A newborn girl has a large external mass arising from the coccygeal region, extending into the gluteal fold. Ultrasound confirms it is predominantly solid with calcification. Serum alpha-fetoprotein is markedly elevated. The single most important reason to plan complete surgical excision early, within the first weeks of life, is:

• A Risk of tethering of the spinal cord
• B Risk of high-output cardiac failure from arteriovenous shunting within the mass
• C Risk of mechanical airway obstruction during delivery
• D Risk of malignant transformation rises steeply after 2 months of age ✓

Explanation

Sacrococcygeal teratoma is the commonest neonatal tumour, and benign mature lesions predominate at birth. However, the proportion of malignant yolk sac tumours rises sharply with delay beyond about 2 months of life, so complete excision including the coccyx is performed early. High-output cardiac failure can occur prenatally but is managed separately, and spinal cord tethering is associated with presacral extension rather than being the primary indication for neonatal resection.

Reference: Pediatric Surgery, Ashcraft's, 7th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.