The preferred first treatment for<unk>  is complete surgical removal (i.e., complete resection). The preferred approach to a small<unk>  is through the perineum; a large<unk>  may require an additional approach through the abdomen. Resection should include the coccyx and may also include portions of the sacrum. The surgery should include reattachment of the small muscles and ligaments formerly attached to the coccyx, in effect reconstructing the posterior perineum. If not, there is an increased risk of perineal hernia later in life.<unk> s are classified morphologically according to their relative extent outside and inside the body: *Altman type I — entirely outside, sometimes attached to the body only by a narrow stalk *Altman type II — mostly outside *Altman type III — mostly inside *Altman type IV — entirely inside; this is also known as a presacral<unk>  or retrorectal<unk>  The Altman type is significant in the contexts of management of labor and delivery, surgical approach, and complications of<unk> . Serial ultrasound and MRI monitoring of<unk> s in fetuses in utero has demonstrated that the Altman type can change over time. As the tumor grows, it can push between other organs and through the perineum to the body surface where the tumor appears as a bulge covered only by skin. Sometimes, the tumor bulge later slips back inside the perineum. Like all<unk> s, a<unk>  has the potential to be malignant, and the standard of care requires long-term followup by an oncologist. Management of fetal<unk> s Management of most fetal<unk> s involves watchful waiting prior to any treatment. An often used decision tree is as follows: *Perform detailed ultrasound exam including fetal echocardiogram and Doppler flow analysis *If fetal high output failure, placentomegaly, or hydrops *If fetus not mature, perform pregnancy termination or fetal intervention *Else fetus mature, perform emergency Cesarean section *Else no emergent problems, perform serial non-stress tests and ultrasound biophysical profiles and plan delivery, as follows *If emergent problems develop, return to top of decision tree *Else if<unk>  over 5–10 cm or polyhydramnios, perform early (37 weeks gestation) elective Cesarean section *Else<unk>  small and no complications, permit term spontaneous vaginal delivery Emergent problems include maternal mirror syndrome, polyhydramnios, and preterm labor. Poor management decisions, including interventions that are either premature or delayed, can have dire consequences. A very small retrospective study of 9 babies with<unk> s greater than 10 cm diameter reported slightly higher survivorship in babies remaining in utero slightly longer. In many cases, a fetus with a small<unk>  (under 5 or 10 cm) may be delivered vaginally. Prior to the advent of prenatal detection and hence scheduled C-section, 90% of babies diagnosed with<unk>  were born full term. Management of adult<unk> s<unk> s are very rare in adults, and as a rule these tumors are benign and have extremely low potential for malignancy. This estimation of potential is based on the idea that because the tumor existed for decades prior to diagnosis, without becoming malignant, it has little or no potential to ever become malignant. For this reason, and because coccygectomy in adults has greater risks than in babies, some surgeons prefer not to remove the coccyx of adult survivors of<unk> . There are case reports of good outcomes.
Sacrococcygeal teratoma
Myxoid cyst
Gonadoblastoma
Pineal gland cyst
Ectopic testis
Luteoma
Chordoma
Hydrocele testis