Sacrococcygeal teratoma differential diagnosis

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]Associate Editor(s)-in-Chief: Mirdula Sharma, MBBS [2]


Sacrococcygeal teratoma must be differentiated from endodermal sinus tumor, ependymoma, fibromatosis, ganglioneuroma, giant cell tumor of the sacrum, leiomyoma, meningomyelocele, ovarian teratoma, neuroblastoma, retrorectal hamartoma, intracanalicular epidermoid tumor, rhabdomyosarcoma, paraganglioma, dermal sinus stalk ascending towards the conus modullaris, and hydromelia.[1]

Differenting Sacrococcygeal Teratoma from other Diseases

Diseases Clinical manifestations Para-clinical findings Gold standard Additional findings
Physical examination
Vertebra column defect Protrusions, Dimples, Hair patch in the spine Motor and sensory abnormalities X-ray

(PA and Lateral view)

Sacrococcygeal teratoma +/- ++ +/- Ultrasound
Spina bifida ++ ++ +/- Incomplete union of the posterior elements of vertebral levels MRI -
Terminal myelocystocele +/- Protrusions and dimples +/- Incomplete union of the posterior elements of vertebral levels MRI
Spine segmental dysgenesis + - +/- Defects in the segments of the spine and spinal cord
  • Spinal cord at the level of the abnormality is thinned or even indiscernible
  • a bulky, low-lying cord segment may be present caudad to the focal abnormality in most cases
  • The spinal column distal to the abnormality may be partially bifid
Caudal regression syndrome (sacral agenesis) + +/- +/- Agenesis of the sacrum and lumbar spine
  • Lumbosacral vertebral body dysgenesis/hypogenesis
  • The level of atresia/dysgenesis is usually below L1 and often limited to sacrum
MRI Associated with other developmental malformations (orthopedic, neurological, genito-urinary, gastrointestinal…)
VACTERL association + +/- +/- Vertebral body dysgenesis/hypogenesis - MRI, Ct scan, X ray VACTERL stands for:
  • Vertebral defects
  • Anal atresia
  • Cardiac defects
  • Tracheo-Esophageal fistula
  • Renal anomalies
  • Limb abnormalities
Arnold-chiari malformation + + + None MRI
Syringomyelia + + + MRI
  • Impaired ambulation and loss of penile erection when syrinx involves lumbosacral area
Scoliosis +/- +/- +/-
  • Abnormality that may be causing the deformity
  • Spinal cord abnormalities may be seen
Leg length discrepancy - - - None Orthoroentogram
  • Repeat standing x-rays with the patient standing on a block to account for the discrepancy demonstrates correction of the postural abnormality.


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