ABSTRACT
A sacrococcygeal teratoma is a neoplasm arising from the
caudal end of the spine, usually protruding from the inferior
end of the infant’s spinal column and displacing the anus
forwards. These tumors have a female-to-male ratio of at
least 3:1.19 The incidence is approximately one in 40 000 live
births.10,11 There is general agreement that sacrococcygeal
teratoma (SCT) is the result of continued multiplication of
totipotent cells from Hensen’s node which fail to apoptose at
the end of embryonic life.7,12,13 This concept has recently
received support from the work of Busch et al.14 who have
identified histochemical markers in SCTs supporting an
origin from caudal embryonic stem cells. This provides
convincing evidence against the theory that these tumors
arise from migrating germ cells traveling from the yolk sac to
gonad. Most authorities reject the concept that these are
suppressed twins or parasitic fetuses. Pantoja and Rodriguez-
Ibanez15 reviewed the conflicting theories as to the origin of
these tumors. A familial distribution of sacrococcygeal
teratoma has occasionally been reported.1618
Willis defined the term teratoma as follows: ‘A teratoma is a
true tumor or neoplasm composed of multiple tissues of
kinds foreign to the part in which it arises’.13 The sacrococ-
cygeal teratoma was second on Willis’ list of sites where
teratomata are found, but in almost all pediatric surgical
series, the sacrococcygeal site is the most common site.14,19
By definition, then, sacrococcygeal teratomata are composed
of several types of tissue, usually derived from two or three
germ layers. Robbins20 defines a teratoma as ‘a tumor
composed of cells representing more than one germ layer’.
