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Gupta L. Presacral Keratinous and Dermoid Cyst Masquerading as Meningocele - A Rare Case Report. Afr J Paediatr Surg 2024; 21:271-272. [PMID: 39279621 DOI: 10.4103/ajps.ajps_153_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Accepted: 10/25/2023] [Indexed: 09/18/2024] Open
Abstract
ABSTRACT Presacral tumours are rare developmental tumours associated with midline closure defects. A fifteen-month-old girl presented with pain in the lower abdomen and dysuria. After examination, the child underwent investigations and was diagnosed as a presacral mass with intergluteal extension and caudal mass in the subcutaneous tissue of the left gluteal region. Complete excision of mass along with coccygectomy was done. Histopathology showed presacral as a keratinous cyst and gluteal as a dermoid cyst. Later on, the child also developed a left facial dermoid cyst which was also excised.
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Affiliation(s)
- Lucky Gupta
- Department of Pediatric Surgery, AIIMS, Jammu, Jammu and Kashmir, India
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2
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Bardol T, Souche R, Druet C, Bertrand MM, Ferrandis C, Prudhomme M, Borie F, Fabre JM. Minimally invasive approach for retrorectal tumors above and below S3: a multicentric tertiary center retrospective study (MiaRT study). Tech Coloproctol 2024; 28:67. [PMID: 38860990 PMCID: PMC11166785 DOI: 10.1007/s10151-024-02938-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2024] [Accepted: 05/15/2024] [Indexed: 06/12/2024]
Abstract
BACKGROUND Retrorectal tumors are uncommon lesions developed in the retrorectal space. Data on their minimally invasive resection are scarce and the optimal surgical approach for tumors below S3 remains debated. METHODS We performed a retrospective review of consecutive patients who underwent minimally invasive resection of retrorectal tumors between 2005 and 2022 at two tertiary university hospital centers, by comparing the results obtained for lesions located above or below S3. RESULTS Of over 41 patients identified with retrorectal tumors, surgical approach was minimally invasive for 23 patients, with laparoscopy alone in 19, with transanal excision in 2, and with combined approach in 2. Retrorectal tumor was above S3 in 11 patients (> S3 group) and below S3 in 12 patients (< S3 group). Patient characteristics and median tumor size were not significantly different between the two groups (60 vs 67 mm; p = 0.975). Overall median operative time was 131.5 min and conversion rate was 13% without significant difference between the two groups (126 vs 197 min and 18% vs 8%, respectively; p > 0.05). Final pathology was tailgut cyst (48%), schwannoma (22%), neural origin tumor (17%), gastrointestinal stromal tumor (4%), and other (19%). The 90-day complication rates were 27% and 58% in the > S3 and < S3 groups, respectively, without severe morbidity or mortality. After a median follow-up of 3.3 years, no recurrence was observed in both groups. Three patients presented chronic pain, three anal dysfunction, and three urinary dysfunction. All were successfully managed without reintervention. CONCLUSIONS Minimally invasive surgery for retrorectal tumors can be performed safely and effectively with low morbidity and no mortality. Laparoscopic and transanal techniques alone or in combination may be recommended as the treatment of choice of benign retrorectal tumors, even for lesions below S3, in centers experienced with minimally invasive surgery.
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Affiliation(s)
- T Bardol
- Digestive and Minimally Invasive Surgery Unit, Montpellier University Hospital, University of Montpellier-Nîmes, 641 Avenue du Doyen Gaston Giraud, 34090, Montpellier, France.
| | - R Souche
- Digestive and Minimally Invasive Surgery Unit, Montpellier University Hospital, University of Montpellier-Nîmes, 641 Avenue du Doyen Gaston Giraud, 34090, Montpellier, France
| | - C Druet
- Department of Digestive and Oncological Surgery, Nîmes University Hospital, Montpellier-Nîmes University, Montpellier, France
| | - M M Bertrand
- Department of Digestive and Oncological Surgery, Nîmes University Hospital, Montpellier-Nîmes University, Montpellier, France
| | - C Ferrandis
- Digestive and Minimally Invasive Surgery Unit, Montpellier University Hospital, University of Montpellier-Nîmes, 641 Avenue du Doyen Gaston Giraud, 34090, Montpellier, France
| | - M Prudhomme
- Department of Digestive and Oncological Surgery, Nîmes University Hospital, Montpellier-Nîmes University, Montpellier, France
| | - F Borie
- Department of Digestive and Oncological Surgery, Nîmes University Hospital, Montpellier-Nîmes University, Montpellier, France
| | - J-M Fabre
- Digestive and Minimally Invasive Surgery Unit, Montpellier University Hospital, University of Montpellier-Nîmes, 641 Avenue du Doyen Gaston Giraud, 34090, Montpellier, France
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Otote J, Butnari V, Ravichandran PS, Mansuri A, Ahmed M, Pestrin O, Rajendran N, Kaul S. Presacral tumors: A systematic review of literature. J Clin Imaging Sci 2024; 14:17. [PMID: 38841312 PMCID: PMC11152553 DOI: 10.25259/jcis_27_2024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2024] [Accepted: 04/22/2024] [Indexed: 06/07/2024] Open
Abstract
Presacral/Retrorectal tumors (RRT) are rare lesions that comprise a multitude of histological types. Data on surgical management are limited to case reports and small case series. The aim of the study was to provide a comprehensive review of the epidemiology, pathological subtypes, surgical approaches, and clinical outcomes. A PubMed search using terms "retrorectal tumor" and "presacral tumor" was used to identify articles reporting RRT of non-urological, non-gynecologic, and non-metastatic origin. Articles included were between 2015 and 2023. A total of 68 studies were included, comprising 570 patients. About 68.2% of patients were female, and the mean overall age of both sexes was 48.6 years. Based on histopathology, 466 patients (81.8%) had benign lesions, and 104 (18.2%) were malignant. In terms of surgical approach, 191 (33.5%) were treated anteriorly, 240 (42.1%) through a posterior approach, and 66 (11.6%) combined. The mean length of stay was 7.6 days. Patients treated using the posterior approach had a shorter length of stay (5.7 days) compared to the anterior and combined approaches. RRT are rare tumors of congenital nature with prevalence among the female sex. R0 resection is crucial in its management, and minimal access surgery appears to be a safer option in appropriate case selection.
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Affiliation(s)
- Jeffrey Otote
- Department of Surgery, Barking Havering and Redbridge Univerisity Hospitals NHS Trust, Romford, United Kingdom
| | - Valentin Butnari
- Department of Surgery, Barking Havering and Redbridge Univerisity Hospitals NHS Trust, Romford, United Kingdom
| | - Praveen Surya Ravichandran
- Department of Surgery, Barking Havering and Redbridge Univerisity Hospitals NHS Trust, Romford, United Kingdom
| | - Ahmer Mansuri
- Department of Surgery, Barking Havering and Redbridge Univerisity Hospitals NHS Trust, Romford, United Kingdom
| | - Mehnaz Ahmed
- Department of Surgery, Barking Havering and Redbridge Univerisity Hospitals NHS Trust, Romford, United Kingdom
| | - Olivia Pestrin
- Department of Surgery, Barking Havering and Redbridge Univerisity Hospitals NHS Trust, Romford, United Kingdom
| | - Nirooshun Rajendran
- Department of Surgery, Barking Havering and Redbridge Univerisity Hospitals NHS Trust, Romford, United Kingdom
| | - Sandeep Kaul
- Department of Surgery, Barking Havering and Redbridge Univerisity Hospitals NHS Trust, Romford, United Kingdom
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4
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Dsouza R, A R, Mathew A, Raghunath R. Benign ectopic prostate-a rare differential for a presacral mass. BMJ Case Rep 2024; 17:e257319. [PMID: 38649245 PMCID: PMC11043737 DOI: 10.1136/bcr-2023-257319] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/25/2024] Open
Abstract
A man in his mid-40s presented to the colorectal surgery clinic with complaints of chronic perianal pain for over 20 years. He had episodes of urinary incontinence associated with pain. There were no other symptoms to suspect bowel pathology. On examination, he was found to have a tender mass in the retro-rectal plane without any evidence of rectal mucosal irregularity. He underwent an MRI of the pelvis, which showed a well-defined T2 hyperintense partly cystic lesion in the presacral region abutting the mesorectal fascia and a normal prostate gland. With a suspicion of a tailgut cyst or a duplication cyst, he underwent an excision of the presacral mass. Intraoperatively, there was a 2 × 2 cm well-defined firm, cystic lesion anterior to the fifth sacral vertebra and coccyx. The lesion was adherent to the mesorectum and was excised. On histopathology, there were features of muscular stroma and bilayered glandular epithelium with clear cytoplasm conclusive of a benign ectopic prostate.
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Affiliation(s)
- Royson Dsouza
- Surgery Unit 2 and Colorectal Surgery, Christian Medical College and Hospital Vellore, Vellore, Tamil Nadu, India
| | - Ramachandran A
- Pathology, Christian Medical College Vellore, Vellore, Tamil Nadu, India
| | - Aleena Mathew
- Radiology, Christian Medical College Vellore, Vellore, Tamil Nadu, India
| | - Rajat Raghunath
- Surgery Unit 2 and Colorectal Surgery, Christian Medical College and Hospital Vellore, Vellore, Tamil Nadu, India
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5
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Akinmade A, Adekeye OA, Edem EE, Adegbehingbe O, Adegbilero-Iwari OE. Determination of the width of the presacral space on magnetic resonance imaging among adults in south-western Nigeria. Acta Radiol 2024; 65:253-258. [PMID: 38055976 DOI: 10.1177/02841851231216042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/08/2023]
Abstract
BACKGROUND The presacral space is a clinically relevant potential space and contents may give rise to a variety of benign and malignant conditions, hence the need for detailed knowledge of its dimensions. PURPOSE To determine the width of the presacral space and existing variations among adults in south-western Nigeria using a magnetic resonance imaging (MRI) technique. MATERIAL AND METHODS A total of 369 consenting adults were included in the study. Measurements of the presacral space were then made electronically by consensus of two radiologists. Values derived were recorded and subjected to analyses of variance. RESULTS The mean normal widths of the presacral space in men and women were 11.7 mm and 11.1 mm at the S1 level, 11.7 mm and 10.35 mm at the S2 level, and 12.3 mm and 9.7 mm at the S3 level, respectively. Measurements of the presacral space width were significantly larger in the male population. Variations in the dimensions due to age greater than 40 years, male sex, and increasing body mass index (BMI) were also noted. CONCLUSION This study provides baseline dimensions under more physiological conditions and gives more accurate information about the true width of the space in Nigerian adults. Variations due to age, sex, and BMI may also be considered while interpreting abnormal values.
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Affiliation(s)
- Akinola Akinmade
- Department of Human Anatomy, Afe Babalola University, Ado-Ekiti, Nigeria
- Department of Orthopaedics and Trauma, ABUAD Multisystem Hospital, Ado-Ekiti, Nigeria
| | | | - Ekpenyong E Edem
- Department of Human Anatomy, Afe Babalola University, Ado-Ekiti, Nigeria
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6
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Bilkhu AS, Wild J, Sagar PM. Management of retrorectal tumours. Br J Surg 2024; 111:znae012. [PMID: 38291005 DOI: 10.1093/bjs/znae012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Revised: 01/06/2024] [Accepted: 01/10/2024] [Indexed: 02/01/2024]
Affiliation(s)
- Amarvir S Bilkhu
- Colorectal & Peritoneal Oncology, The Christie Foundation NHS Trust, Manchester, UK
| | - Jonathan Wild
- Colorectal & Peritoneal Oncology, The Christie Foundation NHS Trust, Manchester, UK
| | - Peter M Sagar
- John Goligher Unit, Leeds Teaching Hospitals NHS Trust, Leeds, UK
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7
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A E, Prakash A, Ashta A, Garg A, Verma A, Padaliya P. Pediatric presacral tumors with intraspinal extension: a rare entity with diagnostic challenges. Acta Radiol 2023; 64:3056-3073. [PMID: 37753549 DOI: 10.1177/02841851231202688] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/28/2023]
Abstract
The presacral space is a potential space located between the rectum and the lumbosacral spine. It contains various primitive germ cell types that serve as the origin for a range of tumors. Imaging is crucial in characterizing, assessing the extent of and evaluating the treatment response to these tumors. We report a series of six cases of pediatric presacral tumors with intraspinal extension, including 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. These tumors can be broadly categorized as tumors of germ cell, neuroblastic, mesenchymal and osteogenic origin. Despite overlapping imaging features, a review of the existing literature and careful retrospective observation revealed several distinctive features that aid in the optimal characterization of tumors. These include the tumor's epicenter, the pattern and degree of bone involvement, the status of sacral foramina and neural elements, and internal tumor characteristics such as the presence of fat, calcification, hemorrhage and necrosis.
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Affiliation(s)
- Ebinesh A
- Department of Radiodiagnosis, Maulana Azad Medical College and associated Lok Nayak Hospital, Jawahar Lal Nehru Marg, New Delhi, India
| | - Anjali Prakash
- Department of Radiodiagnosis, Maulana Azad Medical College and associated Lok Nayak Hospital, Jawahar Lal Nehru Marg, New Delhi, India
| | - Aanchal Ashta
- Department of Radiodiagnosis, Maulana Azad Medical College and associated Lok Nayak Hospital, Jawahar Lal Nehru Marg, New Delhi, India
| | - Anju Garg
- Department of Radiodiagnosis, Maulana Azad Medical College and associated Lok Nayak Hospital, Jawahar Lal Nehru Marg, New Delhi, India
| | - Abhishek Verma
- Department of Radiodiagnosis, Maulana Azad Medical College and associated Lok Nayak Hospital, Jawahar Lal Nehru Marg, New Delhi, India
| | - Prerna Padaliya
- Department of Radiodiagnosis, Maulana Azad Medical College and associated Lok Nayak Hospital, Jawahar Lal Nehru Marg, New Delhi, India
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8
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Ponsiglione A, Campo I, Sachs C, Sofia C, Álvarez-Hornia Pérez E, Ciabattoni R, Sharaf DE, Causa-Andrieu P, Stanzione A, Cuocolo R, Zawaideh J, Brembilla G. Extraprostatic incidental findings on prostate mpMRI: A pictorial review from the ESUR junior network. Eur J Radiol 2023; 166:110984. [PMID: 37480649 DOI: 10.1016/j.ejrad.2023.110984] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Revised: 07/10/2023] [Accepted: 07/16/2023] [Indexed: 07/24/2023]
Abstract
The role of multiparametric MRI (mpMRI) in prostate cancer setting is increasingly consolidated and, as a result, its usage in clinical practice is in exponential growth. However, beyond the prostate gland, several key structures are included in the field of view of mpMRI scans. Consequently, various extra-prostatic incidental findings (IFs) belonging to different anatomical systems can be accidentally recognized. Therefore, it is mandatory for a radiologist to be familiar with the wide range of pathologies potentially encountered, to guide management and avoid patient anxiety and costs due to additional work-up prompted by clinically insignificant extra-prostatic findings. With this pictorial review, we aim to illustrate a wide range of IFs that can be detected when performing mpMRI of the prostate, focusing on their imaging characteristics, differential diagnosis, and clinical relevance. Additionally, we propose the CheckDEEP, the Checklist for DEtection of ExtraProstatic findings, to be used for a thorough evaluation of target areas within each anatomical system.
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Affiliation(s)
- Andrea Ponsiglione
- Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy.
| | - Irene Campo
- Radiology Unit, Department of Medical, Surgical and Health Sciences, University of Trieste, Trieste, Italy
| | - Camilla Sachs
- Department of Radiology, Ospedale Ca' Foncello, 31100, Treviso, Italy
| | - Carmelo Sofia
- Department of Biomedical Sciences and Morphologic and Functional Imaging, Policlinico Universitario G. Martino, University of Messina, Messina, Italy
| | | | - Riccardo Ciabattoni
- Department of Radiology, Ospedale San Salvatore di Pesaro, Azienda Sanitaria Territoriale Pesaro Urbino, Pesaro, Italy
| | - Doaa E Sharaf
- Department of Radiology, Urology & Nephrology Center, Mansoura University, Mansoura, Egypt
| | | | - Arnaldo Stanzione
- Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy
| | - Renato Cuocolo
- Department of Medicine, Surgery and Dentistry, University of Salerno, Baronissi, Italy
| | - Jeries Zawaideh
- Department of Radiology, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Giorgio Brembilla
- Department of Radiology, IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
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Khalaf Z, Al Hindi S. Sacrococcygeal spindle cell tumour: A case report. JOURNAL OF PEDIATRIC SURGERY CASE REPORTS 2023. [DOI: 10.1016/j.epsc.2023.102611] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/16/2023] Open
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10
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Nayab A, Malik MH, Madhavan AA, Glockner J, Collins DA, Wenger DE. Incidental diagnosis of presacral ganglioneuroma in a patient with hematuria. Radiol Case Rep 2023; 18:1324-1328. [PMID: 36704366 PMCID: PMC9870923 DOI: 10.1016/j.radcr.2022.11.084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Revised: 11/26/2022] [Accepted: 11/29/2022] [Indexed: 01/20/2023] Open
Abstract
Ganglioneuromas are benign neuroblastic tumors seen most in pediatric population. The most common locations are mediastinal, retroperitoneal and adrenal regions. Ganglioneuromas rarely occur in presacral space. We present one such case of an incidentally diagnosed presacral ganglioneuroma in an asymptomatic 71-year-old male who initially presented with hematuria.
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Affiliation(s)
- Asra Nayab
- Corresponding author at: Mayo Clinic, Department of Radiology, 200 1st St SW Rochester MN 55905.
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11
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Lee SH, Kwok KY, Wong SM, Chan CXJ, Wong YT, Tsang ML. Chordoma at the skull base, spine, and sacrum: A pictorial essay. J Clin Imaging Sci 2022; 12:44. [PMID: 36128361 PMCID: PMC9479632 DOI: 10.25259/jcis_62_2022] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2022] [Accepted: 07/10/2022] [Indexed: 11/04/2022] Open
Abstract
Chordomas are rare tumors believed to be arising from the notochord remnant in the axial skeleton. Diagnosis is often difficult since they show overlapping imaging features with other more common disease including metastases. Since individualized papers are only discussing the imaging features at different locations, the aim of this pictorial review is to have a comprehensive review on the common imaging findings of chordomas along the entire neuroaxis with a series of pathological proven cases in a local tertiary hospital in Hong Kong.
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Affiliation(s)
- Sin Hang Lee
- Department of Radiology, Tuen Mun Hospital, Tuen Mun, Hong Kong,
| | - Kai Yan Kwok
- Department of Radiology, Tuen Mun Hospital, Tuen Mun, Hong Kong,
| | - Sin Man Wong
- Department of Radiology, CUHK Medical Centre, Sha Tin, Hong Kong,
| | | | - Yu Ting Wong
- Department of Radiology, Tuen Mun Hospital, Tuen Mun, Hong Kong,
| | - Man Lung Tsang
- Department of Radiology, Tuen Mun Hospital, Tuen Mun, Hong Kong,
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12
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Elsherif SB, Agely A, Gopireddy DR, Ganeshan D, Hew KE, Sharma S, Lall C. Mimics and Pitfalls of Primary Ovarian Malignancy Imaging. Tomography 2022; 8:100-119. [PMID: 35076619 PMCID: PMC8788482 DOI: 10.3390/tomography8010009] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Revised: 12/18/2021] [Accepted: 12/21/2021] [Indexed: 11/17/2022] Open
Abstract
The complex anatomy and similarity of imaging features of various pathologies in the pelvis can make accurate radiology interpretation difficult. While prompt recognition of ovarian cancer remains essential, awareness of processes that mimic ovarian tumors can avoid potential misdiagnosis and unnecessary surgery. This article details the female pelvic anatomy and highlights relevant imaging features that mimic extra-ovarian tumors, to help the radiologists accurately build a differential diagnosis of a lesion occupying the adnexa.
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Affiliation(s)
- Sherif B. Elsherif
- Department of Radiology, University of Florida College of Medicine—Jacksonville, Jacksonville, FL 32209, USA; (D.R.G.); (S.S.); (C.L.)
- Correspondence:
| | - Ali Agely
- Department of Radiology, Mayo Clinic Florida, Jacksonville, FL 32224, USA;
| | - Dheeraj R. Gopireddy
- Department of Radiology, University of Florida College of Medicine—Jacksonville, Jacksonville, FL 32209, USA; (D.R.G.); (S.S.); (C.L.)
| | | | - Karina E. Hew
- Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, University of Florida College of Medicine—Jacksonville, Jacksonville, FL 32209, USA;
| | - Smita Sharma
- Department of Radiology, University of Florida College of Medicine—Jacksonville, Jacksonville, FL 32209, USA; (D.R.G.); (S.S.); (C.L.)
| | - Chandana Lall
- Department of Radiology, University of Florida College of Medicine—Jacksonville, Jacksonville, FL 32209, USA; (D.R.G.); (S.S.); (C.L.)
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13
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Burke JR, Shetty K, Thomas O, Kowal M, Quyn A, Sagar P. OUP accepted manuscript. BJS Open 2022; 6:6570930. [PMID: 35441209 PMCID: PMC9019068 DOI: 10.1093/bjsopen/zrac044] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Revised: 02/03/2022] [Accepted: 02/13/2022] [Indexed: 11/12/2022] Open
Abstract
Aim Tumours of the retrorectal space are uncommon, pathologically heterogeneous, and difficult to diagnose, with ongoing controversy over their surgical management. The aim of this study was to evaluate the surgical management of a consecutive series of patients who had undergone excision of primary retrorectal tumours (PRRTs) at a tertiary referral centre. Method Patients were identified from a prospectively maintained database between 1 March 2001 and 1 August 2021. Electronic patient records were reviewed for demographics, preoperative imaging, operative details, histology, and follow-up. A chi-squared test was used to assess the statistical significance of findings. Results A total of 144 patients were included in the study. Of these, 103 patients were female (71.5 per cent), 46 patients (31.9 per cent) presented incidentally, and 99 of the patients had tumours located below S3 (68.7 per cent). Overall, 76 patients underwent a transperineal approach (52.7 per cent) with the most common findings of a benign tailgut cyst occurring in 59 (40.9 per cent) of cases. Preoperative MRI predicted urovascular and pelvic sidewall involvement assessed intraoperatively with a sensitivity of 83.3 and 90 per cent and a specificity of 98.1 and 98 per cent respectively. Risk of malignancy in solid tumours was 31.4 versus 8.8 per cent in cystic tumours (relative risk 3.5, 95 per cent c.i. 1.6 to 7.6, P < 0.001). Major complications (Clavien–Dindo grade III and above) occurred in eight patients (5.6 per cent) and all-cause long-term mortality was 4.8 per cent (seven patients). Discussion PRRTs can be safely excised with minimal complications in specialized centres by surgical teams with the relevant expertise. This study questions the conservative management of cystic tumours and given the risk of solid tumour malignancy, supports surgical management.
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Affiliation(s)
- Joshua R. Burke
- Correspondence to: Joshua R. Burke, 7.19 Clinical Sciences Building, Leeds Teaching Hospital Trust, Beckett Street, Leeds, West Yorkshire, LS9 7TF, UK (e-mail: )
| | - Kunal Shetty
- The John Golligher Colorectal Surgery Unit, St. James’s University Hospital, Leeds Teaching Hospital Trust, Beckett Street, Leeds, UK
- Leeds Institute of Biomedical & Clinical Sciences, Clinical Sciences Building, St James’s University Hospital, Leeds, UK
| | - Owen Thomas
- The John Golligher Colorectal Surgery Unit, St. James’s University Hospital, Leeds Teaching Hospital Trust, Beckett Street, Leeds, UK
- Leeds Institute of Biomedical & Clinical Sciences, Clinical Sciences Building, St James’s University Hospital, Leeds, UK
| | - Mikolaj Kowal
- The John Golligher Colorectal Surgery Unit, St. James’s University Hospital, Leeds Teaching Hospital Trust, Beckett Street, Leeds, UK
- Leeds Institute of Biomedical & Clinical Sciences, Clinical Sciences Building, St James’s University Hospital, Leeds, UK
| | - Aaron Quyn
- The John Golligher Colorectal Surgery Unit, St. James’s University Hospital, Leeds Teaching Hospital Trust, Beckett Street, Leeds, UK
- Leeds Institute of Biomedical & Clinical Sciences, Clinical Sciences Building, St James’s University Hospital, Leeds, UK
| | - Peter Sagar
- The John Golligher Colorectal Surgery Unit, St. James’s University Hospital, Leeds Teaching Hospital Trust, Beckett Street, Leeds, UK
- Leeds Institute of Biomedical & Clinical Sciences, Clinical Sciences Building, St James’s University Hospital, Leeds, UK
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Sakurai T, Nakamura M, Endo N. Postoperative complications and long-term outcomes in Currarino syndrome. Pediatr Surg Int 2021; 37:1773-1781. [PMID: 34462793 DOI: 10.1007/s00383-021-04984-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/01/2021] [Indexed: 11/26/2022]
Abstract
PURPOSE This study aimed to present ten cases of Currarino syndrome, study their postoperative complications and prognosis, and analyze whether patient background and clinical factors influenced outcomes. METHODS Ten patients with Currarino syndrome who were followed up at our institution between 2004 and 2020 were enrolled. Patient records were retrospectively reviewed for clinical details, postoperative complications, and long-term outcomes. RESULTS The incidence of early postoperative complications was 80%, most of which were transient dysuria. The dysuria significantly developed in the higher normal sacral vertebra (p = 0.024) and the complete type of Currarino syndrome (p = 0.033). Later, intractable constipation requiring rectal irrigation and intractable dysuria requiring clean intermittent catheterization occurred in 40% and 30% of the patients, respectively. There was a tendency for tethered cord syndrome (p = 0.076), and the height of the normal sacral vertebra (p = 0.071) was related to intractable constipation. The height of the normal sacral vertebra (p = 0.05) and the tumor size on the image (p = 0.012) were significantly higher and larger, respectively, in the group with intractable dysuria than in the group without intractable dysuria. CONCLUSION Postoperative complications, especially early ones, occur at a high rate. Long-term intractable constipation and dysuria may be influenced by the degree of sacral dysplasia.
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Affiliation(s)
- Tsuyoshi Sakurai
- Department of Pediatric Surgery, Miyagi Children's Hospital, Sendai, 989-3126, Japan
| | - Megumi Nakamura
- Department of Pediatric Surgery, Miyagi Children's Hospital, Sendai, 989-3126, Japan
| | - Naobumi Endo
- Department of Pediatric Surgery, Miyagi Children's Hospital, Sendai, 989-3126, Japan.
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15
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Patil AR, Bansal A, Chakma N, Bhat R, Shivakumar S. Magnetic Resonance Imaging in Giant Perianal Epidermoid. JOURNAL OF GASTROINTESTINAL AND ABDOMINAL RADIOLOGY 2021. [DOI: 10.1055/s-0041-1731966] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
AbstractPerianal epidermoid cyst is a rare entity and is commonly diagnosed late owing to its slow-growing nature. Imaging plays a vital role in diagnosis and differentiation from other cysts such as dermoid, tailgut, and rectal duplication cysts. Magnetic resonance imaging (MRI) is the preferred modality as uncomplicated cases show typical signal changes. Diffusion-weighted imaging has a definite additional role. We report a case of a giant perianal epidermoid diagnosed on MRI and successfully managed surgically.
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Affiliation(s)
- Aruna Raman Patil
- Department of Radiology, Apollo Hospitals, Bengaluru, Karnataka, India
| | - Amit Bansal
- Department of Surgical Gastroenterology, Apollo Hospitals, Bengaluru, Karnataka, India
| | - Nilotpal Chakma
- Department of Gastrosurgery, Apollo Hospitals, Bengaluru, Karnataka, India
| | - Ravishankar Bhat
- Department of Gastrosurgery, Apollo Hospitals, Bengaluru, Karnataka, India
| | - Swarna Shivakumar
- Department of Pathology, Apollo Hospitals, Bengaluru, Karnataka, India
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16
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Sudhakar T, Désir LL, Ellis JA. Tarlov Cyst Rupture and Intradural Hemorrhage Mimicking Intraspinal Carcinomatosis. Cureus 2021; 13:e15423. [PMID: 34249569 PMCID: PMC8253477 DOI: 10.7759/cureus.15423] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/02/2021] [Indexed: 11/05/2022] Open
Abstract
Lumbosacral Tarlov cysts (TCs) have rarely been seen to rupture. Here, we report an unusual presentation of a ruptured TC with intraspinal hemorrhage mimicking carcinomatosis. Pathological diagnosis was obtained using percutaneous biopsy. A conservative approach was utilized and an excellent outcome was achieved. Thus, in cases such as this, a ruptured hemorrhagic TC should be on the differential diagnosis to drive appropriate clinical management decisions.
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Affiliation(s)
- Tejaswi Sudhakar
- Neurosurgery, Lenox Hill Hospital Northwell Health, New York, USA
| | - Likowsky L Désir
- Medicine, City University of New York School of Medicine, New York, USA.,Neurosurgery, Lenox Hill Hospital Northwell Health, New York, USA
| | - Jason A Ellis
- Neurosurgery, Lenox Hill Hospital Northwell Health, New York, USA
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17
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Sambri A, Fiore M, Giannini C, Pipola V, Zucchini R, Aparisi Gomez MP, Musa Aguiar P, Gasbarrini A, De Paolis M. Primary Tumors of the Sacrum: Imaging Findings. Curr Med Imaging 2021; 18:170-186. [PMID: 33982654 DOI: 10.2174/1573405617666210512011923] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Revised: 01/25/2021] [Accepted: 01/28/2021] [Indexed: 11/22/2022]
Abstract
The diagnosis of sacral neoplasms is often delayed because they tend to remain clinically silent for a long time. Imaging is useful at all stages of managing sacral bone tumors: from the detection of the neoplasm to the long-term follow-up. Radiographs are recommended as the modality of choice to begin the imaging workup of a patient with known or suspected sacral pathology. More sensitive examinations such as computerized tomography (CT), magnetic resonance (MRI), or scintigraphy are often necessary. The morphological features of the lesions on CT and MRI help to orientate the diagnosis. Although some imaging characteristics are helpful to limit the differential diagnosis, an imaging-guided biopsy is often ultimately required to establish a specific diagnosis. Imaging is of paramount importance even in the long-term follow-up in order to assess any residual tumor when surgical resection is incomplete, to assess the efficacy of adjuvant chemotherapy and radiotherapy, and to detect recurrence.
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Affiliation(s)
- Andrea Sambri
- University of Bologna, Bologna, Italy.,IRCCS Azienda Ospedaliero Universitaria Policlinico di Sant’Orsola, Bologna, Italy
| | | | | | | | | | - Maria Pilar Aparisi Gomez
- Department of Radiology, Auckland City Hospital; 2 Park Road, Grafton, 1023 Auckland, New Zealand.,Department of Radiology, Hospital Vithas Nueve de Octubre; Calle Valle de la Ballestera, 59, 46015 Valencia, Spain
| | - Paula Musa Aguiar
- Serdil, Clinica de Radiologia e Diagnóstico por Imagem; R. São Luís, 96 - Santana, Porto Alegre - RS, 90620-170. Brazil
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18
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Chandramohan A, Bhat TA, John R, Simon B. Multimodality imaging review of complex pelvic lesions in female pelvis. Br J Radiol 2020; 93:20200489. [DOI: 10.1259/bjr.20200489] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Complex pelvic lesions can originate from various anatomical structures in the pelvis and pose a diagnostic dilemma due to a wide range of possible diagnoses. Accurate characterisation of these lesions would often require an algorithmic approach, which incorporates clinical findings, sequential use of multiple imaging modalities and a multiparametric approach. This approach usually aims at identifying key imaging features, which aid in anatomical localisation, morphology and tissue characterisation. There have been various attempts to standardise the lexicon used for describing adnexal masses in female patients; stratify their risk of cancer and suggest appropriate next steps in the management pathway. Through this review, we extend this approach to complex pelvic masses in female pelvis in general and will focus on optimal use of different imaging modalities to arrive at definitive diagnosis or meaningful differential diagnosis. We will also discuss potential pitfalls of imaging diagnosis and common mimics.
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Affiliation(s)
| | | | - Reetu John
- Department of Radiology, Christian Medical College, Vellore, India
| | - Betty Simon
- Department of Radiology, Christian Medical College, Vellore, India
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19
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Nasim S, Kumar S, Azim D, Rai L, Saeed S. Retrorectal Epidermal Inclusion Cyst: An Incidental Finding During Cesarean Section. Cureus 2020; 12:e11300. [PMID: 33282577 PMCID: PMC7710341 DOI: 10.7759/cureus.11300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
An epidermal inclusion cyst is a benign lesion, frequently observed throughout the body. However, its presence in the retrorectal region is a rare occurrence. With a higher incidence in women and non-specific symptoms, these cysts are mostly an incidental finding. Here, we report a case of a 33-year-old female presenting with complaints of abdominal pain and sensation of incomplete and painful defecation. The patient’s history revealed that a large pelvic cyst was found incidentally during her first cesarean section (CS) owing to an arrest in labor. A presumptive diagnosis of rectal duplication cyst was made based on digital rectal exam (DRE), computed tomography (CT), and magnetic resonance imaging (MRI) findings. For cyst removal, the patient underwent a midline laparotomy. A postoperative biopsy led to the confirmed diagnosis of the retrorectal epidermal inclusion cyst. On follow-up, our patient showed a smooth recovery without any complications. We conclude that when dealing with a pregnant woman with a pelvic mass, developmental cysts should always be kept in mind. Timely diagnosis and management of a retrorectal mass is essential for effective treatment and to prevent subsequent complications.
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Affiliation(s)
- Sundus Nasim
- Internal Medicine, Dow Medical College, Dr. Ruth K. M. Pfau Civil Hospital, Karachi, PAK
| | - Sohail Kumar
- Internal Medicine, Dow Medical College, Dr. Ruth K. M. Pfau Civil Hospital, Karachi, PAK
| | - Dua Azim
- Internal Medicine, Dow Medical College, Dr. Ruth K. M. Pfau Civil Hospital, Karachi, PAK
| | - Lajpat Rai
- Surgery, Dow Medical College, Dr. Ruth K. M. Pfau Civil Hospital, Karachi, PAK
| | - Summaya Saeed
- Surgery, Dow Medical College, Dr. Ruth K. M. Pfau Civil Hospital, Karachi, PAK
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20
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Murphy A, O'Sullivan H, Stirling A, Fenlon H, Cronin C. Integrated multimodality and multi-disciplinary team approach to pre-sacral lesions. Clin Imaging 2020; 67:255-263. [DOI: 10.1016/j.clinimag.2020.08.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Revised: 07/28/2020] [Accepted: 08/18/2020] [Indexed: 01/17/2023]
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21
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Vitale A, Villa R, Giordano F, Napoli E, Ugga L, Manto A. Currarino syndrome in an elderly man: Multimodality imaging findings. Radiol Case Rep 2020; 15:1858-1863. [PMID: 32817777 PMCID: PMC7426326 DOI: 10.1016/j.radcr.2020.07.049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Revised: 07/17/2020] [Accepted: 07/18/2020] [Indexed: 11/23/2022] Open
Abstract
Currarino syndrome is a rare congenital disorder characterized by the triad of anorectal anomalies, sacrococcygeal dysgenesis and presacral mass. Because of the anorectal anomalies, the extrinsic compression due to the presacral mass and neurologic deficits, patients usually present with gastrointestinal symptoms, most commonly chronic constipation. Most cases of Currarino syndromes are diagnosed in childhood, at birth or in the pre-birth period and, even if adult presentation has been reported in few sporadic case reports, the diagnosis in the late stages of life remains extremely rare. In this paper, we describe the imaging findings of an elderly man with a past medical history of megacolon surgically treated in his childhood, who was diagnosed with Currarino syndrome at the age of 72.
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22
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Sacrum agenesis and scimitar sacrum in Currarino syndrome. Childs Nerv Syst 2020; 36:1337-1338. [PMID: 32447453 DOI: 10.1007/s00381-020-04653-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Accepted: 04/28/2020] [Indexed: 10/24/2022]
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23
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Baral JEM. Präsakrale Tumoren. COLOPROCTOLOGY 2020. [DOI: 10.1007/s00053-020-00452-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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24
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Mankowski Gettle L, Kim DH, Pickhardt PJ. Anorectal pitfalls in computed tomography colonography. Abdom Radiol (NY) 2019; 44:3606-3624. [PMID: 31432213 DOI: 10.1007/s00261-019-02186-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
There is a wide array of pathological lesions seen in the anorectal region with CT colonography (CTC), much of which is unique to this location. Many relatively common findings in the anorectal region are typically benign, but can be misinterpreted as malignant. There are also technique-related pitfalls that can impede accurate diagnosis of anorectal findings at CTC. Understanding common and uncommon lesions in the anorectal region as well as recognizing technical pitfalls will optimize interpretation of CTC and decrease the number of missed cancers and false positives. This review will systematically cover that they key pitfalls confronting the radiologist at CTC interpretation of the anorectal region, primarily dividing them into those related to underlying anatomy and those related to technique. Tips for how to effectively handle these potential pitfalls will also be discussed.
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Affiliation(s)
- Lori Mankowski Gettle
- Department of Radiology, University of Wisconsin School of Medicine and Public Health, 600 Highland Ave, E3/380 Clinical Science Center, Madison, WI, 53792, USA
| | - David H Kim
- Department of Radiology, University of Wisconsin School of Medicine and Public Health, 600 Highland Ave, E3/380 Clinical Science Center, Madison, WI, 53792, USA
| | - Perry J Pickhardt
- Department of Radiology, University of Wisconsin School of Medicine and Public Health, 600 Highland Ave, E3/380 Clinical Science Center, Madison, WI, 53792, USA.
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25
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Affiliation(s)
- Santosh Shenoy
- Department of Surgery, KCVA and University of Missouri Kansas City, 4801 E Linwood Blvd., Kansas City, MO, 64128, USA.
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26
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Halleran DR, Vilanova-Sanchez A, Reck CA, Maloof T, Weaver L, Stanek J, Levitt MA, Wood RJ, Aldrink JH. Presacral masses and sacrococcygeal teratomas in patients with and without anorectal malformations: A single institution comparative study. J Pediatr Surg 2019; 54:1372-1378. [PMID: 30630596 DOI: 10.1016/j.jpedsurg.2018.11.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2018] [Revised: 10/31/2018] [Accepted: 11/27/2018] [Indexed: 11/26/2022]
Abstract
BACKGROUND Despite variability at presentation, presacral masses in patients with and without anorectal malformations (ARM) appear histologically similar. The purpose of this study was to identify differences in oncologic outcomes between these two groups. METHODS A retrospective review was performed utilizing our institutional cancer and colorectal and pelvic reconstruction databases for patients with presacral masses and sacrococcygeal teratomas between 1990 and 2017. Data captured included age at surgical resection, type of ARM, tumor location within the pelvis, tumor histopathology, tumor size, adjuvant chemotherapy, recurrence, and follow-up. RESULTS Forty-six patients comprised our cohort, of whom 12 had an ARM. The median age was older at resection for those with an ARM (1.4 years; range 1 day to 29.4 years) compared to those without an ARM (9 days; range 0 days to 6.9 years) (p = 0.01). The mean tumor size was 2.5 cm in patients with an ARM compared to 6.0 cm in patients without an ARM (p = 0.036). All patients with ARM had exclusively intrapelvic tumors, and histopathology included mature teratoma (8), yolk sac tumor (1), lipoma (1), and unknown (2). Tumor location for patients with sacral and presacral masses without ARM included exclusively extrapelvic (10), primarily extrapelvic with large intrapelvic component (7), primarily intrapelvic with extrapelvic component (1), exclusively intrapelvic (8), and unknown (8). Histopathology for patients with presacral masses without ARM included mature teratoma (20), immature teratoma (7), yolk sac tumor (3), ganglioneuroma (1), neuroblastoma (1), benign epithelial cyst (1), and unknown (1). Tumor recurrence rate was similar between patients with ARM (n = 3, 25%) and those without an ARM (n = 5, 15%) (p = 0.41). The 5-year event free survival was 65% (95% CI: 25%-87%) in the group with ARM and 81% (95% CI: 60%-92%) in the group without ARM (p = 0.44). CONCLUSION Sacral and presacral masses in patients with ARM are resected at a later age and are more likely to be intrapelvic. They appear histologically similar and have similar rates of recurrence and malignancy when compared to patients without ARM. LEVEL OF EVIDENCE III TYPE OF STUDY: Retrospective comparative study.
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Affiliation(s)
- Devin R Halleran
- Center for Colorectal and Pelvic Reconstruction, Nationwide Children's Hospital, Columbus, OH
| | | | - Carlos A Reck
- Center for Colorectal and Pelvic Reconstruction, Nationwide Children's Hospital, Columbus, OH
| | - Tassiana Maloof
- Center for Colorectal and Pelvic Reconstruction, Nationwide Children's Hospital, Columbus, OH
| | - Laura Weaver
- Center for Colorectal and Pelvic Reconstruction, Nationwide Children's Hospital, Columbus, OH
| | - Joseph Stanek
- Department of Biostatistics, Division of Hematology/Oncology/Bone Marrow Transplantation, Nationwide Children's Hospital, Columbus, OH
| | - Marc A Levitt
- Center for Colorectal and Pelvic Reconstruction, Nationwide Children's Hospital, Columbus, OH
| | - Richard J Wood
- Center for Colorectal and Pelvic Reconstruction, Nationwide Children's Hospital, Columbus, OH
| | - Jennifer H Aldrink
- Department of Surgery, Division of Pediatric Surgery, Nationwide Children's Hospital, The Ohio State University College of Medicine, Columbus, OH.
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27
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Neuroendocrine tumour developing within a long-standing tailgut cyst: case report and review of the literature. Clin J Gastroenterol 2019; 12:539-551. [PMID: 31147970 DOI: 10.1007/s12328-019-00998-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2019] [Accepted: 05/22/2019] [Indexed: 12/13/2022]
Abstract
A tailgut cyst is a rare congenital lesion that can develop in the presacral space from the remnants of an embryonic hindgut. It is unusual for malignant change to occur in a tailgut cyst. We report a case of a large long-standing tailgut cyst, which was removed during a laparotomy. Histopathology showed a well-differentiated neuroendocrine tumour (primary carcinoid tumour) arising in a tailgut cyst. We reviewed the English literature for all adult cases with this condition. All original articles were reviewed, and data were compiled and tabulated. Including this report, 29 cases of NET developing in a tailgut cyst were found in the English literature. Tailgut cysts have been reported as more common in females, with a mean age of presentation in the fifth decade (Devine, in: Zbar A, Wexner S (eds) Coloproctology. Springer specialist surgery series, Springer, London, 2010; Hjermstad and Helwig in Am J Clin Pathol 89:139-147, 1988). Tailgut cysts may undergo malignant change including adenocarcinoma, sarcoma, and NET (Mathis et al. Br J Surg 97:575-579, 2010; Messick in Dis Colon Rectum 61:151-153, 2018; Patsouras et al. in Colorectal Dis 17:724-729, 2015; Chereau et al in Colorectal Dis 15:e476-e482, 2013). It is difficult to estimate the true incidence of malignant change in a tailgut cyst, with the literature reports only limited to case reports and small-case series. Although rare, our case confirms need to consider the possibility of a malignant component, even in a benign process such as a tailgut cyst. This prompts consideration for upfront definitive management.
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28
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Chaturvedi A, Franco A, Chaturvedi A, Klionsky NB. Caudal cell mass developmental aberrations: an imaging approach. Clin Imaging 2018; 52:216-225. [PMID: 30138861 DOI: 10.1016/j.clinimag.2018.07.014] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2018] [Revised: 07/13/2018] [Accepted: 07/17/2018] [Indexed: 11/30/2022]
Abstract
The objective of this review is to describe antenatal and postnatal imaging criteria, which allow diagnosis and aid workup, prognostication and treatment of developmental anomalies of the caudal cell mass. The lower spinal cord (conus medullaris), filum terminale and inferior lumbar and sacral nerve roots develop from the caudal cell mass, a remnant of the embryologic primitive streak composed of undifferentiated pluripotential cells. Anomalous caudal cell mass development can manifest as tight filum terminale, caudal dysgenesis, terminal myelocystocele, anterior sacral meningocele or sacrococcygeal teratoma. Lower spinal cord development occurs simultaneously and in topological proximity to the developing lower gastrointestinal and genitourinary tracts, leading to coexistent malformations. We review the embryology of the caudal cell mass, describe the role of antenatal and postnatal imaging for diagnosing, staging, prognosticating and guiding intranatal or postnatal intervention for developmental anomalies of this region and briefly discuss clinical manifestations and treatment goals and strategies. An overview of antenatal imaging diagnosis of associated multisystem abnormalities will be provided where applicable.
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Affiliation(s)
| | - Arie Franco
- University of Rochester Medical Center, Rochester, NY, USA
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29
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Gao S, Zheng Y, Liu X, Tian Z, Zhao Y. Effect of early fasting and total parenteral nutrition support on the healing of incision and nutritional status in patients after sacrectomy. Orthop Traumatol Surg Res 2018; 104:539-544. [PMID: 29567321 DOI: 10.1016/j.otsr.2018.02.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2017] [Revised: 09/30/2017] [Accepted: 02/12/2018] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Surgical site infection is one of the most common complications for patients after sacrectomy, which often accompanied by poor wound healing, sinus formation and serious metabolic disturbance. HYPOTHESIS We tried to avoid the surgical site infection caused by feces during early period after surgery through early fasting and total parenteral nutrition (TPN) support, then compared the clinical results of these patients with other patients that received enteral nutrition (EN) early after sacrectomy. METHODS Forty-eight patients after sacrectomy (the level of sacrectomy above S2) were randomly divided into two groups: TPN group and EN group. The patients of two groups received different nutrition support from the first day to the seventh day after surgery, then the factors such as nutritional and metabolic status after surgery, incidence of complications as well as the time of incision healing and hospitalization were observed. RESULTS The p-value of total serum protein, albumin, serum alanine aminotransferase, total bilirubin at seventh day after sacrectomy between TPN group and EN group is <0.0005. The p-value of hemoglobin at seventh day after sacrectomy between TPN group and EN group is 0.001. The p-value of total serum protein at fourteenth day after sacrectomy between TPN group and EN group is 0.003. The p-value of albumin and total bilirubin at fourteenth day after sacrectomy between TPN group and EN group is 0.001. The p-value of hemoglobin, serum alanine aminotransferase at fourteenth day after sacrectomy between TPN group and EN group is <0.0005. The incidence of gastrointestinal complication and delay of apparition of feces in EN group were lower than that in TPN group (p=0.041, p<0.0005). The incidence of surgical site infection, the time of incision healing and hospitalization in TPN group were lower than that in EN group (p=0.048, p=0.008, p<0.0005). CONCLUSIONS The method of fasting and supported by TPN during the early period after sacrectomy contribute to the incision healing, meanwhile, it shortens the hospitalization time and abates the incidence of complications in patients after sacrectomy. TYPE OF STUDY It is a comparative randomized study. LEVEL OF PROOF High-powered prospective randomized trial.
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Affiliation(s)
- S Gao
- Department of Orthopedics, Henan Provincial People's Hospital, People's Hospital of Zhengzhou University, No. 7, Weiwu Road, 450003 Zhengzhou, Henan Province, People's Republic of China.
| | - Y Zheng
- Department of radiology, The First Affiliated Hospital of Zhengzhou University, No. 1, Jianshe Road, 450052 Zhengzhou, Henan Province, People's Republic of China
| | - X Liu
- Department of Orthopedics, The Affiliated Tumor Hospital of Zhengzhou University, No. 127, Dongming Road, 450008 Zhengzhou, Henan Province, People's Republic of China
| | - Z Tian
- Department of Orthopedics, The Affiliated Tumor Hospital of Zhengzhou University, No. 127, Dongming Road, 450008 Zhengzhou, Henan Province, People's Republic of China
| | - Y Zhao
- Department of Orthopedics, The Affiliated Tumor Hospital of Zhengzhou University, No. 127, Dongming Road, 450008 Zhengzhou, Henan Province, People's Republic of China
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30
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Abstract
Although common nonspecific symptoms (i.e., rectal bleeding, pelvic pressure, and change in bowel habits) are associated with rectal cancer, occasionally these are related to a different underlying disease. Over the past few years, considerable progress has been made in imaging of the rectum. Specifically, new magnetic resonance techniques and capabilities provide impressive high-resolution assessment of the rectal wall and enable evaluation and characterization of the perirectal tissues. This paper reviews imaging findings of uncommon causes of rectal and perirectal pathology that may be clinically confounded with rectal cancer. Radiologists need to be aware of uncommon pathologies in this region in order to facilitate optimal management decisions.
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31
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Lee SM, Ha DH, Kang H, Lee HJ. Giant angioleiomyoma of the sacral foramina: an unusual location. Skeletal Radiol 2018; 47:293-297. [PMID: 29058044 DOI: 10.1007/s00256-017-2797-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2017] [Revised: 09/29/2017] [Accepted: 10/09/2017] [Indexed: 02/02/2023]
Abstract
Angioleiomyoma is a benign, vascular smooth muscle tumor originating from the tunica media of the vessel wall. In general, it typically arises in the cutaneous, subcutaneous tissue or fascia of the lower extremities in middle-aged women and is less than 2 cm in diameter. We report an unusual case of an angioleiomyoma of the sacral foramina in an 82-year-old man. MRI revealed a well-defined irregular-shaped deep-seated mass in the sacral foramina, showing branching pattern of growth associated with pressure bony erosion of the adjacent bones, with isointense to hypointense signal on T2-weighted images. Surgical excision was performed and the mass was diagnosed as angioleiomyoma on pathological examination. To the best of our knowledge, there has been no report of an angioleiomyoma involving the sacral foramina.
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Affiliation(s)
- Sang Min Lee
- Department of Radiology, CHA Bundang Medical Center, CHA University, College of Medicine, 59, Yatap-ro, Bundang-gu, Seongnam-si, Gyeonggi-do, 13496, Republic of Korea.
| | - Doo Hoe Ha
- Department of Radiology, CHA Bundang Medical Center, CHA University, College of Medicine, 59, Yatap-ro, Bundang-gu, Seongnam-si, Gyeonggi-do, 13496, Republic of Korea
| | - Haeyoun Kang
- Department of Pathology, CHA Bundang Medical Center, CHA University, College of Medicine, 59, Yatap-ro, Bundang-gu, Seongnam-si, Gyeonggi-do, 13496, Republic of Korea
| | - Hye Jin Lee
- Department of Pathology, CHA Bundang Medical Center, CHA University, College of Medicine, 59, Yatap-ro, Bundang-gu, Seongnam-si, Gyeonggi-do, 13496, Republic of Korea
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32
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Al-Ani Z, Fernando M, Wilkinson V, Kotnis N. The management of deep-seated, lowgrade lipomatous lesions. Br J Radiol 2018; 91:20170725. [PMID: 29303371 DOI: 10.1259/bjr.20170725] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Deep-seated, low-grade lipomatous lesions detected on imaging often cause uncertainty for diagnosis and treatment. Confidently distinguishing lipomas from well-differentiated liposarcomas is often not possible on imaging. The approach to management of such lesions varies widely between institutions. Applying an evidenced-based approach set around published literature that clearly highlights how criteria such as lesion size, location, age and imaging features can be used to predict the risk of well-differentiated liposarcomas and subsequent de-differentiation would seem sensible. Our aim is to review the literature and produce a unified, evidence-based guideline that will be a useful tool for managing these lesions.
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Affiliation(s)
- Zeid Al-Ani
- 1 Radiology Department, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield , United Kingdom
| | - Malee Fernando
- 2 Pathology Department, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield , United Kingdom
| | - Victoria Wilkinson
- 3 Radiology Department, Doncaster and Bassetlaw NHS Foundation Trust, Doncaster , United Kingdom
| | - Nikhil Kotnis
- 1 Radiology Department, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield , United Kingdom
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33
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Primary Cystic Lesions of the Retrorectal Space: MRI Evaluation and Clinical Assessment. AJR Am J Roentgenol 2017; 209:790-796. [PMID: 28705066 DOI: 10.2214/ajr.16.17329] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
OBJECTIVE The purpose of this study was to assess the a priori chance that primary cystic lesions of the retrorectal space are malignant and to investigate MRI characteristics that indicate malignancy. MATERIALS AND METHODS Patients referred to a center for colorectal surgery were recruited from 2000 to 2014. Lesions were proven by clinical assessment and histopathology. MRI was performed at 1.5 T with examinations evaluated by two radiologists. Interobserver agreement was assessed (Cohen kappa) and differences between malignant and benign lesions calculated (Fisher exact test). RESULTS Twenty-eight patients (22 women, six men; age range, 18-70 years) with 31 lesions were included. Lesions were categorized as tailgut cysts (n = 16, 52%), teratomas (n = 9, 29%), lesions of colorectal origin (n = 4, 13%), or neurogenic lesions (n = 2, 6%). Five patients (18%) had malignant lesions. Colorectal lesions had the highest percentage of malignancy (3/4, 75%). A solid tissue component was found in all five (100%) malignant lesions and two (8%) of the benign lesions, which were both teratomas (p < 0.05). Sensitivity and specificity for malignancy according to the presence of a solid tissue component was 100% (5/5) and 92% (24/26). For unilocularity, multilocularity, debris, septa, and wall thickening, differences were not significant. Interobserver agreement was excellent (κ = 1) for all characteristics except debris (κ = 0.795). CONCLUSION The majority of retrorectal cystic lesions are benign. The presence of a solid tissue component should raise suspicion for malignancy.
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Sun W, Ma XJ, Zhang F, Miao WL, Wang CR, Cai ZD. Surgical Treatment of Sacral Neurogenic Tumor: A 10-year Experience with 64 Cases. Orthop Surg 2017; 8:162-70. [PMID: 27384724 DOI: 10.1111/os.12245] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2015] [Accepted: 03/07/2016] [Indexed: 12/16/2022] Open
Abstract
OBJECTIVE To explore the outcomes of surgical treatment of sacral neurogenic tumors METHODS Between 1 January 2003 and 31 December 2012, data on 64 patients with sacral neurogenic tumors treated with surgery were retrospectively analyzed. The mean age of the 64 cases (35 males and 29 females) was 37.2 years (range, 21-69 years); 38 had neurilemmomas and 26 neurofibromas. Thirty-four of the tumors involved S 1 and S 2 , 11 S 3 or lower, and 19 were single presacral soft tissue masses. Tumors were removed via anterior, posterior or combined anteroposterior approaches. Patients with unstable sacroiliac joints underwent iliolumbar fixation. RESULTS Depending on the extent of tumor involvement, one of three surgical approaches was used: a single anterior approach (19 patients), single posterior approach (25 patients), or a combined anteroposterior approach (20 patients). The mean operation time was 3 h (range, 2-6 h) and the mean blood loss 878 mL (range, 400-3120 mL). The mean duration of follow-up was 58.2 months (range, 24-93 months). These surgeries had the following complications. Three patients had massive intraoperative hemorrhage and posterior back pain and discomfort postoperatively. One patient had intraoperative ureteral injuries requiring intraoperative ureteral catheterization. In two patients, the tumor involved the S 1 nerve roots bilaterally, necessitating their removal, which resulted in obvious lower limb motion and sphincteric dysfunction. In 13 patients with unilateral tumor involvement of the nerve roots of S 1 and lower spinal levels, only the contralateral nerve roots of the S1 and lower levels were preserved; eight of these patients had impaired bladder and bowel function. Posterior incisions failed to heal in 10 patients, secondary wound healing occurred in nine of them and one required a gluteus maximus myocutaneous flap. Three patients developed postoperative cerebrospinal fluid leaks that were and alleviated by waist belt compression bandaging and placing them in the Trendelenburg position. Eight patients developed tumor recurrences postoperatively; pathological examination of the tissue excised in the second surgeries revealed malignant changes in the three patients with neurilemmomas. There were no intraoperative deaths. Rod fractures occurred in three of the 18 patients requiring iliolumbar reconstruction. CONCLUSIONS The clinical characteristics of sacral neurogenic tumors make them easy to diagnose. The approach to resection should be determined by the location and size of the tumor. Patients with huge tumors may lose considerable blood intraoperatively and a have higher risk rate of postoperative complications.
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Affiliation(s)
- Wei Sun
- Department of Orthopaedics, Shanghai General Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Xiao-Jun Ma
- Department of Orthopaedics, Shanghai General Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Fan Zhang
- Department of Orthopaedics, Shanghai Tenth People's Hospital, Shanghai, China
| | - Wei-Liang Miao
- School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Chong-Ren Wang
- School of Medicine, Shanghai Tongji University, Shanghai, China
| | - Zheng-Dong Cai
- Department of Orthopaedics, Shanghai General Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
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Dalal V, Kaur M, Bhatnagar A, Bansal A. Retrorectal Epidermoid Cyst: A Rare Entity. J Gynecol Surg 2017. [DOI: 10.1089/gyn.2016.0083] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Varsha Dalal
- National Institute of Pathology (Indian Council of Medical Research), Safdarjung Hospital Campus
| | - Manveen Kaur
- National Institute of Pathology (Indian Council of Medical Research), Safdarjung Hospital Campus
| | - Amar Bhatnagar
- Department of Oncosurgery, Safdarjung Hospital, New Delhi, India
| | - Anju Bansal
- National Institute of Pathology (Indian Council of Medical Research), Safdarjung Hospital Campus
- Department of Oncosurgery, Safdarjung Hospital, New Delhi, India
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Abdominal and pelvic manifestations of Rosai–Dorfman disease: a review of four cases. Clin Imaging 2016; 40:1291-1295. [DOI: 10.1016/j.clinimag.2016.09.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2016] [Revised: 08/16/2016] [Accepted: 09/08/2016] [Indexed: 11/19/2022]
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Toh JWT, Morgan M. Management approach and surgical strategies for retrorectal tumours: a systematic review. Colorectal Dis 2016; 18:337-50. [PMID: 26663419 DOI: 10.1111/codi.13232] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2015] [Accepted: 10/20/2015] [Indexed: 12/11/2022]
Abstract
AIM The management strategy for retrorectal tumours is complex. Due to their rarity, few surgeons have expertise in management. METHOD A systematic literature review was conducted using the PubMed database. English language publications in the years 2011-2015 that assessed preoperative management, surgical strategies and chemoradiotherapy for presacral tumours were included. Two hundred and fifty-one abstracts were screened of which 88 met the inclusion criteria. After review of the full text, this resulted in a final list of 42 studies eligible for review. RESULTS In all, 932 patients (63.2% female, 36.8% male; P < 0.01) with a retrorectal tumour were identified. Most were benign (65.9% vs. 33.7%, P < 0.01). Imaging distinguished benign from malignant lesions in 88.1% of cases; preoperative biopsy was superior to imaging in providing an accurate definitive diagnosis (91.3% vs. 61.4%, P < 0.05) with negligible seeding risk. Biopsy should be performed in solid tumours. It is useful in guiding neoadjuvant therapy for gastrointestinal stromal tumours, sarcomas and desmoid type fibromatosis and may alter the management strategy in cases of diffuse large B-cell lymphoma and metastases. Biopsies for cystic lesions are not recommended. The gold standard in imaging is MRI. The posterior Kraske procedure is the most common surgical approach. Overall, the reported recurrence rate was 19.7%. CONCLUSION This review evaluated the management strategies for retrorectal tumours. A preoperative biopsy should be performed for solid tumours. MRI is the most useful imaging modality. Surgery is the mainstay of treatment. There is limited information on robotic surgery, single-port surgery, transanal endoscopic microsurgery, chemoradiotherapy and reconstruction.
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Affiliation(s)
- J W T Toh
- Department of Colorectal Surgery, Bankstown Hospital, Sydney, New South Wales, Australia
| | - M Morgan
- Department of Colorectal Surgery, Bankstown Hospital, Sydney, New South Wales, Australia
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Patel N, Maturen KE, Kaza RK, Gandikota G, Al-Hawary MM, Wasnik AP. Imaging of presacral masses--a multidisciplinary approach. Br J Radiol 2016; 89:20150698. [PMID: 26828969 DOI: 10.1259/bjr.20150698] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Our objective is to describe an approach for retrorectal/presacral mass evaluation on imaging with attention to imaging features, allowing for refinement of the differential diagnosis of these masses. Elaborate on clinically relevant features that may affect biopsy or surgical approach, of which the radiologist should be aware. A review of current literature regarding the diagnosis and treatment of retrorectal/presacral masses was performed with attention to specific findings, which may lend refinement to the differential diagnosis of these masses. Cases were obtained by searching through a radiology database at a single institution after Institutional Review Board approval. Recent advances in imaging and treatment methods have led to the increased role of radiology in both imaging and tissue diagnosis of retrorectal masses. Surgical philosophies surrounding the treatment of these masses have not significantly changed in recent years, but there are a few key factors of which the radiologist must be aware. The radiologist can offer refinement of the differential diagnosis of retrorectal masses and can elaborate on salient findings which could alter the need for neoadjuvant chemoradiation therapy, pre-surgical tissue diagnosis and surgical approach. This article presents an imaging approach to retrorectal/presacral masses with emphasis on findings which can dictate the ultimate need for neoadjuvant therapy and pre-surgical tissue diagnosis and alter the preferred surgical approach. This article consolidates key findings, so radiologists can become more clinically relevant in the evaluation of these masses.
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Affiliation(s)
- Nishant Patel
- Department of Radiology, University of Michigan Hospital and Health Systems, Ann Arbor, MI, USA
| | - Katherine E Maturen
- Department of Radiology, University of Michigan Hospital and Health Systems, Ann Arbor, MI, USA
| | - Ravi K Kaza
- Department of Radiology, University of Michigan Hospital and Health Systems, Ann Arbor, MI, USA
| | - Girish Gandikota
- Department of Radiology, University of Michigan Hospital and Health Systems, Ann Arbor, MI, USA
| | - Mahmoud M Al-Hawary
- Department of Radiology, University of Michigan Hospital and Health Systems, Ann Arbor, MI, USA
| | - Ashish P Wasnik
- Department of Radiology, University of Michigan Hospital and Health Systems, Ann Arbor, MI, USA
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MR imaging of pelvic extraperitoneal masses: A diagnostic approach. Diagn Interv Imaging 2016; 97:159-70. [DOI: 10.1016/j.diii.2015.07.009] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2015] [Revised: 07/29/2015] [Accepted: 07/30/2015] [Indexed: 11/24/2022]
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Surgical Management of Retrorectal Lesions: What the Radiologist Needs to Know. AJR Am J Roentgenol 2015; 204:386-95. [DOI: 10.2214/ajr.14.12791] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
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Primary malignant tumors of peritoneal and retroperitoneal origin: clinical and imaging features. Surg Oncol Clin N Am 2014; 23:821-45. [PMID: 25246051 DOI: 10.1016/j.soc.2014.06.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Peritoneal carcinomatosis and metastatic involvement of the retroperitoneum are manifestations of many organ-based malignancies and lymphoproliferative disorders. Primary malignancies of peritoneal and retroperitoneal origin occur much less frequently, and are difficult to distinguish from metastatic disease on imaging alone. However, the imaging features of these primary tumors, taken in concert with the clinical data, can be helpful in narrowing the scope of the differential diagnosis. This review presents the clinical and imaging features of primary peritoneal and retroperitoneal tumors arising from the various tissue components that comprise the ligaments, mesenteries, and connective tissues of the peritoneal and retroperitoneal spaces.
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