Les tratomes sacrococcygiens. Exprience dun service de chirurgie pdiatrique nord-africain

Objective: The aim of this study is to review the different aspects of sacrococcygeal teratomas (SCT) in the Tunisian south and centre. Material and methods: This is a retrospective study of 24 SCT observations operated between 1984 and 2004. The diagnosis of SCT was confirmed in all cases by the histological exam. Results: The age of our patients varied from the birth to 5 years. Associated malformations were found in 12.5% of cases and consisted on bladder exstrophy associated to a sexual ambiguity, bilateral cryptorchidism and spina bifida. The surgical treatment consisted on complete resection of the tumour and the coccyx. The approach was perineal in all cases associated to an abdominal approach in two cases. Histological study showed that the teratoma was mature in 66.6% of cases and immature in 16.7%. A yolk sac tumour was encountered in 16.7%. Mortality rate was 16.7% and concerned the cases of yolk sac tumour. Discussion: TheSCT is themost frequent of teratomas of the child. Associated malformations are reported in 18% of cases and are dominated by musculo-scrawny, genito-urinary, digestive, cardiac and chromosomic abnormalities. The SCT treatment is essentially surgical. It must be established the most prematurely and consists on a total resection of the mass taking the coccyx. A therapeutic complementbychemotherapy is indispensable for malignant teratomas and yolk sac tumour. The outcome of the SCT is generally good with a cure rate ranged from 90 to 100%. Conclusion: A clinical, biologic and radiological follow-up is indispensable and has to spread out over at least 3-5 years to discover at time the recurrences.