Two Cases of Symptomatic Tailgut Cysts

Abstract

Tailgut cysts are rare lesions which are found in the rectorectal space. They develop in the final section of the intestine from which the rectum and anus extend and vary from being asymptomatic to symptomatic due to pressure on organs or nerves. Tailgut cysts are more common in females, usually between 30 and 60 years of age. They are thought to be benign, with variable malignancy risks. Surgical excision followed by histological examination is the gold standard of treatment, but access and approach to tailgut cysts depend on the location and morphology of the lesion. We present two symptomatic cases of this very rare pathology. In both cases, the cyst and coccyx bone were successfully excised using different approaches. The first patient was a 40-year-old woman with a large cyst which caused morning tenesmus, urinary outflow disorders and painful ovulation. Due to the cyst size, laparotomy was performed, and a combined approach was used. The second patient is a 36-year-old woman with co-existing endometriosis and a cyst causing pain in the sacral spine, constipation and tenesmus. The tumor was excised using a Kraske approach, and due to the infiltration of the coccyx bone it was removed using an osteotome. In this patient, perforation of the cyst was also observed. Both patients completed follow-ups involving regular surgical check-ups and MRI scans. Descriptions of different symptoms and surgical approaches make our study an important source of knowledge for diagnosing and treating these very rare tumors.

Keywords: malignancy risk; rectorectal cystic; tailgut cyst.

Figure 1

First patient MRI scan of the lesser pelvis. Green arrow shows the lesion.

Figure 2

First patient histopathological examination. (a) Tissue at 4× magnification. (b) Tissue detail at 10× magnification.

Figure 3

Second patient MRI scan of lesser pelvis. Green arrow shows the cyst.

Figure 4

Second patient histopathological examination. (a) Tissue at 4× magnification. (b) Tissue detail at 10× magnification.

Figure 5

Second patient MRI scan of the lesser pelvis eight months after the procedure.