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Brown IS, Sokolova A, Rosty C, Graham RP. Cystic lesions of the retrorectal space. Histopathology 2023; 82:232-241. [PMID: 35962741 DOI: 10.1111/his.14769] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Revised: 08/03/2022] [Accepted: 08/09/2022] [Indexed: 12/24/2022]
Abstract
Cysts of the retrorectal space comprise a heterogeneous group of rare lesions. Most develop from embryological remnants and include tailgut cysts, dermoid cysts, rectal duplication cysts, anal canal duplication cysts, sacrococcygeal teratomas and anterior meningocoele. Tailgut cyst is the most common cyst of developmental origin, usually presenting as a multilocular cystic mass with mucoid content and lined by multiple epithelial types. Compared with tailgut cysts, rectal duplication cysts display all layers of the large bowel wall including a well-defined muscularis propria. Retrorectal cysts of non-developmental origin are far less common and represent lesions that either infrequently involve the retrorectal space or undergo extensive cystic change. This review provides an overview of the various histological types of cystic lesions of the retrorectal space, divided into cysts of developmental origin and those of non-developmental origin. A practical pathological and multidisciplinary approach to diagnosing these lesions is presented.
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Affiliation(s)
- Ian S Brown
- Envoi Specialist Pathologists, Brisbane, Queensland, Australia.,Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia.,University of Queensland, Brisbane, Queensland, Australia
| | - Anna Sokolova
- Sullivan Nicolaides Pathology, Brisbane, Queensland, Australia
| | - Christophe Rosty
- Envoi Specialist Pathologists, Brisbane, Queensland, Australia.,University of Queensland, Brisbane, Queensland, Australia
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2
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Gould LE, Pring ET, Corr A, Fletcher J, Warusavitarne J, Burling D, Northover JMA, Jenkins JT. Evolution of the management of retrorectal masses: A retrospective cohort study. Colorectal Dis 2021; 23:2988-2998. [PMID: 34459085 DOI: 10.1111/codi.15893] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Revised: 05/25/2021] [Accepted: 06/17/2021] [Indexed: 02/08/2023]
Abstract
AIM Retrorectal masses are abnormalities located anatomically in the retrorectal space. A significant proportion are asymptomatic with no malignant potential while others cause symptoms due to mechanical pressure or malignant infiltration. We reviewed and categorised the retrorectal masses encountered over a 30-year time period in a specialist colorectal hospital and describe our management algorithm for consideration by other multidisciplinary teams (MDT). METHODS This was a retrospective analysis of consecutive patients referred between 1984-2019. A detailed review of clinical presentation, imaging features, postoperative histology and impact on morbidity and anorectal function is reported. RESULTS A total of 143 patients with median age of 46 years and female preponderance (74%) were reviewed. The commonest presenting symptom was pain (46%) and all malignant cases had symptoms (n = 17). Over the last decade, more asymptomatic patients have presented with a retrorectal mass (33%, p = 0.04) and more patients are opting for surveillance rather than resection (33%, p = 0.013). Increasing age and lesion size were associated with malignancy (p < 0.05). Radiological features associated with malignancy included: solid/heterogeneous component, lobulated borders or locally invasive. Following surgery, complications included chronic pain (40%), poor wound healing (23%) and bowel dysfunction (10%). CONCLUSIONS The management of retrorectal masses remains complex. There are features, both clinical and radiological, that can help determine the best management strategy. Management should be in a high-volume tertiary centre and preferably through a complex rectal cancer MDT. Long-term sequelae such as chronic pain must be highlighted to patients. We advocate the establishment of an international registry to further record and characterise these rare, potentially troublesome lesions.
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Affiliation(s)
- Laura E Gould
- Complex Cancer Clinic, St Mark's Hospital, Harrow, UK.,Department of Surgery and Cancer, Imperial College, London, UK
| | - Edward T Pring
- Complex Cancer Clinic, St Mark's Hospital, Harrow, UK.,Department of Surgery and Cancer, Imperial College, London, UK
| | - Alison Corr
- Department of Surgery and Cancer, Imperial College, London, UK
| | - Jordan Fletcher
- Complex Cancer Clinic, St Mark's Hospital, Harrow, UK.,Department of Surgery and Cancer, Imperial College, London, UK
| | | | - David Burling
- Department of Surgery and Cancer, Imperial College, London, UK
| | - John M A Northover
- Complex Cancer Clinic, St Mark's Hospital, Harrow, UK.,Department of Surgery and Cancer, Imperial College, London, UK
| | - John T Jenkins
- Complex Cancer Clinic, St Mark's Hospital, Harrow, UK.,Department of Surgery and Cancer, Imperial College, London, UK
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3
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Poudel D, Shrestha BM, Kandel BP, Shrestha S, Kansal A, Joshi Lakhey P. Presacral dermoid cyst in a young female patient: A case report. Clin Case Rep 2021; 9:e05062. [PMID: 34795897 PMCID: PMC8582024 DOI: 10.1002/ccr3.5062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2021] [Revised: 09/30/2021] [Accepted: 10/26/2021] [Indexed: 11/12/2022] Open
Abstract
Presacral dermoid cysts are rare, benign tumors of developmental origin that primarily affect women. Surgical resection is the mainstay of treatment for these cysts, even if asymptomatic, with the laparoscopic approach being safer and more efficient.
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Affiliation(s)
- Diptee Poudel
- Maharajgunj Medical Campus, Institute of MedicineMaharajgunjNepal
| | | | - Bishnu Prasad Kandel
- Department of Surgical GastroenterologyTribhuvan University Teaching HospitalMaharajgunjNepal
| | - Suraj Shrestha
- Maharajgunj Medical Campus, Institute of MedicineMaharajgunjNepal
| | - Ankush Kansal
- Department of Surgical GastroenterologyTribhuvan University Teaching HospitalMaharajgunjNepal
| | - Paleswan Joshi Lakhey
- Department of Surgical GastroenterologyTribhuvan University Teaching HospitalMaharajgunjNepal
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Matrood S, Apostolidis L, Schrader J, Krug S, Lahner H, Ramaswamy A, Librizzi D, Kender Z, Kröcher A, Kreutzfeldt S, Gress TM, Rinke A. Multicenter Analysis of Presacral Neuroendocrine Neoplasms-Clinicopathological Characterization and Treatment Outcomes of a Rare Disease. Front Endocrinol (Lausanne) 2021; 12:709256. [PMID: 34690926 PMCID: PMC8527170 DOI: 10.3389/fendo.2021.709256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Accepted: 09/10/2021] [Indexed: 11/17/2022] Open
Abstract
Background and Aims Neuroendocrine neoplasms (NENs) of the presacral space are an extremely rare disease entity with largely unknown outcome and no established standard of care treatment. Therefore, we wanted to analyze clinical presentation, histopathological findings, treatment outcomes, and prognosis in a multicentric patient cohort. Methods We searched local databases of six German NEN centers for patients with presacral NEN. Retrospective descriptive analyses of age, sex, stage at diagnosis, symptoms, grade, immunohistochemical investigations, biomarkers, treatment, and treatment outcome were performed. Kaplan-Meier analysis was used to determine median overall survival. Results We identified 17 patients (11 female, 6 male) with a median age of 50 years (range, 35-66) at diagnosis. Twelve cases presented initially with distant metastases including bone metastases in nine cases. On pathological review the majority of patients had well-differentiated G2 tumors. Immunohistochemical profile resembled rectal NENs. All but one patient had non-functioning tumors. Somatostatin receptor imaging was positive in 14 of 15 investigated cases. Eight patients were treated surgically including palliative resections; 14 patients received somatostatin analogs with limited efficacy. With 14 PRRTs completed, 79% showed clinical benefit, whereas only one patient with neuroendocrine carcinoma (NEC) responded to chemotherapy. Treatment with everolimus in three patients was not successful, whereas cabozantinib resulted in a disease stabilization in a heavily pretreated patient. During a median observation period of 44.5 months, 6 patients died. Median overall survival was not reached. Conclusion Presacral NEN are histopathologically similar to rectal NENs. Presacral NEN should be considered as possible primary in NEN of unknown primary. The majority of tumors is non-functioning and somatostatin receptor positive. PRRT demonstrated promising activity; tyrosine kinase inhibitors warrant further investigations. Further molecular characterization and prospective evaluation of this rare tumor entity are needed.
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Affiliation(s)
- Sami Matrood
- Department of Gastroenterology and Endocrinology, UKGM Marburg and Philipps University, Marburg, Germany
| | - Leonidas Apostolidis
- Department of Medical Oncology, National Center for Tumor Diseases (NCT) Heidelberg, Heidelberg University Hospital, Heidelberg, Germany
| | - Jörg Schrader
- I. Department of Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Sebastian Krug
- Clinic for Internal Medicine I, Martin-Luther University Halle/Wittenberg, Halle, Germany
| | - Harald Lahner
- Department of Endocrinology and Metabolism, University Hospital Essen, Essen, Germany
| | - Annette Ramaswamy
- Institute of Pathology, UKGM Marburg and Philipps University, Marburg, Germany
| | - Damiano Librizzi
- Department of Nuclear Medicine, UKGM Marburg and Philipps University, Marburg, Germany
| | - Zoltan Kender
- Department of Internal Medicine I and Clinical Chemistry, Heidelberg University Hospital, Heidelberg, Germany
| | - Anke Kröcher
- Clinic for Internal Medicine I, University Hospital Carl Gustav Carus Dresden, Dresden, Germany
| | - Simon Kreutzfeldt
- Department of Translational Medical Oncology, National Center for Tumor Diseases (NCT) Heidelberg and German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Thomas Matthias Gress
- Department of Gastroenterology and Endocrinology, UKGM Marburg and Philipps University, Marburg, Germany
| | - Anja Rinke
- Department of Gastroenterology and Endocrinology, UKGM Marburg and Philipps University, Marburg, Germany
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Bouzid A, Belhadj A, Saidani A, Bokal Z, Khefacha F, Chebbi F. Unusual retrorectal ganglioneuroma: a case report of laparoscopic assisted approach. Pan Afr Med J 2021; 38:241. [PMID: 34104289 PMCID: PMC8164435 DOI: 10.11604/pamj.2021.38.241.27028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Accepted: 02/05/2021] [Indexed: 11/20/2022] Open
Abstract
Ganglioneuromas are benign slow-growing lesions that arise from sympathetic ganglion cells. They are usually found incidentally. Ultrasound and magnetic resonance imaging (MRI), provides only an unspecified diagnosis and it has to be confirmed by pathologic studies. Complete surgical excision is believed to be the curative treatment for symptomatic lesions. In the literature, the pelvic location reported is exceptional. We report a case of laparoscopic assisted excision of a retrorectal presacral ganglioneuroma for 22-year-old female patient.
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Affiliation(s)
- Ahmed Bouzid
- Department of Surgery, Mahmoud El Matri Hospital, University of Medicine Tunis El Manar, Tunis, Tunisia
| | - Anis Belhadj
- Department of Surgery, Mahmoud El Matri Hospital, University of Medicine Tunis El Manar, Tunis, Tunisia
| | - Ahmed Saidani
- Department of Surgery, Mahmoud El Matri Hospital, University of Medicine Tunis El Manar, Tunis, Tunisia
| | - Ziad Bokal
- Department of Surgery, Mahmoud El Matri Hospital, University of Medicine Tunis El Manar, Tunis, Tunisia
| | - Fahd Khefacha
- Department of Surgery, Mahmoud El Matri Hospital, University of Medicine Tunis El Manar, Tunis, Tunisia
| | - Faouzi Chebbi
- Department of Surgery, Mahmoud El Matri Hospital, University of Medicine Tunis El Manar, Tunis, Tunisia
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Nicoll K, Bartrop C, Walsh S, Foster R, Duncan G, Payne C, Carden C. Malignant transformation of tailgut cysts is significantly higher than previously reported: systematic review of cases in the literature. Colorectal Dis 2019; 21:869-878. [PMID: 30932326 DOI: 10.1111/codi.14628] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2018] [Accepted: 03/16/2019] [Indexed: 02/08/2023]
Abstract
AIM The best treatment for tailgut cysts has not been firmly established. We report a systematic review of the cases in the available literature in order to provide an evidence base for treatment. METHOD A systematic search of articles wholly or partly in English was made of PubMed, Embase and Google Scholar; additional studies were discovered by searching reference lists and contacting authors directly. Search terms 'tailgut cyst', 'tail gut cyst', 'retrorectal hamartoma' and 'retrorectal tumour' were used for case reports or case series; no publication date restrictions were imposed. Only studies with histological confirmation of diagnosis and reporting the age and gender of patients were included. Papers were excluded by consensus between the first two authors. RESULTS A total of 196 individual cases were analysed in detail including 51 cases of neoplasia. The overall rate of neoplastic transformation was 26.6%. Although the male:female cyst incidence ratio was 1:4, men over 18 had a significantly greater relative risk of neoplasm at 1.94 (P = 0.0055). Radiological evidence of nodular thickening of the cyst wall significantly increased the relative risk of the presence of cancer (P = 0.0023). CONCLUSIONS Current orthodoxy that these are not dangerous embryological remnants is unfounded and may be false. The available data suggest the risk of malignant transformation is high and will apply to any residual tissue after excision. The same rationale behind total mesorectal excision in rectal cancer applies to tailgut cysts. Consequently they should be resected with similar oncological margins.
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