Radiological findings of tailgut cyst in a fetus

Revisiting Ultrasound of Fetal Abdominal Cysts; the Common, the Uncommon and the Rare: A Pictorial Review

Fetal abdominal cysts are rare. The significance of antenatally discovered abdominal cysts can range from an innocuous finding to serious conditions needing surgery. It is often difficult to arrive at a correct diagnosis based on ultrasonography, as different types of cysts can have similar appearances. A more specific diagnosis is possible if fetal sex, age at appearance, location of the cyst, shape and appearance of the walls, and contents are considered. This review presents an extensive spectrum of fetal abdominal cysts. The common as well as the very rare causes that have only a few reports are discussed. Ultrasound images of confirmed cases are also presented. An algorithmic approach that enables a more specific diagnosis in many cases has been developed.

Isolated lumbar intradural tailgut cyst: A case report and review of the literature

Tailgut cysts are rare developmental cysts arising from remnants of the embryological postnatal gut. Despite being frequently located in the presacral space, isolated cases of aberrant locations have been reported, including, perirenal, perianal, and subcutaneous sites, with only two cases of subdural tailgut cysts reported to date. The clinical course is often marked by linear growth, causing compression of the adjacent structures, however malignant transformation with carcinomatous features has been previously described. Hereby the authors describe a case of an intradural extramedullary tailgut cyst in a 33-year-old man presenting with progressive low back pain and signs of autonomic dysfunction, including urinary retention and bowel incontinence. Whole-spine MRI revealed an intrathecal cystic lesion located at L2-L3 level exhibiting hyperintensity on T2-weighted images not enhancing when contrast was administered. Laminectomy followed by tumor excision was performed and pathological analysis confirmed the diagnosis of tailgut cyst.

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.

Tailgut cysts in children: a report of two cases and literature review

Tailgut cysts are rare congenital lesions that typically manifest as a presacral, retrorectal, multicystic mass. Even though they are derived from remnants of the embryonic tailgut, they most often present in women. Differential diagnosis includes rectal duplication cyst, sacrococcygeal teratoma, and anterior meningocele. Treatment demands complete excision to prevent infection and malignant degeneration. Fewer than 20 pediatric cases have been reported. Two further affected children are described, one of whom presented uniquely with urinary tract obstruction and acute renal failure.

A tailgut cyst-cystic mass diagnosed by prenatal ultrasonography

Tailgut cysts are congenital lesions found in the presacral space. These have been mainly identified in adults and are rare in children, especially neonates. Here, we present the case of a neonate with a presacral cystic mass detected by prenatal ultrasonography that was diagnosed as a tailgut cyst after postnatal surgical removal. When a presacral cyst is encountered, tailgut cyst should be considered in the differential diagnosis.

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.