PMC9632992_01
Magnetic resonance imaging (MRI) and 3D computed tomography (CT) of the patient. (A1-A3) CT showing different views of the teratoma. A huge space-occupying lesion exhibiting different densities can be observed in the pelvic cavity. A clear boundary is observed between the teratoma and pelvis. (B1-B3) MRI showing various views of the teratoma. The massive sacrococcygeal multiloculated lesion comprises a large amount of fat, sebaceous material, and long bone. (C1-C3) Various 3D views of the bone reconstruction based on CT; the 3D reconstruction allowed the visualization of the spatial positions of the bones within the teratoma as well as the lesion's relationship with the pelvis.
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F1
Pelvic enhanced magnetic resonance imaging revealed a massive sacrococcygeal multiloculated teratoma comprised mainly of a fatty, sebaceous material as well as a long bone lacking any obvious abnormalities on enhanced scanning (Figure 1).
The application of 3D reconstruction and mixed reality (MR) technology in our patient. (A,B) The 3D reconstruction images accurately displaying the relationship between the teratoma and surrounding tissues through various angles. (a) teratoma; (b) bladder; (c) rectum. (C,D) mixed reality (MR) technology showing the spatial location of the teratoma and its orientation with respect to the pelvic cavity. This technology was used to devise a surgical strategy and simulate the surgical process.
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The 3D model was then uploaded into the mixed reality (MR) image system, whereupon the surgeon could visualize the 3D model through the mixed reality (MR) helmet (Microsoft Corp, Redmond, WA, United States) (Figure 2).
The gross appearance and pathological examination of the teratoma. (A) The teratoma measured 24 x 23 x 15 cm and weighed 5 kg. Two intact bones were isolated from the mass: one was 11 cm long with a diameter of 3 cm, and the other was irregular (6 x 6 x 5 cm). The two bones formed a pseudoarthrosis. (B-G) Pathological slides stained with hematoxylin and eosin: (B) hair follicle, (C) adipose tissue, (D) sebaceous gland, (E) squamous epithelium, (F) mixed glands, and (G) striated muscle.
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Of particular interest, two intact irregular bones that formed a pseudoarthrosis were isolated from the mass; one was 11 cm long and the other 6 cm (Figure 3A). Microscopically, fibrous squamous epithelium with cutaneous appendages, hair follicles, sebaceous glands, bony trabeculae, and fat tissue was observed in the section (Figures 3B-G).
The therapeutic course of the patient. The current case report is presented based on this sequence of events.
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Her treatment course was summarized in Figure 4.