Gajula Bhargav, Srikanth Kandhala, Huda Farhanul, Sandhu Harindra, Basu Somprakas
Surgery, All India Institute of Medical Sciences, Rishikesh, Rishikesh, IND.
Surgery, Lala Lajpat Rai Memorial Medical College, Meerut, IND.
Cureus. 2021 Mar 29;13(3):e14181. doi: 10.7759/cureus.14181.
Sacrococcygeal teratoma (SCT) in adults is very rare with only a few cases reported in the literature. Its presentation in the adult is asymptomatic to a slow-growing cystic tumor with a 1-2% chance for malignant transformation and may attain a huge size causing pressure effect on pelvic and intra-abdominal organs. It can present unusually as a perianal abscess which needs to be evaluated radiologically. We present a giant, long-standing SCT in an adult male patient which presented as a tender fluctuating swelling with spontaneous rupture and whitish discharge in the perianal region masquerading as a perianal abscess. Diagnosis of our case was suspected by clinical examination, ultrasound, and magnetic resonance imaging of the pelvis and histopathology confirmed the diagnosis. It was excised en bloc with coccygectomy and primary wound closure and had a good postoperative recovery. Long-standing perianal swelling in an adult should raise the suspicion of SCT and should be kept in the differentials. The author prefers the posterior perineal approach for excision in Altman type 2, as it has convenient control over the mass during surgery with good cosmetic results as in our case, but the role of coccygectomy to prevent recurrence needs long-term data.
成人骶尾部畸胎瘤（SCT）非常罕见，文献中仅报道了少数病例。其在成人中的表现从无症状到缓慢生长的囊性肿瘤不等，有1%-2%的恶变几率，且可能长得很大，对盆腔和腹腔内器官产生压迫效应。它可能异常表现为肛周脓肿，需要进行影像学评估。我们报告了一名成年男性患者的巨大、长期存在的SCT，其表现为肛周区域一个有压痛的波动肿胀，伴有自发破裂和白色分泌物，伪装成肛周脓肿。通过临床检查、超声、骨盆磁共振成像怀疑了我们病例的诊断，组织病理学证实了诊断。它与尾骨切除术一起整块切除并进行了一期伤口缝合，术后恢复良好。成人长期存在的肛周肿胀应引起对SCT的怀疑，并应列入鉴别诊断。作者更倾向于采用后会阴入路切除阿尔特曼2型SCT，因为在手术过程中对肿块的控制方便，且如我们的病例所示具有良好的美容效果，但尾骨切除术预防复发的作用需要长期数据。
