1Division of Colon and Rectal Surgery, Mayo Clinic, Rochester, Minnesota 2Department of Surgery, Mayo Clinic, Rochester, Minnesota 3Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota 4Division of Pediatric Surgery, Mayo Clinic, Rochester, Minnesota.
Dis Colon Rectum. 2014 Jul;57(7):851-7. doi: 10.1097/DCR.0000000000000117.
Adult sacrococcygeal teratomas are rare, and limited data exist on their management and outcomes following surgery.
The aim of this study was to review the outcomes in adult patients undergoing surgery for sacrococcygeal teratomas.
A retrospective review of our prospectively maintained surgical pathology and tumor registries was conducted.
This study was conducted at the Mayo Clinic in Rochester. Information was collected on patients treated between 1980 and 2013.
A total of 26 patients with sacrococcygeal teratoma were identified (19 female), with a median age of 37.5 years. Malignancy was seen in 5 patients.
Data on demographics, clinical presentation, tumor pathology, adjuvant therapy, surgical approach, surgical margins, use of preoperative biopsy, radiological investigations, morbidity, mortality, and local recurrence was collected. Complications were assessed by using the Clavien-Dindo system of classification.
Patients most commonly presented with pelvic pain (n = 16) and/or a palpable mass (n = 15). On radiology, 8 lesions were purely cystic, 14 were mixed, and 4 were solid; teratoma was suspected as a diagnosis in 8 patients. Preoperative biopsy (13 patients) had 100% concordance with final pathology. Median tumor size was 6 cm, and the surgical approach was posterior only (n = 15), anterior only (n = 5), and combined anterior-posterior (n = 6). Of 5 patients with malignancy, 3 died of recurrent disease.
Limitations of this study include the small number of patients, the long study period, and the heterogeneous nature of these tumors.
Presacral teratomas require multidisciplinary management and have a risk of malignant transformation. They are more common in females, and the majority are intrapelvic in location in adults. We recommend clinical evaluation, radiological investigation, and image-guided biopsy in all suspicious presacral lesions. A treatment algorithm has been designed to improve the management of these rare tumors.
成人骶尾部畸胎瘤罕见，关于其术后管理和结果的资料有限。
本研究旨在回顾成人骶尾部畸胎瘤手术的结果。
对我们前瞻性维护的外科病理学和肿瘤登记处进行了回顾性分析。
本研究在罗切斯特的梅奥诊所进行。收集了 1980 年至 2013 年间接受治疗的患者信息。
共确定了 26 例骶尾部畸胎瘤患者（19 例为女性），中位年龄为 37.5 岁。5 例为恶性肿瘤。
收集人口统计学、临床表现、肿瘤病理学、辅助治疗、手术方法、手术切缘、术前活检、影像学检查、发病率、死亡率和局部复发的资料。采用 Clavien-Dindo 分类系统评估并发症。
患者最常见的表现为骨盆疼痛（n = 16）和/或可触及的肿块（n = 15）。影像学检查显示，8 个病变为单纯囊性，14 个为混合性，4 个为实性；8 例患者被怀疑为畸胎瘤。术前活检（13 例）与最终病理结果完全一致。肿瘤的中位大小为 6 cm，手术方法为单纯后路（n = 15）、单纯前路（n = 5）和前后联合（n = 6）。5 例恶性肿瘤患者中，3 例死于复发性疾病。
本研究的局限性包括患者数量少、研究时间长以及这些肿瘤的异质性。
骶前畸胎瘤需要多学科管理，并有恶性转化的风险。它们在女性中更为常见，且大多数位于成人的盆腔内。我们建议对所有可疑的骶前病变进行临床评估、影像学检查和影像学引导下活检。已经设计了一种治疗算法来改善这些罕见肿瘤的治疗。
