Presentation
Chronic constipation with a pelvic mass on ultrasound.
Patient Data
bulky midline pelvic mass, centered on the coccyx, with essentially endopelvic development. It has a double solid and cystic component.
the solid component is predominant, presenting a heterogeneous signal, hyperintense on T2 and isointense on T1 compared to the muscles, containing small calcifications,
there is no restricted diffusion. Mild heterogeneous enhancement is noted.
the cystic component is located at the lower pole of the mass.
it pushes back the rectum and the sigmoid colon upwards and forwards. It indirectly pushes the uterus and the vagina forward against the pubic symphysis and raises the bladder above and to the right.
it extends bilaterally to the sacral foramina from S2 to S5 and to the right S1 foramina with an intrameduallary extension. It infiltrates the ischial notches
the exopelvic component extends to the gluteal regions on both sides and infiltrates the gluteus maximus muscles.
Multiple bilateral diffuse pulmonary nodules.
Case Discussion
Features of presacral mass, with differentials including sacrococcygeal teratoma or low-lying neuroblastoma. The diagnosis of a sacrococcygeal teratoma was confirmed by the high levels of alpha-fetoprotein (AFP). The malignant behavior of this mass (lung metastases) was highly suggestive of its immature nature.
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