Presacral mass in the setting of an ovarian cyst and abdominal pain

Abstract

Tailgut cysts, also known as retrorectal hamartomas, are very rare neoplasms located in the presacral/retrorectal space that originate from the embryonic hindgut. Although a majority of lesions in this location are benign, 30% of the reported cases in the literature were found to be malignant. This report describes a case of a presacral mass found on CT of a 37-year-old woman who initially presented with worsening abdominal pain and a history of ovarian cyst rupture. This patient's clinical picture was complicated by an enlarging ovarian cyst. The risk of progression to malignancy warranted excision. She recovered well with resolution of her presenting symptoms. We report this case along with a brief review of the literature with a focus on the surgical considerations.

Keywords: General Surgery; Surgery.

Figure 1

CT with contrast showing a 4 cm mass with thin septations anterior to the tip of the coccyx.

Figure 2

MRI pelvis with 4 cm multiloculated cystic lesion with fluid level posterior to the rectum without inflammatory change.

Figure 3

Gross specimen measuring 4×3.5×1.3 cm, multifocal, cystic and ragged nature.

Figure 4

The mass consisted of multiple cystic spaces with abundant mucoid material lined by transitional and glandular epithelium.

Figure 5

Classification of tumours found in the presacral space. Of the benign congenital tumours, tailgut cysts are the most common.

Figure 6

Retrorectal space lies behind the rectum below the pelvic peritoneum and mesorectum.

Figure 7

Considerations for surgical approach of retrorectal tumours based on anatomical location.