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Adenomatous Hyperplastic Thyroid Nodule
Joseph Junewick, MD FACR
over 11 years ago
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ARSt Case Repository

Mixed Germ Cell Neoplasm

Case Detail

Anatomy: Brain-Spine
Joseph Junewick, MD FACR
Diagnostic Category: Neoplasia Malignant
Created: over 11 years ago
Updated: over 9 years ago
Tags: PEDS
Modality/Study Types: MR
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8 month old with perineal swelling and erythema.

Case Images


Mixed germ cell neoplasia (98% malignant yolk sac tumor, 2% mature teratoma)

Clinical Notes

Markedly elevated serum alpha fetoprotein level.


MRI – Sagittal FSE2, axial T1, axial FS FSE2 and coronal FS post-gadolinium T1 images reveal an enhancing mixed signal macrolobulated presacral pelvic mass. Note that the coccyx is engulfed by the mass.


Germ cell tumors occur in 1 out of 30000 to 70000 live births and occur in females four times as often as males. Abnormal differentiation of fetal germ cells give rise to germ cell tumors. Migration patterns determine the site of tumor development; sacrococcygeal > ovary > testicle> brain > mediastinum > neck. Sacrococcygeal germ cell tumors are congenital. The earlier the diagnosis is made the better the prognosis; external lesions are easily diagnosed at birth or by prenatal imaging but internal lesion diagnosis is often delayed. Survival and risk of recurrence is related to maturity of the germ cells.


Schey WL, Shkolnik A, and White H. Clinical and Radiographic Considerations of Sacrococcygeal Teratomas: An Analysis of 26 New Cases and Review of the Literature. Radiology (1977); 125:189-195.

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