A 47-Year-Old Woman With a Large Unusual Presacral MassM R Mayorga, M L Guerry-Force
- General Medicine
Tumors developing in the presacral space are rare, having been reported in 1 of every 40,000 admissions. Most presacral tumors are congenital defects arising from vestiges of embryonal tissue like neuroectoderm, notochord, and hindgut. For this reason, a wide array of benign and malignant presentations can be expected. Preoperative diagnosis is often challenging due to the risk of seeding malignant cells and the high risk of infection.
A 47-year-old woman presented to our institution with complaints of abdominal pressure and pelvic heaviness for about a year, dyspareunia, epigastric pain, diarrhea, and early satiety with an unintentional weight loss of 30 lbs. On physical examination, a large firm, tender growth posterior to the rectum was palpated, deviating both the rectum and the vagina. An MRI confirmed a 9.3 cm complex mass. Due to the location of the lesion and some of the patient’s symptoms, malignancy could not be ruled out. The MRI was useful for planning the perineal resection as the mass was located below S3. However, the accuracy of MRI for specific histological tumor types has been reported to be only 28% therefore the true nature of the lesion could not be fully assessed. Complete resection was then recommended and performed. The mass was entered during dissection and copious thick consistency contents were encountered. Histopathology revealed a cyst lined by squamous epithelium and laminated keratin debris with the presence of chronic inflammatory cells compatible with an epidermoid cyst. The patient made an uneventful recovery and was discharged home.
Results (if a Case Study enter NA)
In cases where a presacral mass of cystic nature is found, especially in middle-aged women, epidermoid cysts should be one of the diagnoses to consider. Imaging is a good aid for surgical intervention but has a very limited ability to identify the mass thus making the post-operative histopathologic diagnosis crucial.