PMC6441767_01
1a and 1b: Axial and sagittal T2-weighted images showing a septated cystic lesion located within the pelvis. This lesion is in continuity with the spinal canal through a hiatus located in the anterior and right aspect of the sacrum. (Horizontal line on the sagittal view). Dysraphism of the sacrum and coccyx is noted. Note that the urinary bladder contains a Foley catheter and is significantly compressed, as well as anteriorly and superiorly displaced.
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An abdomino-pelvic MRI showed an 8.2*3.7*3.2 cm homogenous cystic multilobulated pelvic mass in the sacrococcygeal area with a 1.5*0.4*0.6 cm dural canal communicating with the mass at the S4-S5 level consistent with an anterior sacral meningocele (Fig. 1).
2A and 2B: Axial T1 weighted image with fat signal suppression following gadolinium administration showing a partially enhancing, large lesion located in the pelvis, in the pre-and post sacral spaces. Sagittal T2 weighted image showing a mixed large lesion with a dominant solid component located at the tip of the sacrum showing an extension to the pelvis and posterior subcutaneous tissues.The urinary bladder is again noted to be anteriorly and superiorly displaced.
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A lumbosacral MRI showed a solid lesion of 7.5 cm of height and 6.5 cm of diameter associated with adenopathies (Fig. 2).
Pathology of tumor. Residual focus of viable yolk sac tumor exhibiting solid growth pattern with glandular formations (a), anti-CK positive and CD30 negative (b), residual glial tissue (c), residual mature cartilage (d), cystically dilated gland lined by simple benign cuboidal to columnar epithelium at 100x magnification (e) with necrosis and dystrophic calcification and histiocytes at 50x magnification with H&E stain (f).
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On pathology, the tumor was found to be an extragonadal germ cell tumor composed of mature benign glial tissue, endodermal derived tissue bone and cartilage with admixed yolk sac tumor, diagnostic of malignant mixed germ cell tumor (Fig. 3).