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Sacrococcygeal teratoma and germ cell tumours in children

Sacrococcygeal teratoma is the common tumour of the newborn; it is benign in most cases at birth, but the risk of malignancy rises the longer excision is delayed — so it is excised early, always together with the coccyx.

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Why it matters in the exam

The tumour is more common in girls and arises from pluripotent cells in the coccygeal region. The Altman classification: type I mostly external, type II external with a pelvic component, type III mostly in the pelvis and abdomen, and type IV entirely presacral. Type IV is not visible from outside, is found late (constipation, difficulty passing urine, a mass on rectal examination) and is therefore more often malignant at diagnosis. When the coccyx is not removed, the recurrence rate is high.

Before birth the tumour can steal a large blood flow and cause high-output heart failure, hydrops and fetal death; a large, very vascular tumour predicts a poor outcome, and for a large tumour caesarean section is planned to prevent rupture and bleeding. After birth the infant is stabilised, blood is prepared and surgery is done in the first days through a posterior approach (sometimes with an abdominal approach to control the vessels). Follow-up after surgery includes rectal examination and AFP for about 3 years; remember that AFP is normally high in newborns and falls gradually during the first year, so it is read against an age curve. Recurrence with rising AFP suggests a malignant yolk sac tumour.

Other germ cell tumours in children: ovarian teratoma (usually mature and cystic, sometimes presenting with torsion), prepubertal testicular tumours (mainly teratoma and yolk sac tumour), and anterior mediastinal teratoma. Markers: AFP for yolk sac tumour and β-hCG for choriocarcinoma. The Currarino triad includes an anterior sacral defect, an anorectal malformation and a presacral mass (teratoma or meningocele), and has a genetic basis. For an ovarian mass in a girl, ovary-sparing surgery is preferred when possible.

Key points

• The common tumour of the newborn; more common in girls.
• Early excision including the coccyx.
• Altman IV — found late and more often malignant.
• AFP follow-up for about 3 years, against an age curve.
• Currarino — sacral defect, anorectal malformation and presacral mass.

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Sources

• Holcomb and Ashcraft's Pediatric Surgery, 7th edition (2019) — Teratomas and Other Germ Cell Tumors
• Children's Oncology Group: Germ cell tumor risk stratification and surveillance, 2020 — Tumor markers and follow-up

Sources are given for further reading; the text is written afresh and not copied from them.

Reviewed by the Examqo AI Professor · 2026-11-06. The text may contain errors; when in doubt, check the source.