure, constipation, and low back pain initially attributed to pregnancy. An incidental pelvic mass detected on ultrasound was misinterpreted as ovarian in origin. During cesarean section, both ovaries and uterus appeared normal, but the lesion was not explored further. Persistent symptoms prompted further evaluation. Computed tomography demonstrated a 10.93 × 12.17 × 9.52 cm multiloculated presacral mass with mixed solid-cystic components and calcifications. The patient underwent complete transabdominal excision with coccygectomy. Histopathology confirmed a mature cystic sacrococcygeal teratoma without malignant transformation. Postoperatively, transient urinary incontinence occurred and resolved within one month.
Clinical Discussion: Consistent with case report and series, adult SCTs often remain asymptomatic until large enough to cause compressive symptoms such as constipation and urinary dysfunction(3). Misdiagnosis as gynecologic pathology is common, particularly in the absence of advanced imaging(4). MRI is the preferred modality, although CT remains a practical alternative in resource-limited settings(4). Comparative data show that tumors ≥10 cm and Type III/IV lesions are associated with increased risk of postoperative pelvic autonomic dysfunction (5). Complete surgical excision with coccygectomy remains the cornerstone of treatment, as failure to remove the coccyx increases recurrence risk(5).
Conclusion: Adult Type IV SCT should be considered in patients with persistent pelvic symptoms. Early diagnosis, appropriate imaging, and complete excision with coccygectomy are essential, with outcomes largely dependent on tumor size and anatomical location.
Keywords: Sacrococcygeal teratoma, Type IV SCT, Mature cystic teratoma, Retrorectal tumor, Adult teratoma, Urinary incontinence
Biography:
Dr. Zaldy C. Cabrera is a first-year General Surgery resident at Southern Philippines Medical Center. He earned his Bachelor of Science in Medical Technology from University of the Immaculate Conception in 2018 and obtained his Medical Technologist licensure in the same year. He completed his Doctor of Medicine degree at Davao Medical School Foundation, Inc. in 2023 and became a licensed physician in 2024. He is currently pursuing surgical training with interests in clinical research and patient-centered surgical care.
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