Laparoscopic Approach to Type IV Sacrococcygeal Teratoma in
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Abstract :
Presacral teratoma is extremely rare in adults. A 35-year-old lady was diagnosed with presacral teratoma on MRI abdomen and pelvis. The tumour was enucleated laparoscopically, this being the first such case to be reported in India and fifth case in world literature. Though traditionally, anterior approach of the presacral tumours meant laparotomy, but recently, laparoscopy has been reported as a safe and effective option for these tumours with the advantages of a magnified view in the narrow pelvis, easier development of natural planes by pneumoperitoneum, faster recovery and less complications if expertise is available.

Case :
A 35-year-old lady presented with dull aching pain in the lower abdomen. On per rectal examination, lower part of a tense cystic mass was palpated which was nontender and had restricted mobility; rectal mucosa was not involved. There was no evidence of neurologic involvement. Transvaginal sonography followed by MRI abdomen and pelvis showed “well defined lesion of about 6.7X4.4X4.7cm size, in presacral space extending inferiorly posterior to the anal canal. It appeared hypointense on T1 weighted imaging with multiple calcific foci and hyperintense in T2 weighted images. There was no evidence of post contrast enhancement of the lesion, involvement of adjacent structures or intraspinal extension (Fig. 1).” Serum tumour markers, including human chorionic gonadotropin, alpha-fetoprotein, carcinoembryonic antigen, lactate dehydrogenase and CA 125 were in normal range.....