Presacral epidermoid cyst: report of a case

A report of presacral epidermoid cyst in perimenopausal women: An extremely rare site and an unusual cause of chronic constipation

BACKGROUND

Epidermoid cyst is rare congenital lesion of ectodermal origin that arises from the remnants of the embryonic tissues. Although epidermal cysts are frequently observed throughout the body, they are rarely found in the presacral regions. It more commonly occurs in women of reproductive age as an asymptomatic, incidental finding during routine physical examination or imaging studies, or during obstetric and gynecologic events.

CASE PRESENTATION

A 48-year-old female patient presented with intermittent constipation, lower abdominal and pelvic pain that had developed progressively during the previous six months, which was temporarily relieved with regular laxatives. Magnetic resonance imaging showed a presacral cystic tumor with a high signal intensity on T1-weighted images and, low signal on T2-weighted images with no significant enhancement post-contrast administration. The mass pushed the rectum laterally by external compression. This tumor was diagnosed as a developmental cyst, and total mass resection with negative margins was performed. After that, tumor was histopathologically diagnosed as an epidermoid cyst.

DISCUSSION AND CONCLUSION

Epidermoid cyst is a common entity but is rare at presacral space. Also, an epidermoid cyst is an uncommon entity among cystic pathologies found in the presacral region, which includes benign and malignant pathologies. Due to the potential of subsequent infection or cancer, a meticulous clinical examination with correlated radiographic imaging, followed by total mass excision and histopathological evaluation are crucial.

Cystic lesions of the retrorectal space

Cysts of the retrorectal space comprise a heterogeneous group of rare lesions. Most develop from embryological remnants and include tailgut cysts, dermoid cysts, rectal duplication cysts, anal canal duplication cysts, sacrococcygeal teratomas and anterior meningocoele. Tailgut cyst is the most common cyst of developmental origin, usually presenting as a multilocular cystic mass with mucoid content and lined by multiple epithelial types. Compared with tailgut cysts, rectal duplication cysts display all layers of the large bowel wall including a well-defined muscularis propria. Retrorectal cysts of non-developmental origin are far less common and represent lesions that either infrequently involve the retrorectal space or undergo extensive cystic change. This review provides an overview of the various histological types of cystic lesions of the retrorectal space, divided into cysts of developmental origin and those of non-developmental origin. A practical pathological and multidisciplinary approach to diagnosing these lesions is presented.

A Case Report of Large Tailgut Cyst Located from the Perirenal to the Perivesical Spaces

Tailgut cysts are known to originate from the remnants of the embryonic hindgut. They occur exclusively in the retrorectal and presacral spaces. There have been limited reports of tailgut cysts occurring in the left perirenal space. The present case features a huge tailgut cyst extending from the right perirenal to the perivesical space. We believe that this case report will help to further elucidate the characteristics of perirenal and perivesical tailgut cysts.

An atypical site of a retroperitoneal epidermoid cyst in a middle-aged woman

INTRODUCTION

Retroperitoneal cysts are rare, usually asymptomatic, abdominal lesions. Epidermoid cysts developing in this space usually occur in middle-aged women and are incidentally discovered in the presacral region during ultrasound examination. Occasionally, cysts may arise from splenic tissue or adrenal glands and develop above the presacral area.

PRESENTATION OF CASE

We present the unusual location of a cyst in the retroperitoneal space in a 41-year-old woman admitted to hospital due to detection of a lesion in ultrasound imaging. A CT scan confirmed large intra-abdominal cyst. At operation, a large retroperitoneal thin-walled cyst with no evident arising point was discovered. Histologic analysis revealed epidermoid cyst.

DISCUSSION

Our patient presented with giant retroperitoneal cyst extending from the subhepatic region to the uterine and bladder. To our knowledge, this unusual location in adult has not been previously reported in the literature. In our case the lesion was adjacent to inferior vena cava and mesenteric vessel which required special attention during preparation and was technically demanding.

CONCLUSION

Surgery is the gold standard for the diagnosis and treatment of retroperitoneal epidermoid cysts. Successful treatment of benign retroperitoneal epidermoid cysts depends on appropriate diagnosis, careful operative technique, and adequate management of the underlying pathology.

Presacral epidermoid cyst in a male: a case report and literature review

Presacral cysts are an uncommon entity most often found incidentally in women. These tumors can arise from any of the 1 or more cell lines present in the presacral space during embryogenesis. We present a case of a 46-year-old male patient who was found to have a well-circumscribed presacral mass on computed tomography (CT) scan, which was obtained for his complaint of vague lower back pain. He underwent transabdominal excision, and pathology revealed a presacral epidermoid cyst filled with keratinaceous material. Presacral cysts are rare, especially in male patients. These tumors originate from an embryologic error during development. Because of the risk of infection and malignant transformation, they should be excised. Surgical options include a posterior approach, transabdominal approach, combined approach, or transrectal approach. The approach is dictated by the tumor size, location, presence of malignancy, and bony invasion.

Squamous cell carcinoma arising from a presacral epidermoid cyst: CT and MR findings

We report CT and MRI findings in a case of squamous cell carcinoma arising from a presacral epidermoid cyst, which has not been previously reported. CT findings revealed a focal wall thickening of the anterior wall of the huge presacral cystic mass. The squamous cell carcinoma was more hypointense than the cystic fluid on T1- and T2-weighted images and showed heterogeneous enhancement on contrast enhanced T1-weighted image.

Laparoscopic and perineal excision of an infected "dumb-bell" shaped retrorectal epidermoid cyst

INTRODUCTION

Extraperitoneal cysts in the pelvis adjacent to the rectum are rare entities. They are of vague etiology, and the pathologic types of the acquired variety are dermoid, epidermoid, and teratoma. As far as we know, laparoscopic excision of a retrorectal epidermoid cyst has never before been reported.

CASE REPORT

The patient was an elderly lady with a large pelvic cyst and another large cyst in the perineum, which displaced the vagina and the anus. Laparoscopy was performed; the pelvic cyst was punctured and then dissected out. The perineal extension of the cyst was excised via a perineal approach. The patient had an uneventful recovery and was discharged on the 4th postoperative day. Histopathologically, the cyst was of the epidermoid type. Follow-up after 26 months revealed no recurrence.

DISCUSSION

Our case presented a diagnostic dilemma. Laparoscopic excision was tedious, though we completed the procedure successfully. Precaution was taken to avoid spillage of the contents and also to avoid injury to vital structures nearby, such as the iliac vessels and ureter. It is feasible to laparoscopically excise retrorectal cysts with a careful and meticulous dissection.

CONCLUSIONS

The major advantages are rapid recovery with minimal morbidity and excellent cosmesis.

Presacral tumours in adults

Presacral tumours represent a heterogeneous group of predominantly benign and occasionally malignant neoplasms. Due to the rarity of these tumours, their management is often performed in an ad hoc fashion and an algorithm for optimal treatment remains undefined. This review aims to present an overview of presacral tumours, focusing on their presentation, pathology, investigation and management.

Presacral epidermoid cyst with right hydronephrosis

OBJECTIVE

Epidermoid cyst of the presacral space is a rare congenital lesion of ectodermal origin. Presacral epidermoid cyst with hydronephrosis is even rarer and has never been reported in Taiwan. Herein, we present a patient with presacral epidermoid cyst with right hydronephrosis.

CASE REPORT

A 62-year-old woman had low abdominal pain for 2 weeks and was referred to our hospital for further management. In our hospital, computed tomography revealed a multilobulated cystic tumor (20 x 15 x 12 cm) in the lower abdomen, complicated with right severe hydronephrosis. Laparotomy was undertaken and a presacral tumor was removed. The pathologic diagnosis was an epidermoid cyst.

CONCLUSION

A presacral epidermoid tumor is a rare tumor and a large presacral cystic tumor may mimic an ovarian tumor in imaging. All presacral tumors with or without symptoms should be evaluated thoroughly before operation. Complete surgical excision, preserving adjacent organs' function, should be kept in mind.

Retroperitoneal cystic masses: CT, clinical, and pathologic findings and literature review

Cystic lesions of the retroperitoneum can be classified as either neoplastic or nonneoplastic. Neoplastic lesions include cystic lymphangioma, mucinous cystadenoma, cystic teratoma, cystic mesothelioma, müllerian cyst, epidermoid cyst, tailgut cyst, bronchogenic cyst, cystic change in solid neoplasms, pseudomyxoma retroperitonei, and perianal mucinous carcinoma. Nonneoplastic lesions include pancreatic pseudocyst, nonpancreatic pseudocyst, lymphocele, urinoma, and hematoma. Because the clinical implications of and therapeutic strategies for retroperitoneal cystic masses vary depending on the cause, the ability to noninvasively differentiate between masses is important. Although there is substantial overlap of computed tomographic (CT) findings in various retroperitoneal cysts, some CT features, along with clinical characteristics, may suggest a specific diagnosis. CT may provide important information regarding lesion location, size, and shape; the presence and thickness of a wall; the presence of septa, calcifications, or fat; and involvement of adjacent structures. The most important clinical parameters include patient gender, age, symptoms, and clinical history. Familiarity with the CT and clinical features of various retroperitoneal cystic masses facilitates accurate diagnosis and treatment.

[Vestigial retrorectal cyst in adults]

STUDY AIM

The aim of this retrospective study was to report three cases of retrorectal vestigial cyst in adults.

PATIENTS AND METHOD

From 1977 to 1999 retrorectal vestigial cyst (RVC) was diagnosed in our department in three women who were 28, 57 and 53 years of age, respectively. RVC was revealed by either pain (n = 2) that occurred in one case in a pregnant woman, or acute intestinal obstruction (n = 1). The patients were operated on using a perineal approach in two cases and an abdominal approach in one case.

RESULTS

One epidermoid cyst and two mixed cysts without any sign of malignancy were observed. Postoperative follow-up was simple in two patients, while complications occurred in the third one via an uretero-vaginal fistula which required uretero-vesical reimplantation. The first two patients, reviewed after a 1-year follow-up, had no functional trouble and no sign of recurrence.

CONCLUSION

Retrorectal vestigial cysts are very rare tumors with a risk for degeneration. Computerized tomography on nuclear magnetic resonance and endorectal ultrasonography allow detection of their structure and topography and help guide their surgical approach. In the absence of malignancy, wide excision, if possible without opening of the cystic wall, leads to good results.