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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: 2] [Impact Index Per Article: 1.0] [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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Ramalingam K, Fiser C, Sabih Q, Rajput A. Retrorectal cyst: proteus in the backyard-case series and literature review. BMJ Case Rep 2020; 13:13/6/e231080. [PMID: 32487521 DOI: 10.1136/bcr-2019-231080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Retrorectal cysts are cystic lesions located in the retrorectal space and are a distinct subset of retrorectal tumours, which are often misdiagnosed due to their rarity and mimicry of symptoms caused by common diseases. We have described the presentation and management of four patients who were diagnosed with retrorectal cysts from a 10-year retrospective chart review at our institute, a tertiary care centre. In middle-aged women, the following should raise suspicion of retrorectal cyst: gastrointestinal or urinary obstructive features, mass or fullness palpable on the posterior wall on digital rectal examination, presacral dimple, perianal fistula and/or recurrent disease. Such features should prompt an MRI evaluation of the pelvis for definitive diagnosis.
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Affiliation(s)
- Kirithiga Ramalingam
- Department of Surgery, University of New Mexico Health Sciences Center, Albuquerque, New Mexico, USA
| | - Caroline Fiser
- Department of Surgery, University of New Mexico Health Sciences Center, Albuquerque, New Mexico, USA
| | - Quratulain Sabih
- Department of Surgery, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
| | - Ashwani Rajput
- Department of Surgery, University of New Mexico Health Sciences Center, Albuquerque, New Mexico, USA
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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: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [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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Amin T, Tay YK, Macaranas M, Davey L, Phan-Thien KC. Rare presentation of a tailgut cyst. ANZ J Surg 2019; 90:E95-E96. [PMID: 31271245 DOI: 10.1111/ans.15324] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2019] [Revised: 04/26/2019] [Accepted: 05/12/2019] [Indexed: 01/23/2023]
Affiliation(s)
- Tahiya Amin
- The University of New South Wales, Sydney, New South Wales, Australia.,Department of Surgery, St George Hospital, Sydney, New South Wales, Australia
| | - Yeng Kwang Tay
- Department of Surgery, St George Hospital, Sydney, New South Wales, Australia
| | - Mark Macaranas
- Department of Surgery, St George Hospital, Sydney, New South Wales, Australia
| | - Louella Davey
- Department of Anatomical Pathology, St George Hospital, Sydney, New South Wales, Australia
| | - Kim-Chi Phan-Thien
- Department of Surgery, St George Hospital, Sydney, New South Wales, Australia
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5
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Aljuhani F, Almunami B, Alsamahi R, Malibary N, Algaithy Z. Alcohol injection for nonsurgical management of tailgut cyst in a middle-aged woman: A case report. Clin Case Rep 2019; 7:1233-1237. [PMID: 31183101 PMCID: PMC6552934 DOI: 10.1002/ccr3.2205] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2018] [Revised: 03/15/2019] [Accepted: 03/27/2019] [Indexed: 12/20/2022] Open
Abstract
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.
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Affiliation(s)
- Farrah Aljuhani
- Faculty of MedicineKing Abdulaziz UniversityJeddahSaudi Arabia
| | | | - Rawan Alsamahi
- Faculty of MedicineKing Abdulaziz UniversityJeddahSaudi Arabia
| | - Nadim Malibary
- Faculty of MedicineKing Abdulaziz UniversityJeddahSaudi Arabia
| | - Zuhoor Algaithy
- Faculty of MedicineKing Abdulaziz UniversityJeddahSaudi Arabia
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Zappa L, Godwin TA, Sugarbaker PH. Tailgut Cyst, an Unusual Cause of Pseudomyxoma Peritonei. TUMORI JOURNAL 2018; 95:514-7. [DOI: 10.1177/030089160909500418] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Background Retrorectal hamartoma, also known as tailgut cyst, is a rare tumor that arises from remnants of the embryonic postanal gut. The tumor occurs in the retrorectal space and may undergo malignant degeneration. Methods The clinical information on a single patient with pseudomyxoma peritonei associated with a tailgut cyst was reviewed and a literature review of the subject performed. Results In this patient there was malignant degeneration of a tailgut cyst localized to the pelvis. Twenty months later a local recurrence in the pelvis and pseudomyxoma peritonei widely distributed in the abdomen were successfully treated by cytoreductive surgery and perioperative chemotherapy. Conclusion Tailgut cyst may, if resected with tumor spillage, result in pseudomyxoma peritonei. Our treatment – which has maintained a disease-free status for one year – was cytoreductive surgery plus perioperative chemotherapy.
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Affiliation(s)
- Luis Zappa
- Washington Cancer Institute, Washington, Washington, DC, USA
| | - Thomas A Godwin
- Department of Pathology, Washington Hospital Center, Washington, DC, USA
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7
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Diagnosis of Tailgut Cyst in Gynecologic Patients: Systematic Review of the Literature. JOURNAL OF ENDOMETRIOSIS AND PELVIC PAIN DISORDERS 2017. [DOI: 10.5301/jeppd.5000293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
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.
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Volk A, Plodeck V, Toma M, Saeger HD, Pistorius S. Treatment of tailgut cysts by extended distal rectal segmental resection with rectoanal anastomosis. Surg Today 2016; 47:457-462. [PMID: 27549774 DOI: 10.1007/s00595-016-1403-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2015] [Accepted: 07/05/2016] [Indexed: 12/17/2022]
Abstract
PURPOSE Complete surgical resection is the treatment of choice for tailgut cysts, because of their malignant potential and tendency to regrow if incompletely resected. We report our experience of treating patients with tailgut cysts, and discuss diagnostics, surgical approaches, and follow-up. METHODS We performed extended distal rectal segmental resection of the tailgut cyst, with rectoanal anastomosis. We report the clinical, radiological, pathological, and surgical findings, describe the procedures performed, and summarize follow-up data. RESULTS Two patients underwent en-bloc resection of a tailgut cyst, the adjacent part of the levator muscle, and the distal rectal segment, followed by an end-to-end rectoanal anastomosis. There was no evidence of anastomotic leakage postoperatively. At the time of writing, our patients were relapse-free with no, or non-limiting, symptoms of anal incontinence, respectively. CONCLUSIONS This surgical approach appears to have a low complication rate and good recovery outcomes. Moreover, as the sphincter is preserved, so is the postoperative anorectal function. This approach could result in a low recurrence rate.
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Affiliation(s)
- Andreas Volk
- Department of Visceral-, Thoracic- and Vascular Surgery, University of Dresden, Fetscherstraße 74, 01307, Dresden, Germany
| | - Verena Plodeck
- Institute of Diagnostic Radiology, University of Dresden, Fetscherstraße 74, 01307, Dresden, Germany
| | - Marieta Toma
- Institute for Pathology, University of Dresden, Fetscherstraße 74, 01307, Dresden, Germany
| | - Hans-Detlev Saeger
- Department of Visceral-, Thoracic- and Vascular Surgery, University of Dresden, Fetscherstraße 74, 01307, Dresden, Germany
| | - Steffen Pistorius
- Department of Visceral-, Thoracic- and Vascular Surgery, University of Dresden, Fetscherstraße 74, 01307, Dresden, Germany.
- University Cancer Center Dresden (UCC), University of Dresden, Fetscherstraße 74, 01307, Dresden, Germany.
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9
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Transanal Endoscopic Microsurgery: Current and Future Perspectives. Surg Laparosc Endosc Percutan Tech 2016; 26:e46-9. [DOI: 10.1097/sle.0000000000000273] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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10
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Masch WR, Kamaya A, Wasnik AP, Maturen KE. Ovarian cancer mimics: how to avoid being fooled by extraovarian pelvic masses. Abdom Radiol (NY) 2016; 41:783-93. [PMID: 26867729 DOI: 10.1007/s00261-015-0570-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
In our clinical experience, pelvic masses from a variety of anatomic sites may be misdiagnosed as ovarian cancer. This tendency to overdiagnose a rare disease probably reflects both its protean imaging appearance and concern for its potential morbidity and mortality. However, radiologists can better serve patients with an analytic approach to the anatomic and tissue features of pelvic masses. We review a range of ovarian cancer mimics and illustrate the radiologic reasoning enabling correct diagnosis.
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11
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Patsouras D, Pawa N, Osmani H, Phillips RKS. Management of tailgut cysts in a tertiary referral centre: a 10-year experience. Colorectal Dis 2015; 17:724-9. [PMID: 25683585 DOI: 10.1111/codi.12919] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2014] [Accepted: 12/31/2014] [Indexed: 12/19/2022]
Abstract
AIM Tailgut cysts are rare congenital lesions typically presenting as presacral masses. A variable clinical presentation often leads to misdiagnosis and unsuccessful operations. METHOD A retrospective analysis was performed of tailgut cysts presenting to one surgeon at St Mark's hospital between 2003 and 2013. The patient demographic data and clinicopathological and radiological features, together with perioperative details and recurrence, were reviewed. RESULTS A total of 17 patients (15 women) with a median age of 35 (21-64) years were included in the study. The mean duration of symptoms before referral was 40 months, with sepsis predominating in 12 cases. Fifteen of the patients had previously undergone surgery (mean 2.9 procedures). A posterior surgical approach was adopted in all patients with a coccygectomy performed in 13. A loop colostomy was formed in three patients. Two of them went on to have a secondary pull-through operation after an initial failed local repair of rectal injury. One case was reported to show malignant degeneration on histological examination. There was one recurrence during a median follow-up period of 13 (3-36) months. CONCLUSION Tailgut cysts are an uncommon yet important cause of chronic perianal sepsis. Suspicion should be raised in a patient, usually female, presenting with a history of unsuccessful procedures. Diagnosis can be made by clinical assessment and MRI. Complete excision usually resolves the problem.
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Affiliation(s)
- D Patsouras
- Department of Surgery, St Mark's Hospital and Academic Institute, Harrow, UK
| | - N Pawa
- Department of Surgery, St Mark's Hospital and Academic Institute, Harrow, UK
| | - H Osmani
- Department of Surgery, St Mark's Hospital and Academic Institute, Harrow, UK
| | - R K S Phillips
- Department of Surgery, St Mark's Hospital and Academic Institute, Harrow, UK
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12
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Haider N, Shaheen I, Squire R, Stringer MD. Tailgut cysts in children: a report of two cases and literature review. Pediatr Surg Int 2015; 31:597-601. [PMID: 25859887 DOI: 10.1007/s00383-015-3704-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/23/2015] [Indexed: 12/19/2022]
Abstract
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.
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Affiliation(s)
- Nadeem Haider
- Department of Paediatric Surgery, Christchurch Hospital, Christchurch, New Zealand
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13
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Shetty AS, Loch R, Yoo N, Mellnick V, Fowler K, Narra V. Imaging of tailgut cysts. ACTA ACUST UNITED AC 2015; 40:2783-95. [DOI: 10.1007/s00261-015-0463-3] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
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14
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Jones H, Cunningham C. Extending the indications: Transanal endoscopic surgery for fistula, stricture, and rare tumors. SEMINARS IN COLON AND RECTAL SURGERY 2015. [DOI: 10.1053/j.scrs.2014.10.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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New surgical approach of retrorectal cystic hamartoma using transanal minimally invasive surgery (TAMIS). JOURNAL OF COLOPROCTOLOGY 2014. [DOI: 10.1016/j.jcol.2014.08.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
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Stallard J, Davies J, Bourke G, Finan PJ. Successful removal of a massive retrorectal cystic hamartoma (tailgut cyst) using a combined paracoccygeal and myocutaneous gluteal flap approach. Tech Coloproctol 2014; 18:673-4. [PMID: 24500729 DOI: 10.1007/s10151-014-1127-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2013] [Accepted: 01/27/2014] [Indexed: 01/17/2023]
Affiliation(s)
- J Stallard
- Department of Plastic, Reconstructive and Hand Surgery, The General Infirmary at Leeds, Leeds, UK
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17
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Duek SD, Gilshtein H, Khoury W. Transanal endoscopic microsurgery: also for the treatment of retrorectal tumors. MINIM INVASIV THER 2013; 23:28-31. [PMID: 24329013 DOI: 10.3109/13645706.2013.872663] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Retrorectal tumors are an uncommon pathological entity. Their clinical importance arises from their occasional malignant nature or malignant transformation. The treatment of choice for most presacral tumors is surgical excision. The approach depends upon the upper limit of the lesion and the presumptive pathology. We reviewed the main features of these tumors with emphasis on transanal endoscopic microsurgery (TEM) as a viable surgical approach for the treatment of the lesions, undertaken in our institution. We present our small case series, consisting of six patients with retrorectal lesions who underwent local excision via TEM. Early and late postoperative outcomes are presented. TEM for retrorectal lesions appears to be a feasible and safe approach. A remarkably low morbidity favors TEM in selected patients.
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Affiliation(s)
- Simon Daniel Duek
- Colorectal Surgery Unit, Department of General Surgery, Rambam Health Care Campus, Bruce Rappaport Medical School, Technion , Haifa , Israel
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18
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Lesions originating within the retrorectal space: a diverse group requiring individualized evaluation and surgery. J Gastrointest Surg 2013; 17:2143-52. [PMID: 24146338 DOI: 10.1007/s11605-013-2350-y] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2013] [Accepted: 09/03/2013] [Indexed: 02/07/2023]
Abstract
BACKGROUND Tumors occurring within the retrorectal space are rare and their low incidence has led to a paucity of literature regarding them. METHODS Adult patients with retrorectal tumors managed at this institution from 1981-2011 were identified. A retrospective chart review was conducted to obtain relevant data. RESULTS Retrorectal tumors were identified in 87 patients (67 female) with median age at diagnosis of 44 years (19-88), and median follow-up 8 months (0.1-225). Of the 25 different histologic tumors diagnosed, hamartomas were most common (32 %; n = 28) followed by epidermal cysts (11 %; n = 10), and teratomas (10 %; n = 9). Twenty-six percent (23/87) of all tumors were malignant. CT scans were obtained in 84 % (73/87) of patients, MRI in 59 % (51/87), and TRUS in 16 % (14/87). While 74 % (64/87) of tumors were at or below the S4 level, operative approach was strictly posterior in 73 % (46/63) of these tumors. Twenty-eight percent (24/87) of patients underwent diagnostic biopsy with no reported biopsy site recurrence. Thirty percent (7/23) of resected malignant (all recurrences: distant) and eleven percent (7/64) of benign tumors (all recurrences: local) recurred. Survival was 70 % (16/23) for malignant tumors and 98 % (63/64) for benign tumors. CONCLUSIONS Retrorectal tumors remain heterogeneous and a diagnostic challenge. Pre-operative imaging may help guide surgeons; however, malignancy portends worse outcomes. Despite preoperative biopsy site recurrence concerns, no patient in this study had biopsy site recurrence. As their natural history remains unclear, more studies are necessary to further characterize their behavior.
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Transanal endoscopic microsurgery for the resection of submucosal and retrorectal tumors. Surg Laparosc Endosc Percutan Tech 2013; 23:66-8. [PMID: 23386155 DOI: 10.1097/sle.0b013e3182757860] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
BACKGROUND Transanal endoscopic microsurgery (TEM) was originally designed for local endoscopic excision of benign and low-grade mucosal rectal lesions through an endoscopic system. The procedure is particularly challenging for submucosal and retrorectal lesions, as the tumor margins are not well defined. OBJECTIVE To investigate patient and surgical characteristics of TEM as a treatment for submucosal rectal and retrorectal lesions. METHODS All the patients in our department of general surgery who underwent TEM for a submucosal rectal or retrorectal lesion, between the years 2001 and 2011, were identified. Their charts were reviewed and data pertaining to demographic characteristics and medical history, including tumor characteristics, were collected. Operative notes and histopathology reports were also reviewed. The adequacy of the tumor resection, that ism attainment of free margins, endoscopic completion of the procedure, and perioperative complications, were assessed. RESULTS Fifteen patients (5 females, 10 males), mean age 53.9 ± 16.9 years, were identified. The main indications for surgery were gastrointestinal stromal tumor (5 patients) and tailgut or duplication cyst (4 patients). All procedures were completed endoscopically. The median distance from the anal verge was 7.3 cm (range, 5 to 10 cm), and the mean diameter of the tumors was 3 ± 1.1 cm. The one patient in whom the margins presented tumoral involvement underwent repeated TEM. No intraoperative complications were reported. The postoperative complication rate was 13.3%, and the mean length of hospital stay was 1.85 ± 1.77 days. CONCLUSIONS TEM for retrorectal and submucosal rectal lesions is feasible and safe. A remarkably low morbidity rate and limited surgical injury favor TEM in selected patients.
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20
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Johnson KN, Young-Fadok TM, Carpentieri D, Acosta JM, Notrica DM. Case report: misdiagnosis of tailgut cyst presenting as recurrent perianal fistula with pelvic abscess. J Pediatr Surg 2013; 48:e33-6. [PMID: 23414899 DOI: 10.1016/j.jpedsurg.2012.12.022] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2012] [Revised: 12/05/2012] [Accepted: 12/08/2012] [Indexed: 10/27/2022]
Abstract
Tailgut cysts are uncommon lesions that usually occur within the presacral space. The relative rarity and nonspecific complaints associated with these lesions often lead to misdiagnosis or unnecessary procedures before the correct diagnosis is made. We describe a case of a 16-year-old female who presented with pelvic pain. She had previously undergone several procedures at an outside institution for recurrent perianal fistula and perirectal abscess. Subsequent evaluation under anesthesia revealed a presacral cystic mass with a well-developed tract within the anorectal ring in the posterior midline. This mass was surgically removed using a combined transanal and posterior sagittal excision technique and was found to be a tailgut cyst upon pathologic evaluation. Tailgut cysts and other presacral masses should be included in the differential for patients with recurrent abscess in the presacral space or fistula within the anal canal. A variety of surgical approaches are available depending on the anatomy of the lesion.
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Affiliation(s)
- Kevin N Johnson
- Department of General Surgery, Mayo Clinic, Phoenix, AZ, USA
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21
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Bathla L, Singh L, Agarwal PN. Retrorectal cystic hamartoma (tailgut cyst): report of a case and review of literature. Indian J Surg 2012; 75:204-7. [PMID: 24426565 DOI: 10.1007/s12262-012-0633-2] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2011] [Accepted: 06/12/2012] [Indexed: 02/07/2023] Open
Abstract
Retrorectal cystic hamartoma is a rare type of congenital cystic lesion usually diagnosed in middle-aged women. Although mostly asymptomatic, patients may present with symptoms resulting from local mass effect or with a complication. The most important complications of these cysts are infection with secondary fistulization and malignant degeneration. Because of such non-specific nature of symptoms and rare incidence, it is not unusual to have a delay in clinical diagnosis. MRI has evolved to be the investigation of choice for the evaluation of presacral tumors as it can provide excellent anatomic detail and soft tissue contrast. Role of preoperative biopsy is controversial especially with improvements in the imaging techniques. When diagnosed these lesions should be excised because of the risk of malignant transformation.
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Affiliation(s)
- Lokesh Bathla
- Section of Transplant Surgery, University of Nebraska Medical Center, 983285 Nebraska Medical Center, Omaha, NE 68198-3285 USA ; Department of Surgery, Maulana Azad Medical College, New Delhi, India
| | - Lakhvinder Singh
- Department of Surgery, Maulana Azad Medical College, New Delhi, India
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22
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A rare cause of low back pain: report of a tailgut cyst. Case Rep Med 2012; 2012:623142. [PMID: 22431937 PMCID: PMC3295332 DOI: 10.1155/2012/623142] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2011] [Accepted: 11/13/2011] [Indexed: 12/17/2022] Open
Abstract
Tailgut cysts, also known as retrorectal cystic hamartomas, are rare developmental abnormalities that typically occur in the retrorectal space. They are believed to arise from remnants of the embryonic hindgut (Hjermstad and Helwig, 1988). They can present as incidental findings during routine examination but over half of patients are thought to present with symptoms. MRI has become the modality of choice to image these frequently misdiagnosed cysts. Biopsy is not recommended. Complete intact surgical excision is advised to avoid the potential complications of these cysts which include infection, fistula formation, and the possibility of malignant transformation (Hjermstad and Helwig (1988), Mathis et al. (2010)). We describe the case of a 46-year-old female who presented with a 6-month history of low back pain. CT and MRI imaging demonstrated a complex retrorectal lesion with supralevator and infralevator components. This was removed using a combined transperineal and transabdominal approach. Histology confirmed a tailgut cyst.
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Affiliation(s)
| | - David B. Adams
- Medical University of South Carolina Charleston, South Carolina
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Mueller F, Wunschel A, Ulrich U. Laparoscopic treatment of a tailgut cyst. Eur J Obstet Gynecol Reprod Biol 2011; 159:233-4. [PMID: 21733617 DOI: 10.1016/j.ejogrb.2011.06.017] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2011] [Revised: 05/23/2011] [Accepted: 06/09/2011] [Indexed: 11/25/2022]
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Lu NH, Tseng MJ. Laparoscopic management of tailgut cyst: case report and review of literature. J Minim Invasive Gynecol 2011; 17:802-4. [PMID: 20955994 DOI: 10.1016/j.jmig.2010.07.011] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2010] [Revised: 07/15/2010] [Accepted: 07/22/2010] [Indexed: 11/30/2022]
Abstract
Tailgut cyst, also called retrorectal hamartoma, is a rare congenital lesion that arises from the remnants of the postanal primitive gut and is usually located anterior to the sacrum and posterior to the rectum. It is usually asymptomatic or demonstrates mass effects, and preoperatively is frequently misdiagnosed as adnexal tumor. Treatment is complete surgical resection. The English-language literature contains only limited reports of the laparoendoscopic approach to retrorectal cystic tumor and tailgut cyst. Herein, we report our experience with successful laparoscopic management of a tailgut cyst, discuss the laparoscopic resection technique, and present a review of the literature.
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Affiliation(s)
- Nien-Hsien Lu
- Department of Obstetrics and Gynecology, Taiwan Adventist Hospital, Taipei, Taiwan
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Serra Aracil X, Gómez Díaz C, Bombardó Junca J, Mora López L, Alcántara Moral M, Ayguavives Garnica I, Navarro Soto S. Surgical excision of retrorectal tumour using transanal endoscopic microsurgery. Colorectal Dis 2010; 12:594-5. [PMID: 19906055 DOI: 10.1111/j.1463-1318.2009.02126.x] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Abstract Surgical excision is the best therapeutic option for tumours in the retrorectal space. Classically, surgery in this area required an abdominal or posterior approach, or a combination of the two methods. We report the use of transanal endoscopic microsurgery for the treatment of retrorectal tumours as an alternative to classical procedures.
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Affiliation(s)
- X Serra Aracil
- General and Digestive Surgery Service, Coloproctology Unit, Corporació Sanitària Parc Tauli, Sabadell, Spain.
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A large cystic gastrointestinal stromal tumor of the rectum in the retrorectal space. Int J Clin Oncol 2010; 15:601-7. [DOI: 10.1007/s10147-010-0084-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2009] [Accepted: 04/08/2010] [Indexed: 10/19/2022]
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28
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Affiliation(s)
- Nam-Hyuk Lee
- Department of Surgery, College of Medicine, Yeungnam University, Daegu, Korea
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Vestigial retrorectal cystic tumors in adults: A review of 30 cases. ACTA ACUST UNITED AC 2008; 32:769-78. [DOI: 10.1016/j.gcb.2008.03.011] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2007] [Revised: 02/28/2008] [Accepted: 03/01/2008] [Indexed: 12/24/2022]
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30
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Tailgut cysts: MRI findings. Eur Radiol 2008; 18:2586-93. [PMID: 18566821 DOI: 10.1007/s00330-008-1028-4] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2007] [Revised: 03/18/2008] [Accepted: 04/09/2008] [Indexed: 01/16/2023]
Abstract
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.
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Vega Menéndez D, Quintáns Rodríguez A, Hernández Granados P, Nevado Santos M, García Sabrido JL, Rueda Orgaz JA, Ochando F, Ojeda Pérez F, Loinaz C. Hamartomas quísticos retrorrectales. Cir Esp 2008; 83:53-60. [DOI: 10.1016/s0009-739x(08)70506-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
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Garcia-Donas J, Rodriguez N, Jara C, Urioste M, Nevado M, Cañamero M, Cuartero V, Albillos J, Vega D, Quintans A. Retrorectal cystic hamartoma as benign cause of CA 19-9 elevation. J Clin Oncol 2007; 25:4012-4. [PMID: 17761987 DOI: 10.1200/jco.2007.12.4214] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Affiliation(s)
- Jesus Garcia-Donas
- Department of Medical Oncology, Fundación Hospital Alcorcón, Alcorcón, Spain
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Jang SH, Jang KS, Song YS, Min KW, Han HX, Lee KG, Paik SS. Unusual prerectal location of a tailgut cyst: A case report. World J Gastroenterol 2006; 12:5081-3. [PMID: 16937513 PMCID: PMC4087420 DOI: 10.3748/wjg.v12.i31.5081] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Tailgut cyst is a rare congenital cystic lesion arising from the remnants of the embryonic postanal gut. It occurs exclusively within the retrorectal space and rarely in the perirenal area or in the subcutaneous tissue. A prerectal and retrovesical location of tailgut cyst is extremely rare. To the best of our knowledge, only three cases have been reported in the English literature. We experienced an unusual case of tailgut cyst developed in the prerectal and retrovesical space in a 14-year-old boy. Abdominal computed tomography demonstrated a prerectal cyst which was located at the anterolateral portion to the rectum. The cyst contained yellowish inspissated mucoid material. Microscopically, the cyst was lined by squamous, columnar, cuboidal and transitional epithelia and the wall was fibrotic with dispersed smooth muscle cells. Although tailgut cyst arising in prerectal area is extremely rare, its possibility should be considered in differential diagnosis of a prerectal and retrovesical cystic mass.
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Affiliation(s)
- Si-Hyong Jang
- Department of Pathology, College of Medicine, Hanyang University, Seongdong-Gu, Seoul 133-792, Korea
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