RESACRAI. teratomas are usually detected in P early childhood and may, in that age poup, occasionally be malignant. They seldom become clinically manifest in adults, and malignant change is rarely observed in perjons past the second decade. T h e following is in account of a malignant neoplasm that had originated from a presacral teratoma in a middle-aged woman.
REPORT OF A CASE
A 59-year-old woman entered the hospital because of rectal pain of 2 weeks' duration. T h e past history was negative except that she had had an appendectomy and a bilateral salpingo-oophorectom y 23 years earlier. Physical examination revealed marked edema and tenderness of the perineum associated with an ill defined mass that extended from the sacrum to the left anal margin. On rectal examination, the tumor seemed to occupy the left ischiorectal fossa and appeared to be attached to the sacrum. Roentgenological studies demonstrated a mass lying posterior to the rectum, to which it did n o t seem attached. Calcific deposits were visualized in the roentgenograms, and the radiographic finding were considered suggestive of a dermoid cyst. T h e growth lay close to the coccyx, but no defects were demonstrated in any of the bony structures. Under local anesthesia the mass was removed in 5 pieces. T h e incision failed to heal, and during the next 2 months there was continued drainage from the defect. A colostomy was then performed followed by en bloc resection of the tumor-bearing area with the cautery. T h e resected structures included the lower part of the sacrum, the coccyx, and the rectal ampulla. Wound healing was again unsatisfactory, and hence no attempt was made to cover the exposed area with a graft. Enlargement of the inguinal lymph nodes became noticeable within the next few weeks and several of these nodes were removed from both inguinal regions 3 months after the first operation. T h e primary tumor was classified as a malignant teratoma combining differentiated tissue de-From the dcpartrnents of Pathology, Baylor IJniver-