A Case of Altman IV Sacrococcygeal Teratoma Including Pancreatic Tissue

Abstract

The patient was a girl aged 8 months. She was brought to a private clinic owing to fever and vomiting. The next day, she had abdominal distension and was transported to our hospital. Blood tests showed an inflammatory response and elevated levels of pancreatic amylase. Abdominal MRI revealed an Altman type IV sacrococcygeal teratoma. Surgery was scheduled after improvement of the inflammatory response of peritonitis by fasting and administration of antibiotics. After that, when oral intake was resumed to improve the nutritional status, symptoms of pancreatitis relapsed, and inflammatory reaction and elevation of pancreatic amylase levels were observed. When fasting was started again, fever was reduced, and abdominal symptoms and pancreatic amylase levels improved. The tumor was resected on the 18th day of admission. It was diagnosed as mature cystic teratoma including pancreatic tissue on the basis of histopathological findings. In addition, elevated levels of pancreatic enzymes in the cyst fluid and ascites fluid were observed. We experienced treating a case of Altman type IV sacrococcygeal teratoma, which contained pancreatic tissue in the tumor and caused peritonitis owing to pancreatic enzymes released from the tumor. If the tumor contains ectopic pancreatic tissue, pancreatic enzymes secreted by the tumor may cause inflammation of surrounding organs.