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Malliou P, Syrnioti A, Koletsa T, Karlafti E, Karakatsanis A, Raptou G, Apostolidis S, Michalopoulos A, Paramythiotis D. Mucinous adenocarcinoma arising from a tailgut cyst: A case report. World J Clin Oncol 2022; 13:853-860. [PMID: 36337315 PMCID: PMC9630997 DOI: 10.5306/wjco.v13.i10.853] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Revised: 06/12/2022] [Accepted: 10/11/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Retrorectal hamartomas or tailgut cysts (TCs) are rare. In most cases, they are asymptomatic and benign; however, rarely, they undergo malignant transformation, mainly in the form of adenocarcinoma. CASE SUMMARY A 55-year-old woman presented to our hospital with lower back pain. On magnetic resonance imaging, a large pelvic mass was found, which was located on the right of the ischiorectal fossa, extending to the minor pelvis. The patient underwent extensive surgical resection of the lesion through the right buttock. Histological examination confirmed the diagnosis of a retrorectal mucinous adenocarcinoma originating from a TC. Surgical resection of the tumour was complete, and the patient recovered without complications. The pilonidal sinus was then excised. One year later, semi-annual positron emission tomography-computed tomography and magnetic resonance imaging scans did not reveal any evidence of local recurrence or metastatic disease. CONCLUSION Preoperative recognition, histological diagnosis, and treatment of TCs pose significant challenges. In addition, the possibility of developing invasive mucinous adenocarcinoma, although rare, should be considered.
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Affiliation(s)
- Petra Malliou
- The First Propaedeutic Surgery Department, AHEPA University General Hospital of Thessaloniki, Thessaloniki 54636, Greece
| | - Antonia Syrnioti
- Department of Pathology, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki 54636, Greece
| | - Triantafyllia Koletsa
- Department of Pathology, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki 54636, Greece
| | - Eleni Karlafti
- Department of Emergency, AHEPA University Hospital, Thessaloniki 54636, Greece
| | - Anestis Karakatsanis
- The First Propaedeutic Surgery Department, AHEPA University General Hospital of Thessaloniki, Thessaloniki 54636, Greece
| | - Georgia Raptou
- Department of Pathology, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki 54636, Greece
| | - Stylianos Apostolidis
- The First Propaedeutic Surgery Department, AHEPA University General Hospital of Thessaloniki, Thessaloniki 54636, Greece
| | - Antonios Michalopoulos
- The First Propaedeutic Surgery Department, AHEPA University General Hospital of Thessaloniki, Thessaloniki 54636, Greece
| | - Daniel Paramythiotis
- The First Propaedeutic Surgery Department, AHEPA University General Hospital of Thessaloniki, Thessaloniki 54636, Greece
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Wang YS, Guo QY, Zheng FH, Huang ZW, Yan JL, Fan FX, Liu T, Ji SX, Zhao XF, Zheng YX. Retrorectal mucinous adenocarcinoma arising from a tailgut cyst: A case report and review of literature. World J Gastrointest Surg 2022; 14:1072-1081. [PMID: 36185552 PMCID: PMC9521465 DOI: 10.4240/wjgs.v14.i9.1072] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2022] [Revised: 06/30/2022] [Accepted: 08/21/2022] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Tailgut cysts are defined as congenital cysts that develop in the rectosacral space from the residue of the primitive tail. As a congenital disease, caudal cysts are very rare, and their canceration is even rarer, which makes the disease prone to misdiagnosis and delayed treatment. We describe a case of caudal cyst with adenocarcinogenesis and summarize in detail the characteristics of cases with analytical value reported since 1990.
CASE SUMMARY A 35-year-old woman found a mass in her lower abdomen 2 mo ago. She was asymptomatic at that time and was not treated because of the coronavirus disease 2019 pandemic. Two weeks ago, the patient developed abdominal distension and right waist discomfort and came to our hospital. Except for the high level of serum carcinoembryonic antigen, the medical history and laboratory tests were not remarkable. Magnetic resonance imaging showed a well-defined, slightly lobulated cystic-solid mass with a straight diameter of approximately 10 cm × 9 cm in the presacral space, slightly high signal intensity on T2-weighted imaging, and moderate signal intensity on T1-weighted imaging. The mass was completely removed by laparoscopic surgery. Histopathological examination showed that the lesion was an intestinal mucinous adenocarcinoma, and the multidisciplinary team decided to implement postoperative chemotherapy. The patient recovered well, the tumor marker levels returned to normal, and tumor-free survival has been achieved thus far.
CONCLUSION The case and literature summary can help clinicians and researchers develop appropriate examination and therapeutic methods for diagnosis and treatment of this rare disease.
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Affiliation(s)
- Yan-Shuai Wang
- Department of General Surgery, The Fourth Affiliated Hospital, School of Medicine, Zhejiang University, Yiwu 322000, Zhejiang Province, China
| | - Qing-Yun Guo
- Department of Gynecology, Women's Hospital, School of Medicine, Zhejiang University, Hangzhou 310006, Zhejiang Province, China
| | - Fang-Hong Zheng
- Department of General Surgery, The Fourth Affiliated Hospital, School of Medicine, Zhejiang University, Yiwu 322000, Zhejiang Province, China
| | - Zi-Wei Huang
- Department of General Surgery, The Fourth Affiliated Hospital, School of Medicine, Zhejiang University, Yiwu 322000, Zhejiang Province, China
| | - Jia-Lang Yan
- Department of General Surgery, The Fourth Affiliated Hospital, School of Medicine, Zhejiang University, Yiwu 322000, Zhejiang Province, China
| | - Fu-Xiang Fan
- Department of General Surgery, The Fourth Affiliated Hospital, School of Medicine, Zhejiang University, Yiwu 322000, Zhejiang Province, China
| | - Tian Liu
- Department of Intensive Care Unit, The Fourth Affiliated Hospital, School of Medicine, Zhejiang University, Yiwu 322000, Zhejiang Province, China
| | - Shun-Xian Ji
- Department of Pathology, The Fourth Affiliated Hospital, School of Medicine, Zhejiang University, Yiwu 322000, Zhejiang Province, China
| | - Xiao-Feng Zhao
- Department of Gynecology, Women's Hospital, School of Medicine, Zhejiang University, Hangzhou 310006, Zhejiang Province, China
| | - Yi-Xiong Zheng
- Department of General Surgery, The Fourth Affiliated Hospital, School of Medicine, Zhejiang University, Yiwu 322000, Zhejiang Province, China
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Ujaimi R. Adenocarcinoma in a Recurrent Retrorectal Cyst: A Case Report. Int Med Case Rep J 2021; 14:223-228. [PMID: 33854384 PMCID: PMC8039191 DOI: 10.2147/imcrj.s294090] [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: 12/14/2020] [Accepted: 03/11/2021] [Indexed: 11/25/2022] Open
Abstract
I present a case of an adenocarcinoma in a retrorectal cyst in a 63-year-old female with a prior history of a congenital cyst excised as a newborn. The patient had a resection with positive margins, followed by chemotherapy and radiotherapy at progression. Her disease did not respond to chemotherapy or radiotherapy and she died with systemic manifestations related to her disease 28 months after diagnosis.
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Affiliation(s)
- Reem Ujaimi
- Department of Radiology, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
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4
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Robotic approach to large tailgut cyst with malignant transformation: A case report. Int J Surg Case Rep 2020; 77S:S57-S60. [PMID: 33041256 PMCID: PMC7876925 DOI: 10.1016/j.ijscr.2020.09.025] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Accepted: 09/05/2020] [Indexed: 12/25/2022] Open
Abstract
Introduction Tailgut cysts (TGC) are rare congenital retrorectal lesions deriving from vestiges of the hindgut. The risk of malignant transformation is relatively high. Thus early diagnosis and a complete removal of the mass are of paramount importance. We present a case of successful robotic exeresis of a large TGC adenocarcinoma. Presentation of case A healthy 35-year-old woman was found to have a retrorectal TGC with suspected malignant transformation. The patient underwent complete robotic resection of the mass and pathology confirmed a TGC adenocarcinoma. The patient’s post-operative course was unremarkable. At 24 months, the patient has not experienced any recurrence nor complained functional disorders. Discussion The current case highlights the importance of TGC as a differential diagnosis of presacral masses, underscoring that malignant transformation can occur and may result in mortality and morbidity if radical surgery is not performed. Diagnosing TGC adenocarcinoma can be challenging because of its relatively low incidence. Biopsy is not recommended while magnetic resonance imaging (MRI) is indispensable in the evaluation of this lesion as the presence of intracystic vegetations could indicate a malignant transformation. Surgery is the mainstay of treatment and minimally invasive techniques have the potential to minimize morbidity and enhance recovery. Amongst these, the robotic approach can make the dissection of large lesions easier, reducing their manipulation and preventing nerve injuries. Conclusion Robot-assisted resection of a TGC adenocarcinoma is safe and feasible. This approach can be particularly useful in the pelvis providing acceptable functional and oncological outcomes.
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Martins P, Canotilho R, Peyroteo M, Afonso M, Moreira A, de Sousa A. Tailgut cyst adenocarcinoma. AUTOPSY AND CASE REPORTS 2019; 10:e2019115. [PMID: 32039057 PMCID: PMC6945306 DOI: 10.4322/acr.2019.115] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2018] [Accepted: 02/22/2019] [Indexed: 12/14/2022] Open
Abstract
Tailgut cysts (TGCs) are rare congenital entities arising from remnants of the embryological postanal primitive gut. Malignancy in TGCs is rare, with the majority being adenocarcinomas and carcinoid tumors. A search of the published literature yielded only 27 cases of adenocarcinoma developing in TGCs. We described the case of a 54-year-old female who presented with complaints of pelvic and perineal pain of several weeks. After the initial work-up, a mass in the right presacral location was diagnosed. She underwent radical resection of the tumor, using a posterior approach. The lesion was removed en bloc with the middle rectum, coccyx, and sacrum (S4-S5). The histopathologic examination revealed an adenocarcinoma arising in a TGC, and the patient received adjuvant chemoradiotherapy. Our case underlines that diagnosing a TGC is difficult as it is a rare congenital lesion. Clinical examination may be challenging as TGCs present with various symptoms, which can mimic other commonly proctologic disorders. Patients should be referred to a tertiary center with experience in pelvic surgery and must be managed by a multidisciplinary approach to maximize successful treatment. The recommended treatment is surgical excision given the malignant potential of TGCs and their risk of causing local complications.
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Affiliation(s)
- Pedro Martins
- Instituto Português de Oncologia do Porto Francisco Gentil, Entidade Pública Empresarial, Surgical Oncology Service. Porto, Portugal
| | - Rita Canotilho
- Instituto Português de Oncologia do Porto Francisco Gentil, Entidade Pública Empresarial, Surgical Oncology Service. Porto, Portugal
| | - Mariana Peyroteo
- Instituto Português de Oncologia do Porto Francisco Gentil, Entidade Pública Empresarial, Surgical Oncology Service. Porto, Portugal
| | - Mariana Afonso
- Instituto Português de Oncologia do Porto Francisco Gentil, Entidade Pública Empresarial, Anatomic Pathology Service. Porto, Portugal
| | - Augusto Moreira
- Instituto Português de Oncologia do Porto Francisco Gentil, Entidade Pública Empresarial, Surgical Oncology Service. Porto, Portugal
| | - Abreu de Sousa
- Instituto Português de Oncologia do Porto Francisco Gentil, Entidade Pública Empresarial, Surgical Oncology Service. Porto, Portugal
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6
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Roy SP, Khalessi A, Phan-Thien KC. Robotic resection of a multicystic tailgut cyst. BMJ Case Rep 2019; 12:12/9/e231286. [PMID: 31511270 DOI: 10.1136/bcr-2019-231286] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
A 29-year-old woman with recurrent pelvic pain that progressed post partum was diagnosed with a multicystic pararectal lesion on ultrasound and CT scan. Physiology was conducted to establish a preoperative function and pudendal nerve integrity. The lesion was resected using a Da Vinci Xi robotic system. She recovered uneventfully with complete resolution of her symptoms. Hindgut cysts most often arise in the presacral space as the result of incomplete embryogenesis. Patients may present with various non-specific symptoms. Although the majority are benign, resection is recommended, as there is a 30%-43% risk of malignancy.
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Affiliation(s)
- Susmit Prosun Roy
- Department of Medicine and Surgery, University of New South Wales - Randwick Campus, Randwick, New South Wales, Australia.,Department of General Surgery, Saint George Hospital, Kogarah, New South Wales, Australia
| | - Amirala Khalessi
- Department of Surgery, Hurstville Private, Hurstville, New South Wales, Australia
| | - Kim-Chi Phan-Thien
- Department of Colorectal Surgery, Saint George Hospital, Kogarah, New South Wales, Australia
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7
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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: 0.3] [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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8
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Kaistha S, Gangavatiker R, Harsoda R, Kinra P. A case of adenocarcinoma in a tail gut cyst and review of literature. Med J Armed Forces India 2018; 74:390-393. [PMID: 30449930 DOI: 10.1016/j.mjafi.2017.06.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2016] [Accepted: 06/06/2017] [Indexed: 01/17/2023] Open
Affiliation(s)
- Sumesh Kaistha
- Classified Specialist (Surgery & GI Surgeon), Command Hospital (Central Command), Lucknow 226002, India
| | - Rajesh Gangavatiker
- Senior Advisor (Surgery & GI Surgeon), Command Hospital, Air Force, Bangalore 560007, India
| | - Rohan Harsoda
- Graded Specialist (Surgery), 169 Military Hospital, C/O 56 APO, India
| | - Prateek Kinra
- Senior Advisor (Pathology), Armed Forces Medical College, Pune 411040, India
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9
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George M, Alina-Roxani G, Zoi T, Maria O, George C, Charalampos C. A Rare Case Report of a Tail-Gut Cyst from a Gynecological Point of View. J Family Reprod Health 2018; 12:117-120. [PMID: 30820216 PMCID: PMC6391304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
A tail-gut cyst can be often a misleading clinical entity. In half of the patients there is no presenting symptom. On the other half, the patients most commonly present with a variety of symptoms such as rectal pain, constipation, lower back pain, dysuria or dyspareunia. The recommended treatment of choice for the tail-gut cyst is complete surgical excision without rupture of the cyst. We present the case of a 29-year-old female with history of dyspareunia over a 5-month period, who discovered an "ovarian" cyst during an annual scheduled ultrasound appointment. However, the intraoperative findings were surprising. The bottomline is always to keep in mind the Pandora's Box of the retrorectal space.
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Affiliation(s)
- Maroudias George
- Department of Obstetrics and Gynecology, Attikon Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Gouloumi Alina-Roxani
- Department of Pathology, Attikon University Hospital, School of Medicine, University of Athens, Athens, Greece
| | - Tsakiraki Zoi
- Department of Pathology, Attikon University Hospital, School of Medicine, University of Athens, Athens, Greece
| | - Oikonomou Maria
- Department of Obstetrics and Gynecology, Attikon Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Chrelias George
- Department of Obstetrics and Gynecology, Attikon Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Chrelias Charalampos
- Department of Obstetrics and Gynecology, Attikon Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
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10
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Hancu D, Williams J, Kubba F, Chopada A. Unusual presentation for a tailgut cyst. BMJ Case Rep 2017; 2017:bcr-2016-217449. [PMID: 28438771 DOI: 10.1136/bcr-2016-217449] [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: 12/26/2022] Open
Abstract
A 67-year-old man with a slow-growing, asymptomatic perianal lesion was presented to the colorectal clinic. Physical examination and radiological investigation were suggestive of an externally prolapsing colonic polyp. However, intraoperative findings of a cystic lesion containing a thick brown substance questioned the initial diagnosis. After complete surgical resection of the encapsulated lesion, histological examination revealed a tailgut cyst (cystic hamartoma). These uncommon lesions originate from an embryological remnant of the hindgut. They are generally benign but may have extremely rare malignant potential which warrants complete surgical resection. Throughout the literature, they are described to present with various symptoms and may be found in several anatomical locations, most commonly within the retrorectal space. In very rare instances, with only two other documented cases, they can be found externally at the anorectal junction. Although very rare, an anal tailgut cyst should be taken into account in differential diagnosis.
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Affiliation(s)
- Daniel Hancu
- Department of General Surgery, North West London Hospitals NHS Trust, London, UK
| | - James Williams
- Department of General Surgery, North West London Hospitals NHS Trust, London, UK
| | - Faris Kubba
- Department of Pathology, North West London Hospitals NHS Trust, London, UK
| | - Abhay Chopada
- Department of General Surgery, North West London Hospitals NHS Trust, London, UK
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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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12
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Sheikh AA, Rotimi O, Jacob D, Hyland R, Sagar PM. Transitional cell carcinoma arising in a tailgut cyst. J Surg Case Rep 2015. [PMID: 26217002 PMCID: PMC4515855 DOI: 10.1093/jscr/rjv085] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
Malignant transformation in tailgut cysts (TGCs) is extremely rare, with no reports of transitional cell carcinoma arising in them in the UK literature. Here, we discuss a case of a patient with a malignant TGC encapsulating the rectum. This case report highlights the pathological and diagnostic considerations and discusses its management.
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Affiliation(s)
- Adnan A Sheikh
- The John Goligher Colorectal Surgery Unit, St James University Hospital, Leeds LS9 7TF, UK
| | - Olorundi Rotimi
- The John Goligher Colorectal Surgery Unit, St James University Hospital, Leeds LS9 7TF, UK
| | - Deepa Jacob
- The John Goligher Colorectal Surgery Unit, St James University Hospital, Leeds LS9 7TF, UK
| | - Racheal Hyland
- The John Goligher Colorectal Surgery Unit, St James University Hospital, Leeds LS9 7TF, UK
| | - Peter M Sagar
- The John Goligher Colorectal Surgery Unit, St James University Hospital, Leeds LS9 7TF, UK
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