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Virtual Pediatric Hospital: Correlapaedia - a Correlative Encyclopedia of Pediatric Imaging, Surgery, and Pathology: Case 49

Correlapaedia - a Correlative Encyclopedia of Pediatric Imaging, Surgery, and Pathology

Case 49

Michael P. D'Alessandro, M.D.,
Steven J. Fishman, M.D.,
Deborah E. Schofield, M.D.

Peer Review Status: Internally Peer Reviewed
Chief Complaint:
Newborn 32 week premature female with a sacral mass.

Clinical History:
The patient was a 32 week premature female born at an outside hospital who was diagnosed with a large sacral soft tissue mass at birth. The antenatal history was remarkable for polyhydramnios diagnosed via prenatal ultrasound, pregnancy induced hypertension, and removal of a maternal dermoid during pregnancy.

Clinical Physical Exam:
Large exophytic soft tissue mass in the region of the sacrum.

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Clinical Labs:
Non-contributory

Clinical Differential Diagnosis:
Sacrococcygeal teratoma.

Imaging Findings:
Babygram from the first day of life showed a huge soft tissue mass arising from the gluteal region.

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Imaging Differential Diagnosis:
Sacrococcygeal teratoma

Operative Findings:
The patient was taken to the operating room on the second day of life. The sacral mass was excised.

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Pathological Findings:
Examination of the surgical specimen revealed it to be 22 x 18 x 12 cm in size and was composed of multiple cysts within it. A single soft tissue focus that resembled brain tissue was noted. No hair or teeth were seen. A microscopic foci of embryonal carcinoma and endodermal sinus tumor was noted. The findings were consistent with a diagnosis of immature teratoma.

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Final Diagnosis:
Sacrococcygeal Teratoma

Follow-up and Prognosis:
Postoperatively, the patient developed a sciatic nerve palsy and poor anal control and underwent a perineal reconstruction at 16 months of age.

Similar Cases:
Case 43

References:

Title Page


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