Sacro-Coccygeal Teratoma (SCT) in a Pacific Island Nation

Background: SCT is a rare tumour most common in children with quoted textbook incidences ranging from 1 in 27,000 to 1 in 40,000 live births. Several recent series suggest a higher incidence close to 1/10,000. Since 2015 our unit has been providing paediatric surgical support services to a developing tropical nation, and we have also noted an incidence of approximately 1/10,000.

Objective: To review the incidence and details of our series of Pacific Island SCT.

Methods: Retrospective review of SCT cases 2015- April 2019 inclusive was performed, including patient demographics, diagnosis, operation performed, and histopathology (where available). Incidence was calculated using World Bank population data. Statistical analyses were performed using Stata©.

Results: In total 8 patients presented with SCT in the study period. Mean age was 1 year (range 0-4). Five (62.5%) were female. Four (50%) were type 1 SCT, with two Type 2, and two Type 3. All eight were surgically typical of SCT, and were treated with primary excision. One is lost to follow-up. Of the eight operated on, three have been brought to Australia, and five had their operations at home. Available pathology showed benign mature SCT in all. One report has been lost, and one is awaited. Given a local birth rate of 28.7 per 1000/year, the approximate incidence of SCT regionally was 1 per 9840 births.

Conclusion: SCT remains a rare tumour, but local real incidence may be higher. Given that our observed incidence fits with the higher recently published incidences, we ask whether there has been a real worldwide increase in incidence of SCT over recent decades, or whether there is significant regional variability in incidence.
We incidentally note the benefits of links between rich and poor world health services.