CT and MR findings of a retrorectal cystic hamartoma confused with an adnexal mass on ultrasound

Pararectal Epidermal Inclusion Cyst in a Pediatric Patient

Epidermal inclusion cysts, commonly found cutaneously, rarely manifest in the pelvis. They are typically asymptomatic and often occur following trauma or surgical interventions. Imaging modalities, notably computed tomography (CT) scans and magnetic resonance imaging (MRI), play a crucial diagnostic role. Herein, we report a rare case of a four-year-old female with a complicated medical and surgical history, presented with pain in the right gluteal region in the setting of past history of abscess drainage in the same area. Imaging revealed a cystic lesion in the right pararectal space and a fistula extending between the pelvic cavity and gluteal region. A laparotomy was performed, and a histopathologic examination confirmed the diagnosis of an epidermal inclusion cyst with no evidence of malignancy.

Tailgut Cysts with Malignant Transformation: Features, Diagnosis, and Treatment

A tailgut cyst is a type of benign congenital disease that mainly develops in the retro-rectal space. However, malignant transition can occur in some cases of tailgut cysts. Early and precise diagnosis, and proper treatment, are vital for patients with tailgut cysts with malignant transformation. In this review, we aim to summarize the similarities and differences in the diagnosis and treatment methods among the 3 most frequently reported types of tailgut cysts with malignant transformation. In our study, PubMed and Web of Science databases were used to search for the studies and the key words were “tailgut cysts” and “malignancy”. We found 176 articles and selected 75 articles in our survey, with 9 reviews, 35 case reports, and 31 case reports and reviews.

Malignant transformation of tailgut cysts is significantly higher than previously reported: systematic review of cases in the literature

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.

Alcohol injection for nonsurgical management of tailgut cyst in a middle-aged woman: A case report

Managing recurrent tailgut cyst in a patient who is refraining from the definitive surgical en bloc resection can be challenging. Therefore, in this case report we outlined a less invasive approach which is computed tomography-guided aspiration with alcohol injection which resulted in prolongation of symptoms free period in our patient.

Ischiorectal fossa: benign and malignant neoplasms of this "ignored" radiological anatomical space

PURPOSE

To review the pertinent anatomy and the imaging features of common and uncommon benign and malignant neoplasms and masses of the ischiorectal fossa.

RESULTS

The ischiorectal or ischioanal fossa is the largest space in the anorectal region. The benign neoplasms that develop in the ischiorectal originate from the different components that forms the fossa including vascular tumors such as aggressive angiomyxoma or hemangioma; neural tumors as plexiform neurofibroma or schwannoma; fat tumors as lipoma; skin/skin appendages tumors as hidradenoma papilliferum; smooth or skeletal muscle tumors as solitary fibrous tumor. The malignant neoplasms that develop in the ischiorectal fossa also originate from different components that forms the fossa including vascular tumors such as angiosarcoma, neural tumors as malignant granular cell tumor and malignant peripheral nerve sheath tumor; fat tumors as liposarcoma; smooth or skeletal muscle tumors as leiomyosarcoma, rhabdomyosarcoma, malignant PEComa, or undifferentiated pleomorphic sarcoma. Additionally, the ischiorectal fossa can also harbor secondary hematogenous metastases and be affected by direct invasion from neoplasms of adjacent pelvic organs and structures. Furthermore, other miscellaneous masses can occur in the ischiorectal fossa including congenital and developmental lesions, and inflammatory and infectious processes.

CONCLUSION

Knowledge of the anatomy, and the spectrum of imaging findings of common and uncommon benign and malignant neoplasms of the ischiorectal fossa is crucial for the radiologists during interpretation of images allowing them to make contributions to the diagnosis and better patient management.

Diagnosis of Tailgut Cyst in Gynecologic Patients: Systematic Review of the Literature

Tailgut cysts, also called retrorectal cystic hamartomas, are rare findings that usually occur in the retrorectal space. The incidence is estimated to be about 1 in 40,000.

The aim of our review is to evaluate the potential pitfalls in the diagnosis of this rare pathologic condition, according to diagnostic procedures for this rare but misleading and subtle entity.

We conducted a Medline literature review of the English literature discussing tailgut cysts in female patients. We concentrated on imaging technology used for diagnosis in gynecologic patients. For our search, we used the key words “tailgut cyst”, “retrorectal cystic hamartoma”, “gynecology”, focusing on clinical presentation, imaging technology used for diagnosis, presence of malignancy, and misdiagnosis with more common gynecologic pathology.

Our search revealed 143 articles during the years 1975–2016 and, of these, 30 articles describing 91 female patients were considered.

We concluded that tailgut cyst should be included in the differential diagnosis of pelvic lesions in gynecologic patients.

Imaging of presacral masses--a multidisciplinary approach

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.

Transsacrococcygeal Approach for Resection of Retrorectal Tumors

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

MR imaging features of nongynaecologic cystic lesions of the pelvis

OBJECTIVE

The purpose of our article is to review the magnetic resonance imaging (MRI) features of nongynaecologic cystic lesions of the pelvis.

CONCLUSION

The rising use of MRI for pelvic exploration will result in an increase in incidental detection of pelvic cystic cysts. Pelvic cysts of non gynecologic origin are less frequent than gynecologic cysts. However, they account for a wide range of abnormalities, and radiologists must be aware of their features and characteristics.

Retrorectal hamartoma: A 'tail' of two cysts!

Retrorectal hamartomas or tail gut cysts are rare congenital anomalies most commonly seen in a retrorectal location; most common in middle aged women. This article describes the radiological appearance in two cases of tail gut cysts in males, one a child with a visible perianal swelling since birth and the other, a 72-year-old man with symptoms for one week. In both, the tailgut cysts were in a right perirectal location. Presentation in such a location in males, at extremes of age, is unusual for tailgut cysts.

Giant pararectal epidermoid tumor mimicking ovarian cyst: combined laparoscopic and perineal surgical approach

Epidermoid cysts are benign tumors that can develop in any part of the human body. Pelvic cysts adjacent to the rectum develop rarely, and few cases have been described in the literature. We report the case of a 58-year-old woman who underwent laparoscopic and perineal excision of a giant pararectal cyst that was discovered during laparoscopy performed for preoperative provisional diagnosis of an adnexal mass detected on an imaging study. To our knowledge, this is the second case of a pararectal cyst excised using combined laparoscopic and perineal approaches. In the hands of skilled laparoscopic surgeons, we suggest a combined laparoscopic and perineal approach for excision of giant pararectal cystic tumors to avert laparotomy.

Retrorectal Tumors: The Choice of Surgical Approach Based on a New Classification

Because retrorectal-presacral tumors differ in histologic origin, symptoms, and prognosis, and often involve various neighboring structures, successful treatment of this heterogeneous group of tumors depends on the surgical approach chosen and the specialist surgeons involved. We investigated whether a new classification of retrorectal tumors based on findings from CT and MRI would simplify presurgical planning. The clinical records of a series of 34 patients who underwent surgery for retrorectal tumors from 1989 to 2003 were reviewed. Two radiologists, who were blind to the patients’ records, separately reviewed the preoperative CT and MRI findings and classified tumors according to whether they arose from the presacral area (Group 1), sacrum or spinal cord growing anteriorly (Group 2), or rectum growing posteriorly (Group 3). The preoperative CT and MRI findings for the retrorectal tumors yielded the information required to allow surgery to be properly planned (surgical approach and need to involve various specialist surgeons) in nearly all cases: 17 of the 18 patients (94.5%) with tumors arising from the retrorectal space, all 12 of those with tumors arising from the sacrum or spinal cord, and all four of those with rectal tumors. With the findings yielded by currently available CT and MRI techniques, retrorectal tumors can be anatomically and topographically classified preoperatively so as to allow surgery to be adequately planned in advance and thus optimize the surgical resection.

Tailgut cysts: report of two cases

AIM

An illustration of the diagnosis and management of tailgut cysts.

MATERIALS AND METHODS

Two cases of tailgut cyst and a review of the literature.

RESULTS

A female patient presented with acute urinary retention with a retrorectal mass felt during rectal examination and confirmed on ultrasound and magnetic resonance imaging underwent surgical resection and histology confirmed a chronically inflamed mucoid fluid-filled cyst partly lined by non-keratinised squamous epithelium. A male patient with ureteric obstruction and a prerectal cyst found on ultrasound scan underwent computed tomography with biopsies, but without reaching a conclusive diagnosis. Surgical resection was carried out and histology showed a chronically inflamed mucoid fluid-filled cyst partly lined with columnar epithelium.

DISCUSSION

Tailgut cysts are a rare developmental abnormality arising from remnants of the embryological postanal gut. Usually presenting incidentally or with pressure symptoms in middle-aged females, tailgut cysts are often initially mistaken for other clinical entities. Magnetic resonance imaging helps to differentiate tailgut cysts from other retrorectal lesions and developmental cysts. Histologically, the cyst wall demonstrates a wide variety of epithelial types and has a malignant potential. Malignancy is difficult to rule out with imaging or biopsy.

CONCLUSIONS

Magnetic resonance imaging is the favoured imaging modality and surgical resection is recommended to relieve pressure symptoms, provide a definitive diagnosis and rule out malignancy.

Tailgut cysts: MRI findings

Magnetic resonance imaging (MRI) features of 11 surgically resected pelvic tailgut cysts were analyzed with reference to histopathologic and clinical data. Homogeneity, size, location, signal intensity, appearance and presence of septa and/or nodules and/or peripheral rim and involvement of surrounding structures were studied. Histological examination demonstrated 11 tailgut cysts (TGC), including one infected TGC and one TGC with a component of adenocarcinoma. Lesions (3-8 cm in diameter) were exclusively or partly retrorectal in all cases but one, with an extension down the anal canal in five cases. Lesions were multicystic in all patients but one. On T1-weighted MR images, all cystic lesions contained at least one hyperintense cyst. The peripheral rim of the cystic lesion was regular and non or moderately enhancing in all cases but the two complicated TGC. Nodular peripheral rim and irregular septa were seen in the degenerated TGC. Marked enhancement of the peripheral structures was noted in the two complicated TGC. Pelvic MRI is a valuable tool in the preoperative evaluation of TGC.

Radiological findings of tailgut cyst in a fetus

Tailgut cyst, or retrorectal cystic hamartoma, is a rare congenital lesion found in the presacral space. The lesion has not been adequately reported in the literature. In this article, we describe a case of tailgut cyst that was demonstrated as a large cystic lesion within a fetal pelvis using ultrasonography and magnetic resonance imaging.

Magnetic resonance imaging of the ischiorectal fossa: spectrum of disease

OBJECTIVE

Pelvic magnetic resonance imaging (MRI) studies are widely used to assess the rectum, anal canal, and their environment. The purpose of this article is to review the current role of MRI in the evaluation of diseases involving the ischiorectal fossa and their imaging features.

CONCLUSIONS

The radiologist plays an essential role in the evaluation of some conditions typically located in this space and of other conditions that occasionally involve this area or invade the ischioanal space. The accurate assessment of these diseases that MRI provides further cements its role as the primary technique for the evaluation of pelvic pathology.