Recurrent Retrorectal Teratoma

Retrorectal tumors are a rare group of neoplasms that occur most commonly in the neonatal and infant population. They vary in presentation, but teratomas are the most common and often present as a protruding mass from the sacrococcygeal region. Immediate surgical resection is indicated when found and coccygectomy is performed to prevent recurrence. When teratomas recur, the patients most often have vague symptoms and the tumors usually have malignant transformation. Here, we present the case of a young woman who underwent surgical resection of a sacrococcygeal teratoma at 3 days of age where the coccyx was not removed. She presented at 31 years of age with lower extremity paresthesias and radiography revealed a cystic mass extending from the sacrum. After resection, pathology revealed a recurrent teratoma with nests of adenocarcinoma. 1. Introduction Retrorectal neoplasms refer to a rare and heterogeneous group of tumors that occur in what is known anatomically as the retrorectal space. This is a potential space defined superiorly by the rectal peritoneal reflection, anteriorly by the rectum, posteriorly by the sacrum, and inferiorly by the rectosacral fascia. Although the retrorectal space does not technically include the more inferiorly located supralevator and deep postanal spaces, lesions occurring within these areas are still generally referred to as retrorectal or presacral neoplasms. As mentioned, retrorectal neoplasms are rare and occur more commonly in the neonatal population with a female？:？male ratio of 3-4？:？1 [1, 2]. They have a reported incidence as low as 1 in 40,000–60,000 hospital admissions at tertiary centers [3–5]. A wide variety of pathologic entities may develop in the retrorectal space owing to its complicated embryologic development and several classification systems have been proposed to describe them. The most commonly used taxonomy puts the lesions into the following categories: congenital, inflammatory, neurogenic, osseous, and miscellaneous [6, 7]. Of the congenital lesions, teratomas usually are found in the sacrococcygeal region and they continue to be the most common tumor found in newborns where 80% are found in the first six months of life [6, 7]. They are often found on initial physical exam as a large mass protruding from the sacrococcygeal area. The neonatal form is commonly benign, but those found in the adult population can possess malignant transformation potential if left untreated [8–10]. In these patients, the standard of care is immediate surgical excision taking care to define anatomic landmarks