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Petersen CL, Byriel MR, Shkurti J, Rafaelsen SR. Large retrorectal spindle cell sarcoma: A case report and brief review of the literature. Radiol Case Rep 2024; 19:2684-2688. [PMID: 38645943 PMCID: PMC11033112 DOI: 10.1016/j.radcr.2024.03.059] [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: 11/22/2023] [Revised: 03/16/2024] [Accepted: 03/24/2024] [Indexed: 04/23/2024] Open
Abstract
Large retrorectal tumors are rare and often a diagnostic and surgical challenge due to their anatomical location. We report the case of a 55-year-old patient with weight loss and changed bowel habits, where digital rectal examination revealed a retrorectal mass raising suspicion of a tumor. Magnetic resonance imaging (MRI) and computed tomography (CT) showed a large retrorectal tumor and histopathology after surgical resection showed undifferentiated spindle cell sarcoma. This tumor type has not been previously reported as the etiology of large retrorectal tumors. We discuss the implications of diagnostic imaging, especially MRI, in the approach to diagnosis and surgical treatment of retrorectal tumors with reference to the scientific literature and previously reported cases of retrorectal tumors.
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Affiliation(s)
- Christian Lund Petersen
- Department of Radiology, University Hospital of Southern Denmark, Beriderbakken 4, DK-7100 Vejle, Denmark
| | - Mathias Rosenfeldt Byriel
- Department of Radiology, University Hospital of Southern Denmark, Beriderbakken 4, DK-7100 Vejle, Denmark
- Department of Regional Health Research, University of Southern Denmark, J.B. Winsløwvej 19, DK-5000 Odense, Denmark
| | - Jona Shkurti
- Department of Diagnostic Oncology, The Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX Amsterdam, the Netherlands
| | - Søren Rafael Rafaelsen
- Department of Radiology, University Hospital of Southern Denmark, Beriderbakken 4, DK-7100 Vejle, Denmark
- Department of Regional Health Research, University of Southern Denmark, J.B. Winsløwvej 19, DK-5000 Odense, Denmark
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Ströse L, Sparn M, Klein M, Benigno L, Bischofberger S, Brunner W. Solitary fibrous tumor within the mesorectum: literature review based on a case report of resection by transanal minimally invasive surgery (TAMIS). Int J Colorectal Dis 2024; 39:87. [PMID: 38847931 PMCID: PMC11161540 DOI: 10.1007/s00384-024-04658-z] [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: 05/23/2024] [Indexed: 06/10/2024]
Abstract
PURPOSE Solitary fibrous tumors (SFT) are a rare entity of in majority benign neoplasms. Nevertheless, up to 20% of cases show a malignant tendency with local infiltration or metastasis. Commonly arising in the thoracic cavity, only few cases of SFT of the mesorectal tissue have been reported in the literature. Complete surgical resection, classically by posterior approach, is the treatment of choice. The purpose of this review is to demonstrate the safety and suitability of transanal minimally invasive surgery (TAMIS) as a surgical approach for the resection of benign pararectal solid tumors. METHODS We report the case of a 52-year-old man who was diagnosed incidentally with SFT of the distal mesorectum. Resection by TAMIS was performed. Based on this case, we describe the steps and potential benefits of this procedure and provide a comprehensive review of the literature. RESULTS Histopathology confirms the completely resected SFT. After uneventful postoperative course and discharge on day four, follow-up was recommended by a multidisciplinary board by clinical examination and MRI, which showed a well-healed scar and no recurrence up to 3 years after resection. CONCLUSION SFT of the mesorectum is a very rare entity. To our knowledge, this is the first report on a TAMIS resection for SFT, demonstrated as a safe approach for complete resection of benign pararectal solid tumors.
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Affiliation(s)
- Lennard Ströse
- Department of General, Visceral, Endocrine and Transplant Surgery, Kantonsspital St. Gallen, 9007, St Gallen, Switzerland.
| | - Moritz Sparn
- Department of General, Visceral, Endocrine and Transplant Surgery, Kantonsspital St. Gallen, 9007, St Gallen, Switzerland
| | - Marie Klein
- Department of General, Visceral, Endocrine and Transplant Surgery, Kantonsspital St. Gallen, 9007, St Gallen, Switzerland
| | - Luca Benigno
- Department of Visceral Surgery, GZO Spital Wetzikon, 8620, Wetzikon, Switzerland
| | - Stephan Bischofberger
- Department of General, Visceral, Endocrine and Transplant Surgery, Kantonsspital St. Gallen, 9007, St Gallen, Switzerland
| | - Walter Brunner
- Department of General, Visceral, Endocrine and Transplant Surgery, Kantonsspital St. Gallen, 9007, St Gallen, Switzerland.
- Paracelsus Medical University, Salzburg, Austria.
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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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Zhao X, Zhou S, Liu N, Li P, Chen L. Is There Another Posterior Approach for Presacral Tumors Besides the Kraske Procedure? — A Study on the Feasibility and Safety of Surgical Resection of Primary Presacral Tumors via Transsacrococcygeal Transverse Incision. Front Oncol 2022; 12:892027. [PMID: 35692749 PMCID: PMC9179022 DOI: 10.3389/fonc.2022.892027] [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: 03/08/2022] [Accepted: 04/22/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundThe aim of the present study was to explore the feasibility and safety of the surgical resection of presacral tumors via a transsacrococcygeal transverse incision.MethodsThe clinical data and prognoses of patients with presacral tumors who underwent surgery at the Chinese People’s Liberation Army (PLA) General Hospital between January 2009 and December 2018 were retrospectively reviewed and analyzed.ResultsA total of 110 patients with presacral tumors were included in this study, including 82 female patients and 28 male patients, with a female-to-male ratio of 2.9:1. A posterior approach (transsacrococcygeal transverse incision) was utilized in 105 patients, an anterior approach (transabdominal excision) was utilized in 1 patient, and a combined (posterior plus anterior) approach was utilized in 4 patients. The mean tumor size was 8.72 ± 4.28 cm. More than half of the patients (n=59/110) with presacral tumors were asymptomatic. Twenty-six pathological types were observed in our study, including 97 benign lesions and 13 malignant lesions. The intraoperative complication rate was 42.7% (n=47/110), whereas the postoperative morbidity rate was 3.6% (n=4/110). The length of hospital stay for patients treated with the posterior approach was shorter than that of patients treated with the anterior and combined approaches. After a mean follow-up of 90.13 ± 31.22 months, 11 patients had local presacral tumor recurrence, and 1 patient had distant metastasis, with a combined recurrence rate of 10.9% (n=12/110).ConclusionsThe surgical resection of primary presacral tumors via a transsacrococcygeal transverse incision is feasible and safe, with acceptable oncological therapeutic outcomes and a low postoperative morbidity rate, making it worth popularizing in clinical practice.
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Philip Sridhar R, Mittal R. Transperineal excision of a retrorectal mass - a video vignette. Colorectal Dis 2020; 22:2354. [PMID: 32881230 DOI: 10.1111/codi.15345] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2020] [Accepted: 08/11/2020] [Indexed: 02/08/2023]
Affiliation(s)
- R Philip Sridhar
- Department of Colorectal Surgery, Christian Medical College, Vellore, India
| | - R Mittal
- Department of Colorectal Surgery, Christian Medical College, Vellore, India
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Morikawa K, Takenaga S, Masuda K, Kano A, Igarashi T, Ojiri H, Ueda K, Ishiyama M, Fukasawa N. A rare solitary fibrous tumor in the ischiorectal fossa: a case report. Surg Case Rep 2018; 4:126. [PMID: 30284069 PMCID: PMC6170515 DOI: 10.1186/s40792-018-0533-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2018] [Accepted: 09/21/2018] [Indexed: 01/19/2023] Open
Abstract
Background A solitary fibrous tumor (SFT) is a rare mesenchymal tumor that occurs mostly in pleural sites, and an SFT occurring in the ischiorectal fossa is extremely rare. Because of the rarity, there are few reports detailing an SFT in the ischiorectal fossa. Case presentation A pararectal tumor was incidentally found in a 42-year-old man during a routine medical examination. The patient had no symptoms and no previous medical history. In the physical examination, a smooth-margined and hard elastic mass was felt, and in a digital rectal examination, the rectal mucosa appeared normal. A computed tomography (CT) scan showed a 5-cm, well-defined, solid mass in the left ischiorectal fossa. Contrast-enhanced CT in the early phase showed intense heterogeneous enhancement that persisted during the delayed phase. T2-weighted images of magnetic resonance imaging yielded heterogeneous intermediate and low signal intensity. Intense arterial enhancement suggested a hypervascular nature, and persistent delayed enhancement and low signal bands on T2-weighted images suggested a fibrous component of the mass. An SFT was suspected. Most SFTs are benign but have malignant potential. Our patient did not hope for surgery if the tumor was benign; therefore, an ultrasound-guided transperineal core needle biopsy was performed to decide on a treatment strategy. Microscopic examination showed tumor cells appearing as spindle and fibroblast-like cells within a collagenous stroma. Immunohistochemistry identified CD34 and vimentin, supporting the diagnosis of an SFT. The patient consented to excision of the mass. He was placed in a prone jackknife position, and the tumor was removed transperineally using a posterior approach (modified Kraske procedure). The levator ani muscle, external sphincter muscles, and rectum were not involved and separated from the tumor. The tumor was successfully resected en bloc with no complications. Five uneventful days post surgery, the patient was discharged. There was no local recurrence during the year following surgery. Conclusion Imaging findings reflect the tissue characterization such as hypervascularity and fibrous nature of SFTs. We have presented a rare case of an SFT in the ischiorectal fossa with useful imaging findings for diagnosis, treatment strategy, and successful surgical removal using a posterior approach.
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Affiliation(s)
- Kazuhiko Morikawa
- Department of Radiology, The Jikei University Katsushika Medical Center, 6-41-2, Aoto, Katsushika-ku, Tokyo, 125-8506, Japan.
| | - Shinsuke Takenaga
- Department of Radiology, The Jikei University Katsushika Medical Center, 6-41-2, Aoto, Katsushika-ku, Tokyo, 125-8506, Japan
| | - Koichi Masuda
- Department of Radiology, The Jikei University Katsushika Medical Center, 6-41-2, Aoto, Katsushika-ku, Tokyo, 125-8506, Japan
| | - Asami Kano
- Department of Radiology, The Jikei University Katsushika Medical Center, 6-41-2, Aoto, Katsushika-ku, Tokyo, 125-8506, Japan
| | - Takao Igarashi
- Department of Radiology, The Jikei University School of Medicine, 3-25-8, Nishi- Shimbashi, Minato-ku, Tokyo, 105-8461, Japan
| | - Hiroya Ojiri
- Department of Radiology, The Jikei University School of Medicine, 3-25-8, Nishi- Shimbashi, Minato-ku, Tokyo, 105-8461, Japan
| | - Kaoru Ueda
- Department of Gastroenterology and Hepatology, The Jikei University Katsushika Medical Center, 6-41-2, Aoto, Katsushika-ku, Tokyo, 125-8506, Japan
| | - Mamoru Ishiyama
- Department of Surgery, The Jikei University Katsushika Medical Center, 6-41-2, Aoto, Katsushika-ku, Tokyo, 125-8506, Japan
| | - Nei Fukasawa
- Department of Pathology, The Jikei University Katsushika Medical Center, 6-41-2, Aoto, Katsushika-ku, Tokyo, 125-8506, Japan
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