Correlapaedia - a Correlative Encyclopedia of Pediatric Imaging, Surgery, and Pathology
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.
Images 1 and 2
Clinical Differential Diagnosis:
Babygram from the first day of life showed a huge soft tissue mass arising from the gluteal region.
Imaging Differential Diagnosis:
The patient was taken to the operating room on the second day of life. The sacral mass was excised.
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.
Images 7, 8, 9, and 10
Images 12, 13, 14, and 15
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.
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