[Giant sacrococcygeal teratoma in adults]

Sacro-coccygeal teratomas (SCT) are rare congenital tumors (1/40,000 births) but the commonest neoplasms in the newborn, generally discovered at birth; they are well known by pediatric surgeons who operate on them during the first days of life because of the high risk of malignant transformation when the diagnosis is delayed after several months of life. Exceptionally these tumors are observed in the adult without being diagnosed during infancy. The case of a 67 year old man is reported; the tumor presented as a solid mass complicated by necrosis and ulceration. The operation involved en bloc resection of the tumor and its sacro-coccygeal bony attaches. The tumor was found to be benign on histological examination. The main problems concerning diagnosis are discussed: possible association with meningocele and intra-pelvic extensions; these two factors must be defined preoperatively as they may change the approach to treatment. TSC can only be treated surgically, and the classical inverted V incision performed with the patient in the prone position is discussed versus other procedures designed a midline sacral scar, including Z plasty. Radical resection of the tumor with its pedunculated last two sacral and coccygeal vertebrae must be performed to avoid recurrence that may be malignant even if the primary lesion was benign.