Imaging in pediatric presacral tumors with intraspinal extension: Lessons from a series of six cases

Abstract Presacral space is a potential space between the rectum anteriorly and lumbosacral spine posteriorly containing derivatives from various primitive germ cell types which serve as origin to a myriad of tumors. Imaging plays a vital role in diagnosis, characterization, assessing extent and evaluation of spread. We present a series of six cases of pediatric presacral tumors with intraspinal extension. The series comprises of an immature sacrococcygeal teratoma (Altman type II), a malignant sacrococcygeal teratoma (Altman type IV), a neuroblastoma, a rhabdomyosarcoma, a clear cell sarcoma and an Ewing’s sarcoma of the ilium which can be broadly categorized as tumors of germ cell, neuroblastic, mesenchymal, osteogenic origin. In spite of overlapping imaging features, careful retrospective observation revealed few distinctive features that would aid in optimal characterization of tumors with a fair degree of certainty.In summary, the salient imaging features that aid in differentiation are the epicentre of the tumor, pattern and degree of bone involvement, status of sacral foramina and neural elements and internal characteristics such as presence of fat, calcification, hemorrhage, necrosis, etc.