Clonal analysis of sacrococcygeal "teratomas"

Congenital masses of the sacrococcygeal region commonly contain multiple tissues and have variously been subclassified as neoplasms or congenital hamartomas based on clinicopathological and embryological observations. We have used a polymerase chain reaction-based assay for nonrandom X chromosome inactivation to infer the clonality of three cogenital sacrococcygeal tumors previously diagnosed as teratomas. One solid immature teratoma was monoclonal, and a predominantly cystic histologically mature mass was polyclonal. A third immature teratoma was noninformative because of baseline asymmetry of polyclonal tissue X inactivation. We confirm that immature teratomas at this site appear to be monoclonal neoplasms and suggest that at least some histologically mature "teratomas" are more appropriately classified as hamartomas.