Transvaginal excision of a retrorectal tumor presenting as rectocele

Perirectal epidermoid cyst in a patient with sacrococcygeal scoliosis and anal sinus: A case report

BACKGROUND

Perirectal epidermoid cysts are rare masses arising from the ectodermal germ cell layer of the hindgut and are predominantly found in middle-aged women. It is often difficult to make an accurate diagnosis of these cysts and it is equally challenging to distinguish it from other developmental cysts.

CASE SUMMARY

We report the case of an 18-year-old female patient with a perirectal mass who presented to the hospital with constipation. The patient experienced sacrococcygeal falls and burns on the left buttocks during growth. Three-dimensional computed tomography scans indicated abnormal sacral vertebrae with the sacral canal partially enlarged and opened. Pelvic magnetic resonance imaging showed a 55 mm × 40 mm × 35 mm unilocular cystic mass in the perirectal space and a solitary sinus in the left ischiorectal fossa. The cyst was completely resected posteriorly using the sacrococcygeal approach. The pathology was verified to be an epidermoid cyst. The patient remained recurrence-free after 6 mo of follow-up.

CONCLUSION

Successful treatment of perirectal epidermoid cysts depends on comprehensive evaluation. This is significant for the surgical approach and prognosis.

Squamous Cell Carcinoma Malignantly Transformed From Frequent Recurrence of a Presacral Epidermoid Cyst: Report of a Case

Backgroud: Presacral tumors are rare space occupying lesions that arise in the presacral space. The incidence of presacral tumor has been reported to be 1 in 40,000 to 63,000 patients. An even rarer occurrence is the transformation of a presacral tumor into a squamous cell carcinoma (SCC).

Case Summary: A 61 years old man was referred to our hospital for a palpable mass near anus and appeared repeatedly in last 10 years. The patient previously underwent two surgeries at another hospital. A posterior approach was implemented in the first two surgeries, and the diagnosis was benign presacral epidermoid cyst. Two months before his admission to our department in 2017, the patient complained of a mass measuring ~2 cm around his anus. Physical examination revealed a 2 cm mass at the 12 o'clock direction in chest-knee position. A digital rectal examination indicated a rubbery lesion located in the presacral space. The Pre-operative pelvic magnetic resonance imaging (MRI) confirmed the presence of a 6.8 cm * 5.2 cm * 7.3 cm mass located at the presacral space. In contrast phase, the center of the lesion exhibited homogenous density without enhancement. The mass was then excised via posterior para-sacral approach with pathological report showing a benign epidermoid cyst after operation. The patient was discharged with full recovery without fecal incontinence. Fifteen months after being discharged from our hospital, the patient discovered a recurrence at the original site of where the mass previously appeared. Unlike the previous instance, the mass was accompanied with swelling, pain, and localized increased skin temperature. Pelvic MRI showed a 3.2 cm * 7.2 cm * 5.8 cm located at the same place, with no enhance in the core of mass. However, a speckled enhancement was observed on the margin of the lesion. The lesion was completely resected using the same procedure as before with a pathological diagnosis of SCC. The patient underwent chemoradiation therapy and remained disease free for more than 1 year.

Conclusion: Although very rare, benign cyst from presacral space can become malignant transformation. This highlights the importance of pre-operative diagnostic tests and evaluation to correctly identify the source of the primary cancer, which is crucial prior to starting adjuvant therapy.

Does a retrorectal tumour remain a challenge for surgeons?

Background: Retrorectal tumours are lesions with a wide range of histological differentiation that are often diagnostic and clinical challenges due to their rare occurrence. Many cases of this pathology are treated in regional hospitals, which results in serious complications because physicians fail to recognize this pathology. We present our experience in treating these tumours. Methods: A retrospective analysis of a prospectively maintained database was performed using the Vilnius University Hospital Santaros Clinics patient database. Thirty-five cases were identified. Results: Occurrence of retrorectal tumours was higher in women than in men and accounted for 82.86% and 17.14%, respectively. Computer tomography and magnetic resonance imaging were the main methods used to confirm diagnosis and plan surgical treatment. We have used a laparotomy, perineal or combined approach for tumour extirpation. The laparotomy approach was the most used, followed by perineal extirpation. The most common histological type was cystic hamartoma, accounting for 20% of cases. In 80% of cases, the histological findings greatly varied. Hospital stays varied from 3 to 21 days with a mean of 11.6 ± 5.83 days. The postoperative complication rate was 17.14% and was present in six cases. Overall survival was 85.17%, with an average follow-up period of 71.83 months. There were no recurrent tumours diagnosed during follow-up. Conclusion: Retrorectal tumours are a very rare pathology with high histological heterogeneity and problematic diagnostics. Patients should be referred to a tertiary centre that has experience and diagnostic capabilities for the best diagnostic and treatment options.

Symptomatic Epidermoid Cyst Presenting as a Paravaginal Mass

BACKGROUND

Ischioanal fossa epidermoid cysts are uncommon masses of epithelial origin and are believed to be either congenital or the result of trauma. Surgical excision is preferred as opposed to incision and drainage because these masses may enlarge, recur, become infected, or undergo malignant transformation.

CASE

This report describes a case of a 62-year-old woman who presented for evaluation of vaginal and perineal discomfort and fullness. Physical examination and computed tomography scan revealed a 7.1-cm cystic mass in the left ischioanal space. Transgluteal surgical excision was performed and pathology revealed an epidermoid cyst. The patient recovered with symptomatic improvement.

CONCLUSIONS

This report demonstrates a rare case of ischioanal fossa epidermoid cyst. In cases of rectal masses, cystic lesions should be considered. Thorough physical examination, imaging studies, and proper surgical management of these masses can improve patient symptomatology, prevent recurrence, and also decrease the risk of malignant transformation.

Transsacrococcygeal Approach for Resection of Retrorectal Tumors

Retrorectal tumors, are a rare and interesting entity, traditionally managed with surgery. The surgical approach is a key to get an easy and safe access. The purpose of this study was to evaluate the results of resection by a transsacrococcygeal approach. Thirty-six patients had retrorectal tumors resected by a transsacrococcygeal approach in our department. All the tumors were en bloc resected, irrespective of size and anatomical depth. The clinic data were retrospectively reviewed. Tumor mean size was 10 ± 4.4 cm. In 16 cases, tumors were 10 cm or more in size. The largest tumor measured 20 cm. The estimated mean blood loss was 130 ml. No mortality and severe postoperative complications were observed. The most significant issues were wound infection and delayed healing. Pathology showed 15 cases of epidermal cysts, two cases of enterogenous cyst, one case of bronchogenic cyst, 12cases of teratoma, two cases of schwannoma, two cases of low-grade malignant fibrous myxoma, one case of aggressive angiomyxoma, one case of desmoid tumor. The trans-sacrococcygeal approach gives an easy access and good visualization with fewer complications. This surgical approach shows to be safe and effective for resection of retrorectal tumors.

Retrorectal tumours: literature review and vilnius university hospital "santariskiu klinikos" experience of 14 cases

Objective

Retrorectal tumours are rare lesions in adults. The diagnosis of retrorectal lesion is often difficult and misdiagnosis is common. We present significant number of cases in view of scarce information available on this matter.

Methods

14 patients were treated at Vilnius university hospital "Santariskiu klinikos" Centre of abdominal surgery from 1997 to 2010. The case notes of patients who underwent surgery for a retrorectal tumour were reviewed retrospectively. Surgical histories, operations, histological tumour type, surgical time, weight of the specimen, blood loss, length of stay were analysed.

Results

13 patients underwent laparotomy, 1 patient had combined perineal approach and laparotomy. The most common types of the tumour were fibroma (3 cases), leiomyosarcoma (2 cases). 5 tumours (35,7%) were found to be malignant. 57% of the patients had undergone at least one operation prior to definitive treatment. 5 female patients were initially admitted under gynaecologists. Hospital stay varied from 14 days to 22 days (mean 16,2 days). A report of a representative case is presented.

Conclusions

Retrorectal lesions in female patients can mimic gynaecological pathology. Patients with this rare pathology are to be treated in a major tertiary hospital by surgeons, who are able to operate safely in the retrorectal space.