Sacrococcygeal Teratoma in an Adult: A Case Report and Systematic Review of the Literature

Abstract

Sacrococcygeal teratomas are germ cell tumors derived from pluripotent cells and are rarely diagnosed in adults, accounting for less than 10% of reported cases. Clinical manifestations are generally nonspecific, and imaging studies are essential for diagnosis and therapeutic planning. We report the case of a 30-year-old female patient with chronic pelvic pain and sacrococcygeal discomfort. Pelvic magnetic resonance imaging revealed a large solid–cystic, multilobulated, and septated lesion with predominantly adipose content, located in the presacrococcygeal space, measuring 8.3 × 10.1 × 9.6 cm, without bone invasion or gynecological involvement. The main diagnostic hypothesis was a mature sacrococcygeal teratoma, with indication for elective surgical resection. A systematic review of the literature was conducted in accordance with PRISMA 2020 guidelines and Cochrane methodology, including 15 studies with 28 adult patients. There was a predominance of females (82.1%), with ages ranging from 19 to 56 years. Pelvic or sacrococcygeal pain was the most frequent symptom (67.8%), and magnetic resonance imaging was used in all cases. All patients underwent surgical resection, with coccygectomy performed in 64.2%, without severe complications or recurrence in cases followed after coccygectomy. Sacrococcygeal teratomas in adults are rare entities that require a high degree of clinical suspicion and imaging investigation. This case reinforces the role of magnetic resonance imaging in the differential diagnosis of pelvic masses and supports complete surgical resection, with or without coccygectomy, as the treatment of choice. The absence of coccygectomy was associated with a higher risk of recurrence during long-term follow-up, although not universally.