Eur Surg (2012) 44/4: 255–266 Printed in Austria DOI 10.1007/s10353-012-0098-3 © Springer-Verlag 2012 Sacrococcygeal Teratoma – a single center study of 43 years (1968 – 2011) including follow-up data and histopathological reevaluation of specimens Th. Hager 2,3 , C. Sergi 2 , J. Hager 1 1 Department of Pediatric Surgery, Medical University of Innsbruck, Innsbruck, Austria 2 Institute of Pathology, Medical University of Innsbruck, Innsbruck, Austria 3 Institute of Pathology and Neuropathology, University Hospital of Essen, University Duisburg-Essen, Essen, Germany Received March 20, 2012; accepted after revision May 10, 2012 Summary. Background: Sacrococcygeal teratomas (SCTs) are neoplasms, which are mostly categorized as benign at birth. If not resected short after birth, malignant transformation can occur in a timely manner. Moreover, timely resected and benign classified SCTs may reoccur years later as malignant relapse. Finally SCTs can cause several intrauterine and/or postoperative complications which can alter the patients for lifetime. Methods: Between January 1968 and December 2011 29 children underwent surgical interventions due to SCT at our Department. One additional, primarily outward treated girl was operated due to a malignant relapse. Clinical records of 24 patients (all survived) and of the girl with the relapse (who died 7 months after second intervention) were accessible. A complete clinical follow-up including optional multidisciplinary examina- tions was carried out, possible in 16 patients, of whom one girl had malignant relapse. A comparison among three of the most common histological classifications of SCT was made using the histology available of the 25 mentioned patients. Results: Except for incontinence problems in four patients and dissatisfaction with scar formation in 5 cases, the results were surprisingly good. Histological reevaluation showed no differences between the classifications. Conclusions: Despite the heterogeneity of treatment within the last 43 years, all 24 “own” patients survived. The 16 re-examined patients showed no significant com- plaints. Histological grading of SCTs is comparable even using different classification systems and does not affect survival rate. Despite accurate resection, annual control investigations should be offered to all patients harboring SCTs, because late recurrence cannot be easily predicted yet. Keywords: Sacrococcygeal teratoma, immature terato- ma, yolk sac tumor, local relapse, follow-up, histological reevaluation. Introduction Sacrococcygeal teratoma (SCT) is the most frequent congenital tumor occurring in 30–40,000 live births with a female prevalence of 3 to 4 times [1–6]. At birth, more than 90% of SCTs are “benign”, but up to 10% can show a primarily malignant component [7–9]. Although these experiences are worldwide known, the behavior of con- genital teratomas remains poorly understood and is frequently considered unpredictable, but studies of large series with follow-up are very few [10, 11]. On one hand, benign SCTs have a certain potential to malignant manifestations increasing with age, i.e. at the age of 9 months in about 70% of cases of malignant SCTs [2, 3, 7, 9, 12]. On the other hand, malignant relapses of SCT after primary resection classified as benign initially may de- velop later on [2, 9, 13, 14]. Furthermore SCTs, depen- dent on their position, size and dignity, can be associated with intrauterine complications, such as uro- logical, anorectal and osteomuscular ones, which can be indistinct at birth [2, 7, 12, 14, 15]. Similar, but now functional problems can occur after resection of SCTs concerning the emptying of the bladder, defecation and/ or the function of the perineal region or/and the lower extremities [7, 14, 16, 17]. Reevaluation of surgical procedures and histopath- ologic diagnoses belongs to measures of quality control Correspondence: Josef Hager, M.D., Department of Pediatric Sur- gery, Medical University of Innsbruck, 6020 Innsbruck, Austria. Fax: þþ43-50504-25693 E-mail: josef.hager@i-med.ac.at SCT – a single center study of 43 years (1968–2011) © Springer-Verlag 4/2012 Eur Surg 255 Main Topic