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Bilkhu AS, Wild J, Sagar PM. Management of retrorectal tumours. Br J Surg 2024; 111:znae012. [PMID: 38291005 DOI: 10.1093/bjs/znae012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Revised: 01/06/2024] [Accepted: 01/10/2024] [Indexed: 02/01/2024]
Affiliation(s)
- Amarvir S Bilkhu
- Colorectal & Peritoneal Oncology, The Christie Foundation NHS Trust, Manchester, UK
| | - Jonathan Wild
- Colorectal & Peritoneal Oncology, The Christie Foundation NHS Trust, Manchester, UK
| | - Peter M Sagar
- John Goligher Unit, Leeds Teaching Hospitals NHS Trust, Leeds, UK
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2
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Galán C, Hernández MP, Martínez MC, Sánchez A, Bollo J, Targarona EM. Surgical treatment of retrorectal tumors: a plea for a laparoscopic approach. Surg Endosc 2023; 37:9080-9088. [PMID: 37798533 PMCID: PMC10709236 DOI: 10.1007/s00464-023-10448-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Accepted: 09/05/2023] [Indexed: 10/07/2023]
Abstract
INTRODUCTION Retrorectal tumors (RRTs) are rare and often surgically excised due to the risk of malignant degeneration and compressive or obstructive symptoms. The approach for excision has traditionally been based on tumor location and performed using either a transabdominal or perineal approach depending on the position of the tumor. The advent of minimally invasive surgery, however, has challenged this paradigm. Here, we determined the applicability and potential advantages of a laparoscopic transabdominal approach in a series of 23 patients with RRTs. MATERIAL AND METHODS We included 23 patients presenting with RRTs treated at the Surgical Gastrointestinal Unit at Hospital de Sant Pau that were registered prospectively since 1998. The preoperative evaluation consisted of colonoscopy, CT scan and/or MRI, mechanical bowel lavage, and antibiotic therapy. Signed consent was obtained from all patients for a laparoscopic transabdominal approach unless the tumor was easily accessible via a perineal approach. In case of recurrence, a transanal endoscopic microsurgery (TEM) approach was considered. Surgical details, immediate morbidity, and short- and long-term outcomes were recorded. RESULTS Of the 23 RRT cases evaluated, 16 patients underwent a laparoscopic transabdominal approach and 6 underwent a perineal approach. No patients required conversion to open surgery. In the laparoscopic transabdominal group, the mean operating time was 158 min, the average postoperative hospital stay was 5 days, and postoperative morbidity was 18%. Three patients had recurrent RRTs, two of the three underwent surgical reintervention. The third patient was radiologically stable and close follow-up was decided. CONCLUSION Our results show that laparoscopic transabdominal excision of RRT is a safe and effective technique, offering the potential advantages of less invasive access and reduced morbidity. This approach challenges the traditional paradigm of excision of these infrequent tumors based solely on tumor location and offers a viable alternative for the treatment of these infrequent tumors.
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Affiliation(s)
- Clara Galán
- Unit of Gastrointestinal Surgery, Service of Surgery, Hospital de Sant Pau, Autonomous University of Barcelona, Barcelona, Spain
| | - M Pilar Hernández
- Unit of Gastrointestinal Surgery, Service of Surgery, Hospital de Sant Pau, Autonomous University of Barcelona, Barcelona, Spain
- Institute for Biomedical Research, Hospital de Sant Pau (IIB Sant Pau), Barcelona, Spain
| | - M Carmen Martínez
- Unit of Gastrointestinal Surgery, Service of Surgery, Hospital de Sant Pau, Autonomous University of Barcelona, Barcelona, Spain
- Institute for Biomedical Research, Hospital de Sant Pau (IIB Sant Pau), Barcelona, Spain
| | - Anna Sánchez
- Unit of Gastrointestinal Surgery, Service of Surgery, Hospital de Sant Pau, Autonomous University of Barcelona, Barcelona, Spain
- Institute for Biomedical Research, Hospital de Sant Pau (IIB Sant Pau), Barcelona, Spain
| | - Jesús Bollo
- Unit of Gastrointestinal Surgery, Service of Surgery, Hospital de Sant Pau, Autonomous University of Barcelona, Barcelona, Spain
- Institute for Biomedical Research, Hospital de Sant Pau (IIB Sant Pau), Barcelona, Spain
| | - Eduardo Mª Targarona
- Unit of Gastrointestinal Surgery, Service of Surgery, Hospital de Sant Pau, Autonomous University of Barcelona, Barcelona, Spain.
- Institute for Biomedical Research, Hospital de Sant Pau (IIB Sant Pau), Barcelona, Spain.
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3
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Bulisani BM, Gomes LGL, Leite MADO, Moreno R, Rodrigues MR, Rossi FMB, Silva RBFD, Carmo LCBD, Waisberg J. Robotic approach to remove four tailgut cyst cases in Brazil: a case series. EINSTEIN-SAO PAULO 2023; 21:eRC0544. [PMID: 37970955 DOI: 10.31744/einstein_journal/2023rc0544] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Accepted: 08/14/2023] [Indexed: 11/19/2023] Open
Abstract
Tailgut cysts are rare congenital lesions that are remnants of the embryonic hindgut. This abnormality presents with non-specific symptoms or no symptoms; therefore, misdiagnosis is common. Here, we present four cases of tailgut cysts that were successfully removed using a robotic surgical approach. A 42-year-old woman with tenesmus, pain in the right gluteal region, and discomfort in the rectal region during evacuation was referred to our medical center. Another patient was a 28-year-old woman who presented with the same symptoms to our general practitioner. Both patients underwent upper abdominal and pelvic magnetic resonance imaging that revealed a tailgut cyst. Further, a 36-year-old woman was referred with coccyx and hypogastric pain. Magnetic resonance imaging revealed two pararectal cystic formations. She underwent robot-assisted surgery, and after analysis by a pathologist, the conclusion was that the tailgut cyst was associated with scarring fibrosis. A 55-year-old woman with posterior epigastric pelvic pain associated with heartburn underwent robot-assisted surgery to resect a retroperitoneal tumor. These cases highlighted the importance of tailgut cysts in the differential diagnosis of rectal lesions. Surgical treatment is preferred because malignant transformations can occur. The difference between laparoscopic and robotic approaches is the better visualization and stability of the latter, inducing less tissue damage. Robotic resection is a safe procedure, especially in patients with a narrow pelvis, because it reduces tissue damage.
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Affiliation(s)
| | | | | | - Ricardo Moreno
- RR Médicos Cirurgiões , São Bernardo do Campo , SP , Brazil
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4
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Rodrigo-Calvo M, Archilla I, Alos S, Vidal-Robau N, Saez de Gordoa K, Moreno J, Sendino O, Cuatrecasas M. Retrorectal hamartoma cyst (tailgut cyst) in a young man. GASTROENTEROLOGIA Y HEPATOLOGIA 2023; 46:466-467. [PMID: 35718015 DOI: 10.1016/j.gastrohep.2022.06.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Revised: 05/31/2022] [Accepted: 06/09/2022] [Indexed: 05/24/2023]
Affiliation(s)
- Maite Rodrigo-Calvo
- Department of Pathology, Hospital Clínic, University of Barcelona, IDIBAPS, Barcelona, Spain
| | - Ivan Archilla
- Department of Pathology, Hospital Clínic, University of Barcelona, IDIBAPS, Barcelona, Spain
| | - Silvia Alos
- Department of Pathology, Hospital Clínic, University of Barcelona, IDIBAPS, Barcelona, Spain
| | - Nuria Vidal-Robau
- Department of Pathology, Hospital Clínic, University of Barcelona, IDIBAPS, Barcelona, Spain
| | - Karmele Saez de Gordoa
- Department of Pathology, Hospital Clínic, University of Barcelona, IDIBAPS, Barcelona, Spain
| | - Julián Moreno
- Radiology Department, Hospital Clínic, Barcelona, Spain
| | - Oriol Sendino
- Gastroenterology Department, Hospital Clínic, Barcelona, Spain; Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain; Universitat de Barcelona (UB), Barcelona, Catalonia, Spain; Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Spain
| | - Miriam Cuatrecasas
- Department of Pathology, Hospital Clínic, University of Barcelona, IDIBAPS, Barcelona, Spain; Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain; Universitat de Barcelona (UB), Barcelona, Catalonia, Spain; Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Spain.
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5
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Deniz GI, Akyel R, Akgun E, Taskın OC, Kapran Y. Neuroendocrine Tumor of Tailgut Cyst with Unexpected Metastases. Nucl Med Mol Imaging 2022; 56:323-327. [PMID: 36425276 PMCID: PMC9679128 DOI: 10.1007/s13139-022-00775-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Revised: 09/13/2022] [Accepted: 09/14/2022] [Indexed: 11/26/2022] Open
Abstract
Neuroendocrine tumors (NETs) originate from the neuroendocrine cells, which are found in various organs. NETs occur frequently in the gastrointestinal tract. NETs arising from tailgut cysts are uncommon. We herein report an interesting case of metastatic tailgut cyst NET, which was firstly diagnosed as plasmacytoma.
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Affiliation(s)
| | - Resit Akyel
- Department of Nuclear Medicine, Yedikule Pulmonary Diseases and Thoracic Surgery Education and Research Hospital, University of Health Sciences Turkey, Istanbul, Turkey
| | - Elife Akgun
- Department of Nuclear Medicine, Basaksehir Cam and Sakura City Hospital, University of Health Sciences Turkey, Istanbul, Turkey
| | - Orhun Cıg Taskın
- Department of Pathology, Koc University School of Medicine, Istanbul, Turkey
| | - Yersu Kapran
- Department of Pathology, Koc University School of Medicine, Istanbul, Turkey
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6
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Gong J, Xu Y, Zhang Y, Qiao L, Xu H, Zhu P, Yang B. Primary malignant tumours and malignant transformation of cysts in the retrorectal space: MRI diagnosis and treatment outcomes. Gastroenterol Rep (Oxf) 2022; 10:goac048. [PMID: 36157328 PMCID: PMC9491843 DOI: 10.1093/gastro/goac048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2022] [Revised: 06/11/2022] [Accepted: 07/08/2022] [Indexed: 12/02/2022] Open
Abstract
Background There are no clear guidelines for the diagnosis and treatment of malignant retrorectal tumours. The purpose of this study was to increase preoperative diagnostic knowledge and to describe the outcomes of treatment for these patients. Methods This retrospective study was conducted on patients who underwent complete retrorectal tumour resection between May 2006 and July 2018, and had confirmed post-operative pathology reports. Demographic and clinical data (including imaging, perioperative, pathological, and prognostic data) were collected and analysed. Results Malignant lesions were identified in 15 (9 [60%], female) patients. The median age of the patients was 59 years (range, 34–72 years). Primary malignant tumours were identified in seven patients with solid tumours, in which gastrointestinal stromal tumours accounted for 71.4% (five of seven) and the remainder were chordoma or mucinous adenocarcinoma. Malignant transformation of cysts occurred in another eight patients with heterogeneous tumours, while histopathological features were present in 75% (six of eight) of patients with mucinous adenocarcinoma, and the remainder were squamous-cell carcinoma or neuroendocrine tumour (Grade 2). The malignant characteristics of the solid portions observed using magnetic resonance imaging (MRI) were as follows: the cyst wall of the tumour was irregularly thickened; the surface was convex or lobed; the solid tumour had no capsule, or the capsule was destroyed; and the surface had a gyrus-like morphology. At a median follow-up time of 52 months (range, 13–100 months), the overall recurrence-free survival rate was 40.0% and the survival rate was 46.7%. Conclusion Some MRI features can be used to distinguish malignant retrorectal tumours from benign retrorectal tumours. The survival rate of patients with malignant retrorectal tumours is poor.
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Affiliation(s)
- Jing Gong
- Department of Colorectal Surgery, Jiangsu Province Hospital of Chinese Medicine, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, Jiangsu, P. R. China.,First Clinical Medical College, Nanjing University of Chinese Medicine, Nanjing, Jiangsu, P. R. China
| | - Yumeng Xu
- Department of Colorectal Surgery, Jiangsu Province Hospital of Chinese Medicine, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, Jiangsu, P. R. China.,First Clinical Medical College, Nanjing University of Chinese Medicine, Nanjing, Jiangsu, P. R. China
| | - Yan Zhang
- Department of Colorectal Surgery, Jiangsu Province Hospital of Chinese Medicine, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, Jiangsu, P. R. China.,First Clinical Medical College, Nanjing University of Chinese Medicine, Nanjing, Jiangsu, P. R. China
| | - Lichao Qiao
- Department of Colorectal Surgery, Jiangsu Province Hospital of Chinese Medicine, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, Jiangsu, P. R. China.,First Clinical Medical College, Nanjing University of Chinese Medicine, Nanjing, Jiangsu, P. R. China
| | - Haixia Xu
- Department of Colorectal Surgery, Jiangsu Province Hospital of Chinese Medicine, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, Jiangsu, P. R. China.,First Clinical Medical College, Nanjing University of Chinese Medicine, Nanjing, Jiangsu, P. R. China
| | - Ping Zhu
- Department of Colorectal Surgery, Jiangsu Province Hospital of Chinese Medicine, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, Jiangsu, P. R. China
| | - Bolin Yang
- Department of Colorectal Surgery, Jiangsu Province Hospital of Chinese Medicine, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, Jiangsu, P. R. China
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7
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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: 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: 04/23/2022] [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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8
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Aldave D, Teijo A, Abril C, Cerezo L. Squamous cell carcinoma arising in a tailgut cyst: role of radiotherapy. BMJ Case Rep 2022. [PMCID: PMC9445786 DOI: 10.1136/bcr-2021-247985] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Tailgut cysts (TGCs) are rare tumours which can undergo malignant transformation. The gold standard of treatment is complete surgical excision. Multidisciplinary assessment is advisable in order to apply adjuvant treatment. Postoperative radiotherapy should be given in case of compromised surgical margins or other factors such as high histological grade or perineural and lymphovascular invasion. Here, we present a case of a squamous cell carcinoma arising from a retrorectal TGC treated with surgery and postoperative radiotherapy and review the main indications and techniques of this therapy.
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Affiliation(s)
- Diego Aldave
- Radiation Oncology, Hospital Universitario de la Princesa, Madrid, Spain
| | - Ana Teijo
- Pathology, Hospital Universitario 12 de Octubre, Madrid, Spain
- Pathology, MD Anderson Madrid, Madrid, Spain
| | - Claudia Abril
- Pathology, Hospital Virgen de la Salud, Toledo, Spain
| | - Laura Cerezo
- Radiation Oncology, Hospital Universitario de la Princesa, Madrid, Spain
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9
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Di Nuzzo MM, De Werra C, Pace M, Franca RA, D’Armiento M, Bracale U, Lionetti R, D’Ambra M, Calogero A. Promoting Laparoscopic Anterior Approach for a Very Low Presacral Primary Neuroendocrine Tumor Arising in a Tailgut Cyst. Healthcare (Basel) 2022; 10:healthcare10050805. [PMID: 35627942 PMCID: PMC9141776 DOI: 10.3390/healthcare10050805] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Revised: 04/13/2022] [Accepted: 04/25/2022] [Indexed: 02/07/2023] Open
Abstract
Background: Tailgut cysts are rare congenital lesions that develop in the presacral space. As they can potentially conceal primary neuroendocrine tumors, surgical excision is suggested as the treatment of choice. However, specific management guidelines have yet to be developed. A posterior approach is usually preferred for cysts extending to the third sacral vertebral body. Conversely, a transabdominal approach is preferred for lesions extending upward to achieve an optimal view of the surgical field and avoid injuries. Case report: Here, we report a case of a 48-year-old man suffering from perianal pain and constipation. Digital rectal examination and magnetic resonance imaging revealed a presacral mass below the third sacral vertebral body. A laparoscopic transabdominal presacral tumor excision was performed. The final histological diagnosis was a rare primary neuroendocrine tumor arising from a tailgut cyst. The postoperative course was uneventful, and no signs of recurrence were observed at the six-month follow-up. Conclusions: This study may help establish more well-grounded recommendations for the surgical management of rectal tumors, demonstrating that the laparoscopic transabdominal technique is safe and feasible, even for lesions below the third sacral vertebral body. This approach provided an adequate view of the presacral space, facilitating the preservation of cyst integrity, which is essential in cases of malignant pathologies.
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Affiliation(s)
- Maria Michela Di Nuzzo
- Department of Public Health, University of Naples Federico II, 80138 Naples, Italy; (C.D.W.); (M.D.); (U.B.); (R.L.); (M.D.); (A.C.)
- Correspondence: ; Tel.: +39-33-8936-9828
| | - Carlo De Werra
- Department of Public Health, University of Naples Federico II, 80138 Naples, Italy; (C.D.W.); (M.D.); (U.B.); (R.L.); (M.D.); (A.C.)
| | - Mirella Pace
- Department of Biomorfological and Functional Sciences, University of Naples Federico II, 80138 Naples, Italy; (M.P.); (R.A.F.)
| | - Raduan Ahmed Franca
- Department of Biomorfological and Functional Sciences, University of Naples Federico II, 80138 Naples, Italy; (M.P.); (R.A.F.)
| | - Maria D’Armiento
- Department of Public Health, University of Naples Federico II, 80138 Naples, Italy; (C.D.W.); (M.D.); (U.B.); (R.L.); (M.D.); (A.C.)
| | - Umberto Bracale
- Department of Public Health, University of Naples Federico II, 80138 Naples, Italy; (C.D.W.); (M.D.); (U.B.); (R.L.); (M.D.); (A.C.)
| | - Ruggero Lionetti
- Department of Public Health, University of Naples Federico II, 80138 Naples, Italy; (C.D.W.); (M.D.); (U.B.); (R.L.); (M.D.); (A.C.)
| | - Michele D’Ambra
- Department of Public Health, University of Naples Federico II, 80138 Naples, Italy; (C.D.W.); (M.D.); (U.B.); (R.L.); (M.D.); (A.C.)
| | - Armando Calogero
- Department of Public Health, University of Naples Federico II, 80138 Naples, Italy; (C.D.W.); (M.D.); (U.B.); (R.L.); (M.D.); (A.C.)
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10
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Broccard SP, Colibaseanu DT, Behm KT, Mishra N, Davis P, Maimone KL, Mathis KL, Stocchi L, Dozois EJ, Merchea A. Risk of malignancy and outcomes of surgically resected presacral tailgut cysts: A current review of the Mayo Clinic experience. Colorectal Dis 2022; 24:422-427. [PMID: 34941020 DOI: 10.1111/codi.16030] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Revised: 11/11/2021] [Accepted: 12/01/2021] [Indexed: 02/08/2023]
Abstract
AIM The aim of this study was to describe the surgical management, outcomes and risk of malignancy of presacral tailgut cysts. METHOD A retrospective analysis of all patients who underwent resection of tailgut cyst at Mayo Clinic in Arizona, Florida and Minnesota between 2008 and 2020 was performed. Demographics, presentation, evaluation, surgical approach, postoperative complications, pathology and recurrence rates were reviewed. RESULTS Seventy-three patients were identified (81% female) with a mean age of 45 years. Thirty-nine patients (53%) were symptomatic, most commonly with pelvic pain (26 patients). Digital rectal examination identified a palpable mass in 68%. Mean tumour size was 6 cm. Resection was primarily performed through a posterior approach (77%, n = 56), followed by a transabdominal approach (18%, n = 13) and a combined approach (5%, n = 4). Six patients underwent a minimally invasive resection (laparoscopic/robotic). Coccygectomy or distal sacrectomy was performed in 41 patients (56%). Complete resection was achieved in 94% of patients. Thirty-day morbidity occurred in 18% and was most commonly wound related; there was no mortality. Malignancy was identified in six patients (8%). For the 30 patients with follow-up greater than 1 year, the median follow-up was 39 months (range 1.0-11.1 years). Local recurrence was identified in three patients and distant metastatic disease in one patient. CONCLUSION The rate of malignancy in presacral tailgut cysts based on this current review was 8%. Overall recurrence was 5% at a median of 24 months.
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Affiliation(s)
- Sacha P Broccard
- Division of Colon and Rectal Surgery, Mayo Clinic, Jacksonville, Florida, USA
| | - Dorin T Colibaseanu
- Division of Colon and Rectal Surgery, Mayo Clinic, Jacksonville, Florida, USA
| | - Kevin T Behm
- Division of Colon and Rectal Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Nitin Mishra
- Division of Colon and Rectal Surgery, Mayo Clinic, Scottsdale, Arizona, USA
| | - Peter Davis
- Division of Colon and Rectal Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Kristi L Maimone
- Division of Colon and Rectal Surgery, Mayo Clinic, Jacksonville, Florida, USA
| | - Kellie L Mathis
- Division of Colon and Rectal Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Luca Stocchi
- Division of Colon and Rectal Surgery, Mayo Clinic, Jacksonville, Florida, USA
| | - Eric J Dozois
- Division of Colon and Rectal Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Amit Merchea
- Division of Colon and Rectal Surgery, Mayo Clinic, Jacksonville, Florida, USA
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11
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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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12
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Mastoraki A, Giannakodimos I, Panagiotou K, Frountzas M, Chrysikos D, Kykalos S, Theodoropoulos GE, Schizas D. Epidemiology, diagnostic approach and therapeutic management of tailgut cysts: A systematic review. Int J Clin Pract 2021; 75:e14546. [PMID: 34137134 DOI: 10.1111/ijcp.14546] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Accepted: 06/16/2021] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Tailgut cysts (TGCs) are benign congenital abnormalities that usually present with non-specific symptoms, constituting a diagnostic dilemma for physicians. The aim of this study was to systematically review the literature concerning clinical manifestations, diagnostic modalities and histologic findings of TGCs and highlight current knowledge on therapeutic management of this rare entity. METHODS PubMed and Embase databases were systematically searched by two independent investigators (last search 18 February 2021) for studies concerning TGCs published in the past two decades. RESULTS Totally, 144 articles, including 135 case reports and 9 case series, met our inclusion criteria. One hundred eighty-four patients were included (3:1/female:male) with an age of 42.3 ± 18.7 years (mean, SD), while 5 cases concerned new-born infants. Pain was the prevailing clinical manifestation (41.8%), whereas 16.8% were asymptomatic. MRI and CT were utilized for diagnosis in 58.7% and 54.7% of cases, respectively. The majority of cysts were multilocular, while ciliated columnar epithelium and smooth muscles of the cyst wall were the prevailed histological findings. Malignant degeneration of TGCs was reported in 32.1% of cases, while carcinoid tumours were the most frequent malignancies. Surgical resection was performed in 155 cases, while laparoscopic and robotic approach was preferred in 18 and 2 cases, respectively. A posterior approach was implemented in 80.9%, anterior technique in 9% and combined technique in 6.7% of cases. Postoperative complications and recurrence of the cystic lesion were reported in 17.4% and 7.6% of cases, respectively. CONCLUSIONS TGCs constitute a dilemma for the physicians. Surgical resection comprises the ultimate treatment to avoid complications or malignant transformation of the cyst. Concrete follow-up strategies and optimal therapeutic options should be outlined through consensus guidelines and at the time being, such decisions can be made only on the basis of extrapolation and on a case-by-case approach.
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Affiliation(s)
- Aikaterini Mastoraki
- First Department of Surgery, National and Kapodistrian University of Athens, Laikon General Hospital, Athens, Greece
| | - Ilias Giannakodimos
- First Department of Surgery, National and Kapodistrian University of Athens, Laikon General Hospital, Athens, Greece
| | - Karmia Panagiotou
- First Department of Surgery, National and Kapodistrian University of Athens, Laikon General Hospital, Athens, Greece
| | - Maximos Frountzas
- First Propaedeutic Department of Surgery, National and Kapodistrian University of Athens, Hippocration General Hospital, Athens, Greece
| | - Dimosthenis Chrysikos
- Department of Anatomy and Surgical Anatomy, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Stylianos Kykalos
- Second Propaedeutic Department of Surgery, National and Kapodistrian University of Athens, Laikon General Hospital, Athens, Greece
| | - Georgios E Theodoropoulos
- First Propaedeutic Department of Surgery, National and Kapodistrian University of Athens, Hippocration General Hospital, Athens, Greece
| | - Dimitrios Schizas
- First Department of Surgery, National and Kapodistrian University of Athens, Laikon General Hospital, Athens, Greece
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Glyn T, Sagar P, Frizelle F. Re: Malignant transformation of tailgut cysts is significantly higher than previously reported: Systematic review of cases in the literature. Colorectal Dis 2021; 23:3027. [PMID: 34510701 DOI: 10.1111/codi.15908] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2021] [Accepted: 06/17/2021] [Indexed: 02/08/2023]
Affiliation(s)
- Tamara Glyn
- Christchurch Public Hospital, Christchurch, New Zealand.,University of Otago, Christchurch, New Zealand
| | | | - Frank Frizelle
- Christchurch Public Hospital, Christchurch, New Zealand.,University of Otago, Christchurch, New Zealand
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Surgical Management of Retrorectal Tumors: A French Multicentric Experience of 270 Consecutives Cases. Ann Surg 2021; 274:766-772. [PMID: 34334645 DOI: 10.1097/sla.0000000000005119] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To report the largest multicentric experience on surgical management of retrorectal tumors (RRT). SUMMARY BACKGROUND DATA Literature data on RRT is limited. There is no consensus concerning the best surgical approach for the management of RRT. METHODS Patients operated for RRT in 18 academic French centers were retrospectively included (2000-2019). RESULTS 270 patients were included. Surgery was performed through abdominal (n=72, 27%), bottom (n=190, 70%) or combined approach (n=8, 3%). Abdominal approach was laparoscopic in 53/72 (74%) and bottom approach was a Kraske modified procedures in 169/190 (89%) patients. In laparoscopic abdominal group, tumors were more frequently symptomatic (37/53, 70% vs 88/169, 52%, p=0.02), larger (mean diameter = 60.5 ± 24 (range, 13-107) vs 51 ± 26 (20-105) mm, p=0.02) and located above S3 vertebra (n=3/42, 7% vs 0, p=0.001) than those from Kraske modified group. Laparoscopy was associated with a higher risk of postoperative ileus (n=4/53, 7.5% vs 0%, p=0.002) and rectal fistula (n=3/53, 6% vs 0%, p=0.01) but less wound abscess (n=1/53, 2% vs 24/169, 14%, p=0.02) than Kraske modified procedures. RRT was malignant in 8%. After a mean follow up of 27 ±39 (1-221) months, local recurrence was noted in 8% of the patients. After surgery, chronic pain was observed in 17% of the patients without significant difference between the 2 groups (15/74, 20% vs 3/30, 10%; p=0.3). CONCLUSIONS Both laparoscopic and Kraske modified approaches can be used for surgical treatment of RRT (according to their location and their size), with similar long-term results.
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15
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Kardoun N, Hadrich Z, Akrout A, Harbi H, Boujelben S, Mzali R. Tailgut cyst: 2 case reports. Clin Case Rep 2021; 9:e04490. [PMID: 34295496 PMCID: PMC8283855 DOI: 10.1002/ccr3.4490] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Revised: 06/02/2021] [Accepted: 06/03/2021] [Indexed: 02/02/2023] Open
Abstract
Tailgut cysts, or retrorectal cystic hamartomas, are rare congenital developmental lesions. It is a benign lesion, but there is a risk of degeneration, so surgical resection is necessary.
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Affiliation(s)
- Nizar Kardoun
- Departement of SurgeryHabib Bourguiba HospitalSfaxTunisia
- Faculty of Médecine of SfaxSfaxTunisia
| | - Zied Hadrich
- Departement of SurgeryHabib Bourguiba HospitalSfaxTunisia
- Faculty of Médecine of SfaxSfaxTunisia
| | - Amira Akrout
- Departement of SurgeryHabib Bourguiba HospitalSfaxTunisia
- Faculty of Médecine of SfaxSfaxTunisia
| | - Houssem Harbi
- Departement of SurgeryHabib Bourguiba HospitalSfaxTunisia
- Faculty of Médecine of SfaxSfaxTunisia
| | - Salah Boujelben
- Departement of SurgeryHabib Bourguiba HospitalSfaxTunisia
- Faculty of Médecine of SfaxSfaxTunisia
| | - Rafik Mzali
- Departement of SurgeryHabib Bourguiba HospitalSfaxTunisia
- Faculty of Médecine of SfaxSfaxTunisia
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Ross L, Adams E, Parrish A, Zhai J, Chithriki M, Magner D, Johnson P. Coccygectomy a novel and definitive approach to surgical treatment of a tailgut cyst. INTERDISCIPLINARY NEUROSURGERY 2021. [DOI: 10.1016/j.inat.2021.101093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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17
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Li Z, Lu M. Presacral Tumor: Insights From a Decade's Experience of This Rare and Diverse Disease. Front Oncol 2021; 11:639028. [PMID: 33796466 PMCID: PMC8008122 DOI: 10.3389/fonc.2021.639028] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Accepted: 02/01/2021] [Indexed: 12/13/2022] Open
Abstract
Background Presacral tumors are a group of rare and heterogeneous tumors that arise from the potential presacral space between the rectum and sacrum. The low occurrence and diverse origins make the diagnosis and treatment of these tumors a challenge. The aim of the study was to retrospectively review patient demographics and to identify advantages and disadvantages in the diagnosis and treatment of these tumors. Methods Retrospectively collected and reviewed data from patients who received treatment of presacral tumors at the First Affiliated Hospital of China Medical University between August 2009 and June 2019. Results The data from forty-four patients (33 females) with a median age of 50 years who were diagnosed with a presacral/retrorectal tumor were analyzed. The majority of tumors were congenital (61.4%) and benign tumors are more common (59.1%). The median age of patients with benign tumor was significantly higher than that of malignant tumor. The most common symptoms were sacrococcygeal/perianal pain (56.8%) and mass (36.4%), and 8 out of 9 patients having lower limb symptoms diagnosed with malignant tumor. The tumor detection rate of digital rectal examination was 75% and more than 90% of all patients underwent one or more radiology imaging exams for tumor diagnosis. Every patient had a biopsy result. The most common type of tumor was presacral cyst (40.9%) with overall tumor median size of 5.6 cm. Thirty-one (70.5%) patients underwent surgery, most often via the posterior route (83.9%). Posterior route surgery had significantly shorter operation time and tumors operated via posterior route were significantly smaller. The survival rate after surgery was 100%. The median course of disease was 6 months and median follow-up was 25 months. Conclusions Presacral tumors have low occurrence and are more frequently observed in females in their 30s and 50s indicating a possible link between tumor occurrence and hormonal changes. Patients with lower limb symptoms were more likely to have a malignant presacral tumor. Posterior route was the most commonly utilized surgical approach. Supplementary iodine tincture treatment of cysts ruptured in operation could potentially be helpful in reducing the chance of recurrence.
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Affiliation(s)
- Zeyu Li
- Department of Colorectal Surgery, First Affiliated Hospital of China Medical University, Shenyang, China.,Department of General Surgery, Shengjing Hospital of China Medical University, Shenyang, China
| | - Min Lu
- Department of Colorectal Surgery, First Affiliated Hospital of China Medical University, Shenyang, China
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18
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19
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Rompen IF, Scheiwiller A, Winiger A, Metzger J, Gass JM. Robotic-Assisted Laparoscopic Resection of Tailgut Cysts. JSLS 2021; 25:JSLS.2021.00035. [PMID: 34354334 PMCID: PMC8325480 DOI: 10.4293/jsls.2021.00035] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Introduction: Tailgut cysts are rare remnants of the embryological hindgut. Resections are difficult to perform due to the narrow and delicate presacral space where they are usually located. Many different approaches have been described, but to date, no studies have been performed concerning robotic assisted surgery for this entity. Therefore, we conducted a retrospective analysis to evaluate the feasibility and outcome parameters of the robotic anterior approach for resection of tailgut cysts and to compare our results with available literature. Material and Methods: Data was retrospectively obtained from hospital records of all patients who underwent robotic assisted resection of tailgut cysts between January 1, 2017 and June 30, 2020. Outcomes include baseline characteristics, pre-operative radiological workup, operative time, intra- and postoperative complications, and histopathological results. Results: Between January 1, 2017 and June 30, 2020, five patients underwent robotic resection of tailgut cysts. All patients were female and mean age was 47.2 years (range 31.6–63.1 years). Only one patient reported to have local symptoms that could be attributed to the tailgut cyst. Median tumor size was 42 mm (range 30–64 mm). There was no conversion and median operating time was 235 minutes (range 184–331 minutes). Four patients had additional procedures. Intra- and postoperative complications included one intra-operative injury of the rectal wall, which was immediately oversewn, and one postoperative presacral hematoseroma with mild neurological symptoms. None of the specimens showed signs of malignant transformation in histopathological workup. Conclusion: This retrospective analysis shows that robotic resections of tailgut cysts are feasible and safe. Regarding the localization of tailgut cysts in the presacral space, the robotic assisted anterior approach is excellently suited, especially if the cysts are localized above the levator muscle. Longer operative times and higher material costs are outweighed by precise and safe preparation with a robotic platform in this delicate region and confined space. We recommend the robotic assisted anterior approach for the resection of tailgut cysts and retrorectal lesions in general.
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Affiliation(s)
- Ingmar F Rompen
- Department of General Surgery, Cantonal Hospital of Lucerne, Lucerne, Switzerland
| | - Andreas Scheiwiller
- Department of General Surgery, Cantonal Hospital of Lucerne, Lucerne, Switzerland
| | - Alain Winiger
- Department of Radiology, Cantonal Hospital of Lucerne, Lucerne, Switzerland
| | - Jürg Metzger
- Department of General Surgery, Cantonal Hospital of Lucerne, Lucerne, Switzerland
| | - Jörn-Markus Gass
- Department of General Surgery, Cantonal Hospital of Lucerne, Lucerne, Switzerland
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20
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Murphy A, O'Sullivan H, Stirling A, Fenlon H, Cronin C. Integrated multimodality and multi-disciplinary team approach to pre-sacral lesions. Clin Imaging 2020; 67:255-263. [DOI: 10.1016/j.clinimag.2020.08.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Revised: 07/28/2020] [Accepted: 08/18/2020] [Indexed: 01/17/2023]
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21
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Carpelan-Holmström M, Koskenvuo L, Haapamäki C, Renkonen-Sinisalo L, Lepistö A. Clinical management of 52 consecutive retro-rectal tumours treated at a tertiary referral centre. Colorectal Dis 2020; 22:1279-1285. [PMID: 32336000 DOI: 10.1111/codi.15080] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2019] [Accepted: 04/01/2020] [Indexed: 12/12/2022]
Abstract
AIM The aim of this single-institution study was to analyse the diagnostic methods, preoperative work-up and outcomes of 52 retro-rectal tumours. METHOD All patients treated for retro-rectal tumours from 2012 to 2017 were included. RESULTS Out of 52 patients, 40 (77%) were women. The median age of patients at the time of surgery was 43 (19-76) years, and 30 (58%) were asymptomatic at the time of diagnosis. All tumours were visible on magnetic resonance imaging (MRI) prior to surgery. The sensitivity and specificity for predicting malignancy on preoperative imaging for retro-rectal tumours were 25% and 98%, respectively. Forty-four procedures (85%) were performed using the perineal approach. The median hospital stay was 3 (1-18) days. There was no 30-day postoperative mortality. Eleven (21%) patients developed postoperative complications, mostly surgical site infections. Twenty-nine tumours (56%) were benign tailgut cysts. Four (8%) tumours were malignant and were considered to be removed with a tumour-free resection margin. Local recurrent disease was detected on MRI in 14 (27%) patients at a median of 1.05 (range 0.78-1.77) years after primary surgery. Only the multi-lobular shape of the tumour was found to be an independent risk factor for recurrence (P = 0.030). CONCLUSION A preoperative MRI is mandatory in order to plan the surgical strategy for retro-rectal tumours. Symptomatic, solid, large tumours should be removed because of the risk of malignancy. Minor cystic lesions with thin walls as well as asymptomatic recurrences of benign tumours are suitable to be followed conservatively.
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Affiliation(s)
- M Carpelan-Holmström
- Department of Colorectal Surgery, Helsinki University Hospital, Helsinki, Finland
| | - L Koskenvuo
- Department of Colorectal Surgery, Helsinki University Hospital, Helsinki, Finland
| | - C Haapamäki
- Department of Colorectal Surgery, Helsinki University Hospital, Helsinki, Finland
| | - L Renkonen-Sinisalo
- Department of Colorectal Surgery, Helsinki University Hospital, Helsinki, Finland
| | - A Lepistö
- Department of Colorectal Surgery, Helsinki University Hospital, Helsinki, Finland
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22
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Merchea A. Role of preoperative biopsy in the management of presacral tumors. SEMINARS IN COLON AND RECTAL SURGERY 2020. [DOI: 10.1016/j.scrs.2020.100761] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
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23
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Brown KG, Lee PJ. Algorithms for the surgical management of benign and malignant presacral tumors. SEMINARS IN COLON AND RECTAL SURGERY 2020. [DOI: 10.1016/j.scrs.2020.100762] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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24
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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: 1.6] [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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Sakr A, Kim HS, Han YD, Cho MS, Hur H, Min BS, Lee KY, Kim NK. Single-center Experience of 24 Cases of Tailgut Cyst. Ann Coloproctol 2019; 35:268-274. [PMID: 31726003 PMCID: PMC6863012 DOI: 10.3393/ac.2018.12.18] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2018] [Accepted: 12/18/2018] [Indexed: 12/11/2022] Open
Abstract
Purpose Tailgut cysts are rare congenital or developmental lesions that arise from vestiges of the embryological hindgut. They are usually present in the presacral space. We report our single-center experience with managing tailgut cysts. Methods We conducted a retrospective analysis of 24 patients with tailgut cyst treated surgically at the Colorectal Surgery Department of Severance Hospital, Yonsei University, Seoul, South Korea, between 2007–2018. Results This study included 24 patients (18 females) with a median age of 51.5 years (range, 21–68 years). Ten cases were symptomatic and 14 were asymptomatic. Cysts were retrorectal in 21 patients. Cysts were below the coccyx level in 16 patients, opposite the coccyx in 6, and above the coccyx in 2. Cysts were supralevator in 5 patients, had a supra- and infralevator extension in 18 patients, and were infralevator in 1. Ten patients were managed using an anterior laparoscopic approach, 11 using a posterior approach, and 3 using a combined approach. Mean cyst size was 5.5 ± 2.7 cm. Postoperative complications were Clavien-Dindo (CD) classification grade II in 9 patients (37.5%) and CD grade III in 1 (4.2%). The posterior approach group showed the highest rate of complications (P = 0.021). Patients managed using a combined approach showed a larger cyst size (P < 0.001), longer operation times (P < 0.001), and a greater likelihood of tumor level above the coccyx (P = 0.002) compared to other approaches. The tumors of 2 male patients were malignant: 1 was a neuroendocrine tumor treated with radiotherapy, while the other was a closely followed adenocarcinoma. Median follow-up was 12 months (range, 1–66 months) with no recurrence. Conclusion Tailgut cysts are uncommon but can cause perineal or pelvic pain. Complete surgical excision via an appropriate approach according to tumor size, location, and correlation with adjacent pelvic floor muscles is the key treatment.
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Affiliation(s)
- Ahmad Sakr
- Division of Colorectal Surgery, Department of Surgery, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea.,Colorectal Surgery Unit, Department of General Surgery, Mansoura Faculty of Medicine, Mansoura University Hospitals, Mansoura, Egypt
| | - Ho Seung Kim
- Division of Colorectal Surgery, Department of Surgery, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Yoon Dae Han
- Division of Colorectal Surgery, Department of Surgery, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Min Soo Cho
- Division of Colorectal Surgery, Department of Surgery, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Hyuk Hur
- Division of Colorectal Surgery, Department of Surgery, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Byung Soh Min
- Division of Colorectal Surgery, Department of Surgery, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Kang Young Lee
- Division of Colorectal Surgery, Department of Surgery, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Nam Kyu Kim
- Division of Colorectal Surgery, Department of Surgery, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
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26
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Lin C, Liu W, Xu Q, Zhang Z, Chen S. A case of malignant transformation of sacrococcygeal tailgut cysts in young woman. Asian J Surg 2019; 43:378-380. [PMID: 31611102 DOI: 10.1016/j.asjsur.2019.09.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2019] [Accepted: 09/01/2019] [Indexed: 10/25/2022] Open
Affiliation(s)
- Chengzhi Lin
- Department of General Surgery, 900 Hospital of the Joint Logistics Taem of the Chinese PLA(Fuzhou General Hospital of Fujian Medical University, Eastern Hospital Affiliated to Xiamen University), Fuzhou, China
| | - Wenchi Liu
- Department of General Surgery, 900 Hospital of the Joint Logistics Taem of the Chinese PLA(Fuzhou General Hospital of Fujian Medical University, Eastern Hospital Affiliated to Xiamen University), Fuzhou, China
| | - Qianhui Xu
- Department of General Surgery, 900 Hospital of the Joint Logistics Taem of the Chinese PLA(Fuzhou General Hospital of Fujian Medical University, Eastern Hospital Affiliated to Xiamen University), Fuzhou, China
| | - Zaizhong Zhang
- Department of General Surgery, 900 Hospital of the Joint Logistics Taem of the Chinese PLA(Fuzhou General Hospital of Fujian Medical University, Eastern Hospital Affiliated to Xiamen University), Fuzhou, China
| | - Shaoquan Chen
- Department of General Surgery, 900 Hospital of the Joint Logistics Taem of the Chinese PLA(Fuzhou General Hospital of Fujian Medical University, Eastern Hospital Affiliated to Xiamen University), Fuzhou, China.
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27
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Kwak HD, Kim CH. Tailgut Cyst, Report of 24 Cases Single Center Experience. Ann Coloproctol 2019; 35:227-228. [PMID: 31725996 PMCID: PMC6863009 DOI: 10.3393/ac.2019.10.14] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Affiliation(s)
- Han Deok Kwak
- Department of Surgery, Chonnam National University Hospital, Gwangju, Korea
| | - Chang Hyun Kim
- Department of Surgery, Chonnam National University Hwasun Hospital, Hwasun, Korea
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28
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Laparoscopic Resection of Presacral Tumor: A New Approach in the Era of the Minimally Invasive Surgery. THE JOURNAL OF MINIMALLY INVASIVE SURGERY 2019; 22:131-133. [PMID: 35599697 PMCID: PMC8980158 DOI: 10.7602/jmis.2019.22.3.131] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/23/2019] [Revised: 09/04/2019] [Accepted: 09/06/2019] [Indexed: 11/13/2022]
Abstract
Presacral tumors are rare; however, once diagnosed, surgical resection is recommended even in asymptomatic patients as there is potential risk for growth or malignant transformation. Many different types of surgical approaches to resect presacral tumors have been reported including posterior, anterior, and combined abdominosacral approaches. With introduction of the minimally invasive approach, laparoscopic or robotic approaches to resect presacral tumors are reported increasingly. We report a case of successful anterior laparoscopic resection for a presacral mass that was incidentally diagnosed during management of pancreatitis.
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29
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30
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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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Neuroendocrine tumour developing within a long-standing tailgut cyst: case report and review of the literature. Clin J Gastroenterol 2019; 12:539-551. [PMID: 31147970 DOI: 10.1007/s12328-019-00998-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2019] [Accepted: 05/22/2019] [Indexed: 12/13/2022]
Abstract
A tailgut cyst is a rare congenital lesion that can develop in the presacral space from the remnants of an embryonic hindgut. It is unusual for malignant change to occur in a tailgut cyst. We report a case of a large long-standing tailgut cyst, which was removed during a laparotomy. Histopathology showed a well-differentiated neuroendocrine tumour (primary carcinoid tumour) arising in a tailgut cyst. We reviewed the English literature for all adult cases with this condition. All original articles were reviewed, and data were compiled and tabulated. Including this report, 29 cases of NET developing in a tailgut cyst were found in the English literature. Tailgut cysts have been reported as more common in females, with a mean age of presentation in the fifth decade (Devine, in: Zbar A, Wexner S (eds) Coloproctology. Springer specialist surgery series, Springer, London, 2010; Hjermstad and Helwig in Am J Clin Pathol 89:139-147, 1988). Tailgut cysts may undergo malignant change including adenocarcinoma, sarcoma, and NET (Mathis et al. Br J Surg 97:575-579, 2010; Messick in Dis Colon Rectum 61:151-153, 2018; Patsouras et al. in Colorectal Dis 17:724-729, 2015; Chereau et al in Colorectal Dis 15:e476-e482, 2013). It is difficult to estimate the true incidence of malignant change in a tailgut cyst, with the literature reports only limited to case reports and small-case series. Although rare, our case confirms need to consider the possibility of a malignant component, even in a benign process such as a tailgut cyst. This prompts consideration for upfront definitive management.
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Hufkens AS, Cools P, Leyman P. Tailgut cyst: report of three cases and review of the literature. Acta Chir Belg 2019; 119:110-117. [PMID: 30776969 DOI: 10.1080/00015458.2017.1353758] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
INTRODUCTION Tailgut cysts or retrorectal cystic hamartomas are congenital developmental lesions which are often misdiagnosed due to their rare incidence, anatomical position and variable clinical presentation. CASE REPORT We report three clinical cases: one of a 67-year old woman with high fever and anal bulging; the second case was a 50-year old woman with diffuse abdominal pain and the third case was a 52-year old woman with high fever and no abdominal or rectal pain. The rectal examination and MRI indicated the presence of a tailgut cyst. In all the cases a complete resection through a posterior perineal route was performed. Histopathological examination confirmed the diagnosis of a tailgut cyst, with a malignant component identified in the third case. DISCUSSION The discussion presents a brief review of the relevant information described in the literature to highlight the cornerstones for appropriate diagnosis and treatment of a tailgut cyst. Tailgut cysts are to be considered in the differential diagnosis of retrorectal or presacral masses as malignant transformation can occur.
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Affiliation(s)
- Ann-Sophie Hufkens
- Department of General and Abdominal Surgery, GZA Hospitals, Campus Sint-Vincentius, Antwerp, Belgium
| | - Peter Cools
- Department of General and Abdominal Surgery, GZA Hospitals, Campus Sint-Vincentius, Antwerp, Belgium
| | - Paul Leyman
- Department of General and Abdominal Surgery, GZA Hospitals, Campus Sint-Augustinus, Wilrijk, Belgium
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Abstract
BACKGROUND Ischiorectal fossa tumors are rare. OBJECTIVE This study reviews a single institution's series of ischiorectal tumors with comparison against presacral tumors and assesses the utility of preoperative biopsy and angioembolization. DESIGN This is a retrospective study. SETTINGS This study was conducted at a quaternary referral center. PATIENTS All patients with ischiorectal tumor treated between February 1995 and April 2017 were retrospectively reviewed. Tumors extending secondarily into the ischiorectal fossa and inflammatory pathologies were excluded. INTERVENTIONS Preoperative biopsy, neoadjuvant therapy, angioembolization, and surgical excision of these tumors were reviewed. MAIN OUTCOME MEASURES Demographic, perioperative, pathological, and oncologic outcomes were evaluated. RESULTS Twenty-four patients (15 female; median age 54) were identified. Two-thirds were symptomatic. Forty-six percent had a palpable mass. All patients had CT and/or MRI. Fifty percent had a preoperative biopsy, of which 83% were diagnostic, and management was altered in 50%. All patients underwent surgical excision. Fifty-five percent had local excision, 38% had radical pelvic excision, and 8% had total mesorectal excision. Two patients had preoperative angioembolization. Both had successful R0 local excision. Morbidity occurred in 25%, with 1 major complication. There was no 30-day mortality. Histopathology demonstrated 17 soft tissue tumors (3 malignant), 2 GI stromal tumors, 1 neuroendocrine tumor, 1 Merkel cell carcinoma, 1 basaloid carcinoma, 1 epidermal cyst, and 1 lipoma. R0 resection was achieved in 75%. All patients were alive after a median follow-up of 33 months. Four patients developed recurrence at a median 10 months postoperatively. All recurrences were malignant, and 75% had had a R1 resection. LIMITATIONS This study is limited by its small numbers. The quaternary institution source may introduce bias. CONCLUSIONS Ischiorectal fossa tumors are heterogeneous and more likely to be malignant than presacral tumors. Biopsy can be useful if a malignant diagnosis is suspected and changes management in 50% of cases. Preoperative embolization may be useful for large vascular tumors. R0 resection is important to minimize recurrence. See Video Abstract at http://links.lww.com/DCR/A779.
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Lorusso D, Santis SD, Lantone G, Armentano R. A rare case of incidental mucinous adenocarcinoma with osseous metaplasia associated with cysts of the presacral space. TURKISH JOURNAL OF GASTROENTEROLOGY 2018; 30:495-496. [PMID: 30460902 DOI: 10.5152/tjg.2018.18598] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Affiliation(s)
- Dionigi Lorusso
- National Institute of Gastroenterology "S. de Bellis", Research Hospital, Castellana Grotte (BA), Italy
| | - Stefania De Santis
- National Institute of Gastroenterology "S. de Bellis", Research Hospital, Castellana Grotte (BA), Italy; Department of Pharmacy, University of Salerno, Fisciano (SA), Italy
| | - Giulio Lantone
- National Institute of Gastroenterology "S. de Bellis", Research Hospital, Castellana Grotte (BA), Italy
| | - Raffaele Armentano
- National Institute of Gastroenterology "S. de Bellis", Research Hospital, Castellana Grotte (BA), Italy
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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: 0.7] [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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Iwata E, Orosz Z, Teh J, Reynolds J, Whitwell D, Tanaka Y, Athanasou NA. Neuroendocrine Tumor Arising in a Tailgut Cyst: A Rare Presacral Tumor. Int J Surg Pathol 2018; 27:336-342. [PMID: 30176741 DOI: 10.1177/1066896918796291] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
A tailgut cyst (retrorectal cystic hamartoma) is an uncommon lesion that develops in the presacral (retrorectal) space. Malignant change in a tailgut cyst is extremely rare and presents as a soft tissue (presacral) or bone (sacral) neoplasm. We report a case of tailgut cyst in which a neuroendocrine tumor developed in a 25-year-old female. Computed tomography and magnetic resonance imaging scans revealed a sacrococcygeal malformation with absent left S4 and S5 and a partly cystic lesion within the right presacral space. Histologically, the lesion contained cystic and solid elements. The cysts were lined by columnar and stratified squamous epithelial cells with underlying patchy smooth muscle. The solid element was a partly necrotic neuroendocrine tumor composed mainly of ribbons of tumor cells, which showed mitotic activity and expressed cytokeratin, chromogranin, and synaptophysin. Histologically, tailgut cysts are lined by epithelium and contain scattered smooth muscle bundles in the cyst wall. Although rare, the possibility of tailgut cyst with neuroendocrine tumor should be included in the differential diagnosis of an enlarging presacral tumor.
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Affiliation(s)
- Eiichiro Iwata
- 1 University of Oxford, Oxford, UK.,2 Nara Medical University, Kashihara-shi, Nara, Japan
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Soyer T, Aydin B, Orhan D, Tanyel FC. Neuroencorine Tumor Arising within a Tailgut Cyst in an Adolescent Boy. Fetal Pediatr Pathol 2018; 37:270-275. [PMID: 29843558 DOI: 10.1080/15513815.2018.1472355] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
INTRODUCTION Neuroendocrine tumors (NET) within tailgut cysts (TC) are usually seen in middle-aged females. A 14 year-old boy who underwent surgical excision of NET within TC is presented to discuss the clinical features, diagnosis and treatment options. CASE REPORT A 14-year-old boy with rectal bleeding and constipation had a 5 × 4 cm mass detected upon rectal examination. The cystic mass was totally excised. The histopathological evaluation revealed a low-grade NET within mucularis layer of the cyst showing a positive immunhistochemical staining for cytokeratin and synaptophysin. CONCLUSION Although, the malignant transition of TC is commonly observed in middle age females, males and children can also be affected. This is first report of a pediatric TC with malignant transformation. Total surgical excision of cysts is mandatory for local control of the disease and chemotherapy should be reserved for the patients who have positive surgical margins.
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Affiliation(s)
- Tutku Soyer
- a Hacettepe University , Faculty of Medicine , Pediatric Surgery , Ankara , Turkey
| | - Burça Aydin
- b Hacettepe University , Faculty of Medicine , Pediatric Oncology , Ankara , Turkey
| | - Diclehan Orhan
- c Hacettepe University , Faculty of Medicine , Pediatric Pathology , Ankara , Turkey
| | - Feridun C Tanyel
- a Hacettepe University , Faculty of Medicine , Pediatric Surgery , Ankara , Turkey
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Al Khaldi M, Mesbah A, Dubé P, Isler M, Mitchell A, Doyon J, Sideris L. Neuroendocrine carcinoma arising in a tailgut cyst. Int J Surg Case Rep 2018; 49:91-95. [PMID: 29966957 PMCID: PMC6039892 DOI: 10.1016/j.ijscr.2018.05.032] [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: 05/04/2018] [Accepted: 05/21/2018] [Indexed: 02/07/2023] Open
Abstract
INTRODUCTION A tailgut cyst, also called retrorectal cystic hamartoma, is a rare congenital lesion that forms most commonly in the retrorectal space. It is presumed to arise from remnants of early embryogenesis. PRESENTATION OF CASE The following report describes a unique case of a retrorectal cystic hamartoma in a 53 year-old French Canadian man with a history of low back pain. The tumour underwent malignant transformation into a well-differentiated neuroendocrine carcinoma three years after the beginning of symptoms. DISCUSSION This condition can be found at any age, but occurs especially among middle-aged women. Not only is it frequently misdiagnosed, but also several complications associated to the cyst have been reported such as infection and malignant transformation. This is why complete surgical excision of the tailgut cyst is currently recommended.
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Affiliation(s)
- Maher Al Khaldi
- Department of Surgery, Division of General Surgical Oncology, Hôpital Maisonneuve-Rosement, University of Montreal, Canada.
| | - Amanda Mesbah
- Department of Surgery, Division of General Surgical Oncology, Hôpital Maisonneuve-Rosement, University of Montreal, Canada
| | - Pierre Dubé
- Department of Surgery, Division of General Surgical Oncology, Hôpital Maisonneuve-Rosement, University of Montreal, Canada
| | - Marc Isler
- Department of Surgery, Division of Orthopedic Surgery, Hôpital Maisonneuve-Rosement, University of Montreal, Canada
| | - Andrew Mitchell
- Department of Pathology, Hôpital Maisonneuve-Rosement, University of Montreal, Canada
| | - Josée Doyon
- Department of Pathology, Hôpital Maisonneuve-Rosement, University of Montreal, Canada
| | - Lucas Sideris
- Department of Surgery, Division of General Surgical Oncology, Hôpital Maisonneuve-Rosement, University of Montreal, Canada
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Gao S, Zheng Y, Liu X, Tian Z, Zhao Y. Effect of early fasting and total parenteral nutrition support on the healing of incision and nutritional status in patients after sacrectomy. Orthop Traumatol Surg Res 2018; 104:539-544. [PMID: 29567321 DOI: 10.1016/j.otsr.2018.02.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2017] [Revised: 09/30/2017] [Accepted: 02/12/2018] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Surgical site infection is one of the most common complications for patients after sacrectomy, which often accompanied by poor wound healing, sinus formation and serious metabolic disturbance. HYPOTHESIS We tried to avoid the surgical site infection caused by feces during early period after surgery through early fasting and total parenteral nutrition (TPN) support, then compared the clinical results of these patients with other patients that received enteral nutrition (EN) early after sacrectomy. METHODS Forty-eight patients after sacrectomy (the level of sacrectomy above S2) were randomly divided into two groups: TPN group and EN group. The patients of two groups received different nutrition support from the first day to the seventh day after surgery, then the factors such as nutritional and metabolic status after surgery, incidence of complications as well as the time of incision healing and hospitalization were observed. RESULTS The p-value of total serum protein, albumin, serum alanine aminotransferase, total bilirubin at seventh day after sacrectomy between TPN group and EN group is <0.0005. The p-value of hemoglobin at seventh day after sacrectomy between TPN group and EN group is 0.001. The p-value of total serum protein at fourteenth day after sacrectomy between TPN group and EN group is 0.003. The p-value of albumin and total bilirubin at fourteenth day after sacrectomy between TPN group and EN group is 0.001. The p-value of hemoglobin, serum alanine aminotransferase at fourteenth day after sacrectomy between TPN group and EN group is <0.0005. The incidence of gastrointestinal complication and delay of apparition of feces in EN group were lower than that in TPN group (p=0.041, p<0.0005). The incidence of surgical site infection, the time of incision healing and hospitalization in TPN group were lower than that in EN group (p=0.048, p=0.008, p<0.0005). CONCLUSIONS The method of fasting and supported by TPN during the early period after sacrectomy contribute to the incision healing, meanwhile, it shortens the hospitalization time and abates the incidence of complications in patients after sacrectomy. TYPE OF STUDY It is a comparative randomized study. LEVEL OF PROOF High-powered prospective randomized trial.
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Affiliation(s)
- S Gao
- Department of Orthopedics, Henan Provincial People's Hospital, People's Hospital of Zhengzhou University, No. 7, Weiwu Road, 450003 Zhengzhou, Henan Province, People's Republic of China.
| | - Y Zheng
- Department of radiology, The First Affiliated Hospital of Zhengzhou University, No. 1, Jianshe Road, 450052 Zhengzhou, Henan Province, People's Republic of China
| | - X Liu
- Department of Orthopedics, The Affiliated Tumor Hospital of Zhengzhou University, No. 127, Dongming Road, 450008 Zhengzhou, Henan Province, People's Republic of China
| | - Z Tian
- Department of Orthopedics, The Affiliated Tumor Hospital of Zhengzhou University, No. 127, Dongming Road, 450008 Zhengzhou, Henan Province, People's Republic of China
| | - Y Zhao
- Department of Orthopedics, The Affiliated Tumor Hospital of Zhengzhou University, No. 127, Dongming Road, 450008 Zhengzhou, Henan Province, People's Republic of China
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Baek SK, Hwang GS, Vinci A, Jafari MD, Jafari F, Moghadamyeghaneh Z, Pigazzi A. Retrorectal Tumors: A Comprehensive Literature Review. World J Surg 2017; 40:2001-15. [PMID: 27083451 DOI: 10.1007/s00268-016-3501-6] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
IMPORTANCE Retrorectal tumors are rare lesions that comprise a multitude of histologic types. Reports are limited to small single-institution case series, and recommendations on the ideal surgical approaches are lacking. OBJECTIVE The purpose of the study was to provide a comprehensive review of the epidemiology, pathologic subtypes, surgical approaches, and clinical outcomes of retrorectal tumors. EVIDENCE REVIEW We conducted a review of the literature using PubMed and searched the reference lists of published studies. RESULTS A total of 341 studies comprising 1708 patients were included. Overall, 68 % of patients were female. The mean age was 44.6 ± 13.7 years. Of all patients, 1194 (70 %) had benign lesions, and 514 patients (30 %) had malignant tumors. Congenital tumors (60.5 %) were the most frequent histologic type. Other pathologic types were neurogenic tumors (14.8 %), osseous tumors (3.1 %), inflammatory tumors (2.6 %), and miscellaneous tumors (19.1 %). Biopsy was performed in 27 % of the patients. Of these patients, incorrect diagnoses occurred in 44 %. An anterior surgical approach (AA) was performed in 299 patients (35 %); a posterior approach (PA) was performed in 443 (52 %), and a combined approach (CA) was performed in 119 patients (14 %). The mean length of stay (LOS) of PA was 7 ± 5 days compared to 8 ± 7 days for AA and 11 ± 7 days for CA (p < 0.05). The overall morbidity rate was 13.2 %: 19.3 % associated with anterior approach, 7.2 % associated with posterior approach, and 24.7 % after a combined approach (p < 0.05). Overall postoperative recurrence rate was 21.6 %; 6.7 % after an anterior approach, 26.6 % after a posterior approach, and 28.6 % after a combined approach (p < 0.05). A minimally invasive approach (MIS) was employed in 83 patients. MIS provided shorter hospital stays than open surgery (4 ± 2 vs. 9 ± 7 days; p < 0.05). Differences in complication rate were 19.8 % in MIS and 12.2 % in open surgery and not statistically significant. CONCLUSIONS AND RELEVANCE Retrorectal tumors are most commonly benign in etiology, of a congenital nature, and have a female predominance. Complete surgical resection is the cornerstone of retrorectal tumor management. A minimal access surgery approach, when feasible, appears to be a safe option for the management of retrorectal tumors, with shorter operative time and length of stay.
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Affiliation(s)
- Seong Kyu Baek
- Keimyung University College of Medicine, Daegu, Republic of Korea
| | - Grace Soon Hwang
- Division of Colorectal Surgery, Department of Surgery, University of California, Irvine School of Medicine, 333 City Boulevard, West Suite 850, Orange, CA, 92868, USA.,Department of Surgery, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Alessio Vinci
- Division of Colorectal Surgery, Department of Surgery, University of California, Irvine School of Medicine, 333 City Boulevard, West Suite 850, Orange, CA, 92868, USA
| | - Mehraneh D Jafari
- Division of Colorectal Surgery, Department of Surgery, University of California, Irvine School of Medicine, 333 City Boulevard, West Suite 850, Orange, CA, 92868, USA
| | - Fariba Jafari
- Division of Colorectal Surgery, Department of Surgery, University of California, Irvine School of Medicine, 333 City Boulevard, West Suite 850, Orange, CA, 92868, USA
| | - Zhobin Moghadamyeghaneh
- Division of Colorectal Surgery, Department of Surgery, University of California, Irvine School of Medicine, 333 City Boulevard, West Suite 850, Orange, CA, 92868, USA
| | - Alessio Pigazzi
- Division of Colorectal Surgery, Department of Surgery, University of California, Irvine School of Medicine, 333 City Boulevard, West Suite 850, Orange, CA, 92868, USA.
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Primary Cystic Lesions of the Retrorectal Space: MRI Evaluation and Clinical Assessment. AJR Am J Roentgenol 2017; 209:790-796. [PMID: 28705066 DOI: 10.2214/ajr.16.17329] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
OBJECTIVE The purpose of this study was to assess the a priori chance that primary cystic lesions of the retrorectal space are malignant and to investigate MRI characteristics that indicate malignancy. MATERIALS AND METHODS Patients referred to a center for colorectal surgery were recruited from 2000 to 2014. Lesions were proven by clinical assessment and histopathology. MRI was performed at 1.5 T with examinations evaluated by two radiologists. Interobserver agreement was assessed (Cohen kappa) and differences between malignant and benign lesions calculated (Fisher exact test). RESULTS Twenty-eight patients (22 women, six men; age range, 18-70 years) with 31 lesions were included. Lesions were categorized as tailgut cysts (n = 16, 52%), teratomas (n = 9, 29%), lesions of colorectal origin (n = 4, 13%), or neurogenic lesions (n = 2, 6%). Five patients (18%) had malignant lesions. Colorectal lesions had the highest percentage of malignancy (3/4, 75%). A solid tissue component was found in all five (100%) malignant lesions and two (8%) of the benign lesions, which were both teratomas (p < 0.05). Sensitivity and specificity for malignancy according to the presence of a solid tissue component was 100% (5/5) and 92% (24/26). For unilocularity, multilocularity, debris, septa, and wall thickening, differences were not significant. Interobserver agreement was excellent (κ = 1) for all characteristics except debris (κ = 0.795). CONCLUSION The majority of retrorectal cystic lesions are benign. The presence of a solid tissue component should raise suspicion for malignancy.
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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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Tailgut cysts: Presentation of four cases. GASTROENTEROLOGIA Y HEPATOLOGIA 2017; 41:103-105. [PMID: 28359549 DOI: 10.1016/j.gastrohep.2017.02.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/30/2016] [Revised: 01/26/2017] [Accepted: 02/03/2017] [Indexed: 01/17/2023]
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Mora-Guzmán I, Alonso-Casado A, Rodríguez Sánchez A, Bermejo Marcos E. Neuroendocrine tumour arising inside a tailgut cyst. Ann R Coll Surg Engl 2016; 99:e91-e93. [PMID: 27917670 DOI: 10.1308/rcsann.2016.0362] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
Tailgut cysts are rare benign retrorectal cysts arising from persistent remnants of an embryonic hindgut. Malignant transformation inside this lesion is very uncommon and occurrence of neuroendocrine tumours in this context is extremely rare. We report the case of a 56-year-old woman who underwent surgical excision of a presacral tailgut cyst, which was found incidentally to include a neuroendocrine tumour.
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Affiliation(s)
- I Mora-Guzmán
- Hospital Universitario de la Princesa , Madrid , Spain
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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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Abstract
A tailgut cyst is an uncommon congenital developmental cyst that arises from the postnatal remnants of the primitive gut. These cysts are generally located in the retrorectal space. The rarity of this lesion and its anatomical position frequently lead to difficulties in its diagnosis and surgical management. Complete surgical resection remains the cornerstone of treatment, and numerous surgical approaches to achieve this objective have been described in the literature. We present 2 cases of tailgut cysts that were resected using a trans-sacral approach. We discuss the surgical management of these cases, including the operative approach that was adopted. Two cases of tailgut cysts that presented as incidentally detected retrorectal tumors are described here. A pelvic magnetic resonance imaging scan revealed a retrorectal multicystic tumor consistent with a tailgut cyst. The patients underwent surgery via a trans-sacral approach with coccygectomy. The histopathologic diagnosis for each patient was a tailgut cyst with no evidence of malignancy. Surgical approaches for tailgut cysts depend on the exact locations of the cysts and suspicions regarding the malignancies of the cysts. En bloc organ resection, including coccygectomy, is required if malignancy is suspected. We endorse the trans-sacral approach as a feasible, easy to perform, minimally invasive, and safe option for treating relatively low-lying tailgut cysts.
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Buchs N, Gosselink M, Scarpa C, Ris F, Saiji E, Bloemendaal A, van Onkelen R, Guy R, Schouten W, Roche B, George B. A multicenter experience with peri-rectal tumors: The risk of local recurrence. Eur J Surg Oncol 2016; 42:817-22. [DOI: 10.1016/j.ejso.2016.02.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2015] [Revised: 01/11/2016] [Accepted: 02/11/2016] [Indexed: 12/31/2022] Open
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Schwarzman P, Sciaky-Tamir Y, Mastrolia SA, Weintraub AY, Baron J, Sheizaf B, Hershkovitz R. Pitfalls in the diagnosis of tailgut cysts. Int J Gynaecol Obstet 2016; 134:340-1. [PMID: 27473333 DOI: 10.1016/j.ijgo.2016.03.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2016] [Revised: 03/16/2016] [Accepted: 05/17/2016] [Indexed: 01/17/2023]
Affiliation(s)
- Polina Schwarzman
- Department of Obstetrics and Gynecology, Soroka University Medical Center, Ben Gurion University of the Negev, School of Medicine, Beer Sheva, Israel.
| | - Yael Sciaky-Tamir
- US Unit, Department of Obstetrics and Gynecology, Soroka University Medical Center, Ben Gurion University of the Negev, School of Medicine, Beer Sheva, Israel
| | - Salvatore Andrea Mastrolia
- Department of Obstetrics and Gynecology, Soroka University Medical Center, Ben Gurion University of the Negev, School of Medicine, Beer Sheva, Israel; Department of Obstetrics and Gynecology, Azienda Ospedaliera Universitaria Policlinico di Bari, Universita' degli Studi di Bari "Aldo Moro", School of Medicine, Bari, Italy
| | - Adi Yehuda Weintraub
- Department of Obstetrics and Gynecology, Soroka University Medical Center, Ben Gurion University of the Negev, School of Medicine, Beer Sheva, Israel
| | - Joel Baron
- US Unit, Department of Obstetrics and Gynecology, Soroka University Medical Center, Ben Gurion University of the Negev, School of Medicine, Beer Sheva, Israel
| | - Boaz Sheizaf
- Department of Obstetrics and Gynecology, Soroka University Medical Center, Ben Gurion University of the Negev, School of Medicine, Beer Sheva, Israel
| | - Reli Hershkovitz
- US Unit, Department of Obstetrics and Gynecology, Soroka University Medical Center, Ben Gurion University of the Negev, School of Medicine, Beer Sheva, Israel
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Toh JWT, Morgan M. Management approach and surgical strategies for retrorectal tumours: a systematic review. Colorectal Dis 2016; 18:337-50. [PMID: 26663419 DOI: 10.1111/codi.13232] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2015] [Accepted: 10/20/2015] [Indexed: 12/11/2022]
Abstract
AIM The management strategy for retrorectal tumours is complex. Due to their rarity, few surgeons have expertise in management. METHOD A systematic literature review was conducted using the PubMed database. English language publications in the years 2011-2015 that assessed preoperative management, surgical strategies and chemoradiotherapy for presacral tumours were included. Two hundred and fifty-one abstracts were screened of which 88 met the inclusion criteria. After review of the full text, this resulted in a final list of 42 studies eligible for review. RESULTS In all, 932 patients (63.2% female, 36.8% male; P < 0.01) with a retrorectal tumour were identified. Most were benign (65.9% vs. 33.7%, P < 0.01). Imaging distinguished benign from malignant lesions in 88.1% of cases; preoperative biopsy was superior to imaging in providing an accurate definitive diagnosis (91.3% vs. 61.4%, P < 0.05) with negligible seeding risk. Biopsy should be performed in solid tumours. It is useful in guiding neoadjuvant therapy for gastrointestinal stromal tumours, sarcomas and desmoid type fibromatosis and may alter the management strategy in cases of diffuse large B-cell lymphoma and metastases. Biopsies for cystic lesions are not recommended. The gold standard in imaging is MRI. The posterior Kraske procedure is the most common surgical approach. Overall, the reported recurrence rate was 19.7%. CONCLUSION This review evaluated the management strategies for retrorectal tumours. A preoperative biopsy should be performed for solid tumours. MRI is the most useful imaging modality. Surgery is the mainstay of treatment. There is limited information on robotic surgery, single-port surgery, transanal endoscopic microsurgery, chemoradiotherapy and reconstruction.
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Affiliation(s)
- J W T Toh
- Department of Colorectal Surgery, Bankstown Hospital, Sydney, New South Wales, Australia
| | - M Morgan
- Department of Colorectal Surgery, Bankstown Hospital, Sydney, New South Wales, Australia
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