Chinese expert consensus on standardized treatment of presacral cysts / 中华肿瘤杂志

Presacral cysts are cystic or cyst-solid lesions between the sacrum and rectum. They are closely connected with adjacent pelvic floor structures such as sacrococcygeal fascia, rectum and anal sphincter. They are usually benign and are believed to be caused by aberrant embryogenesis. Clinically they are rare and its true incidence rate is unknown. Surgical resection remains the major treatment of presacral cysts. Unless the cysts are completely resected, the recurrence are unavoidable. The recurrent cysts even generate hard-to-heal sinus in the sacrococcyx, and cause the patients extreme pain. However, the current knowledge of presacral cysts is vague, even confused with other diseases such as ovarian cysts and perianal abscesses. Moreover, lack of the correct surgical concept or skills leads to palliative treatment of complex presacral cysts and serious complications such as fecal incontinence and massive haemorrhage which were attributed to impairing the function of anal sphincter or important blood vessels and nerves. The consensus summarizes the opinions and experiences of multidisciplinary experts in presacral cysts, and aims to provide clinicians with more detailed concept of the treatment, standardize the surgical approach and improve the resected efficacy of presacral cysts.

Clinical analysis of 33 cases on laparoscopic resection of presacral cysts / 中国综合临床

Objective To summarize and analyze our experiences uponperforming laparoscopic resection ofpresacral cysts,at the aim of generalizing the minimally invasive surgery in the treatment of this disease.Methods The clinical data of 33 patients with presacral cysts treated by laparoscopy in Peking Union Medical College Hospital of Chinese Academy of Medical Sciences from November 2012 to June 2017 were retrospectively analyzed.The operation time, the incidence of intraoperative and postoperative complications and the length of hospital stay were counted.Results Tumor excision was completed according to the plan without conversion to open surgery.The average operation time was ( 124.4 ± 63.0) minutes.There were 1 case of rectal injury and 1 case of presacral venous plexus hemorrhage.The complications were 6%.Postoperative rectal leakage occurred in 2 cases ( 6%).The average hospitalization time after operation was ( 6.7 ± 4.3) days.Of 33 cases, 2 cases were lost.One case had recurrence of presacral cyst one year after operation.Conclusion Laparoscopic resection of presacral cysts is technically feasible,and helps to improve intraoperative exposure,increase operating space and improve the resection rate of tumors.

Laparoscopic Resection of Retroperitoneal Presacral Schwannoma: A Case Report

Retroperitoneal presacral schwannomas are uncommon and are usually diagnosed accidentally. We present here the case of a 23-year-old woman diagnosed with an expansive pelvic lesion during a routine gynecological examination. The precise location of the tumor, as well as its relation to adjacent structures, was determined through magnetic resonance imaging (MRI). The patient underwent laparoscopic lesion resection and the diagnosis was confirmed by immunohistochemistry. An MRI performed 2 months after surgery confirmed complete lesion resection.

Classification and Operative Approaches of Adult Female Presacral Space Tumor / 中国微创外科杂志

[Summary] Adult female presacral space tumor involves in different disciplines .It could be typing according to the tumor location, size, mobility and the relationship with surrounding tissues .Understanding the classification of the tumor is helpful to select a suitable operative approach that lead to a better result .After the strict preoperative evaluation , transvaginal approach should not be neglected in adult female patients with presacral space tumor .

Progressive Transformation of Germinal Centers in Presacral Space: MRI Findings and Literature Review

Progressive transformation of germinal centers (PTGC) is an atypical feature seen in lymph nodes with unknown pathogenesis. PTGC most commonly presents in adolescent and young adult males as solitary painless lymphadenopathy with various durations. Cervical nodes are the most commonly involved ones while involvements of axillary and inguinal nodes are less frequent. PTGC develops extremely rarely in other locations. We report a rare case of solitary mass present in the presacral space. The mass as subsequently proven to be PTGC. To the best of our knowledge, PTGC in the presacral space has not been previously reported in the literature.

The CT and MRI diagnosis of presacral primary tumor / 实用放射学杂志

Objective To investigate the diagnostic values of CT and MRI by analysing the CT and MRI features of presacral tumor.Methods The CT and MRI imaging features of 37 cases of primary presacral tumor with surgical pathology were analyzed retrospectively,and the imaging findings were compared with the pathologic findings.All data were analyzed by Fishersχ2 test.Re-sults 9 cases of presacral tumors were cystic type,18 cases were solid type and 10 cases were cystic-solid type.90.3% (28/31)of benign tumors had round or oval shapes,83.3% (5/6)of malignant tumors were irregular form(χ2=16.093,P=0.001).The den-sity of lesions whether uniform or not,and the presence of enhancement showed no obvious statistical differences between benign and malignant lesions.In all 37 cases,28 cases of benign and 1 case of malignant tumor were found compressed the surrounding tissues and organs;4 cases of benign and 5 cases of malignant tumor invaded adjacent tissues and organs(χ2=13.547,P=0.002).Conclu-sion CT and MRI can differentiate benign and malignant tumor,and can make clear diagnosis in some cases.

Quiste epidermoide gigante del espacio presacro y posanal / Giant epidermoid presacral and retrorectal cyst: case report

Introducción: El espacio presacro, el cual contiene algunos tipos de tejidos embrionarios, es un sitio potencial para varios tumores, siendo el quiste epidermoide uno de ellos. Las lesiones quísticas presacras se dividen en dos grupos: teratomas y quistes del desarrollo, estos últimos son lesiones congénitas raras y sus manifestaciones en el adulto son excepcionales. El objetivo de la presente investigación es informar el caso de un quiste epidermoide gigante del espacio presacro y posanal. Caso clínico: Mujer de 28 años con cuadro clínico que se inició ocho años atrás con masa tumoral perianal y dificultad para la micción. La rectosigmoidoscopia y videocolonoscopia fueron normales. Se solicitó tomografía abdominopélvica simple y contrastada, así como resonancia magnética nuclear, para determinar extensión y localización de la tumoración, con las cuales fue posible apreciar tres tumoraciones en el espacio presacro. Se realizó cirugía por abordaje combinado: abdominal y perianal. El examen patológico indicó quistes epidermoides. La paciente evolucionó favorablemente sin datos de incontinencia fecal. Discusión: La descripción aceptada de quiste epidermoide es que posee epitelio escamoso estratificado con gránulos queratohialinos, pero no con otras estructuras de piel. Los quistes del desarrollo son formaciones de crecimiento lento que por su especial localización se manifiestan de forma tardía a pesar de ser congénitos. El diagnóstico se realiza por ultrasonido, tomografía axial computarizada y resonancia magnética nuclear. La biopsia preoperatoria está contraindicada. Se describen tres vías de abordaje: abdominal, combinada o abdominoposterior y transacra, cada una con sus indicaciones.

BACKGROUND: The presacral space, which contains different types of embryonic tissue, is a potential site for several tumors including epidermoid cyst. Presacral cysts are divided into two major groups: teratomas and developmental cysts. Presacral developmental cysts are rare congenital injuries with significant manifestations in the adult. Our objective was to report a case of a giant epidermoid presacral and retrorectal cyst. CLINICAL CASE: We present the case of a 28-year-old female whose clinical feature was the presence of a perianal mass and difficult micturition of 8 years. Rectosigmoidoscopy and videocolonoscopy were normal. Simple and contrast abdominal and pelvic tomography (CT) were ordered as well as nuclear magnetic resonance (NMR) imaging to determine extension and location of the tumor. These studies demonstrated three tumors in the presacral space. Surgery using a combined abdominal and perianal approach was done. Pathological report was epidermoid cysts. The patient had a favorable evolution with no reports of fecal incontinence. CONCLUSIONS: The accepted definition describing epidermoid cyst is squamous stratified epithelium with keratohyaline grains, but with no other skin structures. Developmental cysts are slow growing due to their unique location, despite being congenital. Diagnosis is confirmed by ultrasound, CT, and NMR. Biopsy is contraindicated. Three described approaches are abdominal, combined or abdominoposterior, and transsacral, each with its specific indications.

A Carcinoembryonic Antigen-Secreting Adenocarcinoma Arising in Tailgut Cyst : Clinical Implications of Carcinoembryonic Antigen

Tailgut cysts (TGCs) are rare congenital cysts that occur in the retrorectal or presacral spaces. Although most tailgut cysts have been reported as benign, there have been at least 9 cases associated with malignant change. We report herein on an unusual case of a 40-year-old woman with a carcinoembryonic antigen (CEA) -producing adenocarcinoma arising within a TGC who underwent surgical resection and local radiation therapy. Despite the complete resection, metastatic adenocarcinoma developed five months after surgery. CEA-producing adenocarcinoma from a TGC is extremely rare and only two cases, including this case, have been reported in the English medical literature. Besides CEA, the serum levels of CA 19-9 became markedly elevated in this patient. Given that the serum CEA level decreased to the normal range after complete resection of tumor and that the tumor recurrence was associated with a rebound of the CEA serum level, our case shows that serial measurements of serum CEA can be used for treatment planning and for assessing the patient's treatment response for this rare disease.

Giant Benign Schwannoma Involving Sacral Bone

Sacral schwannoma is a rare lesion with a tendency to reach large proportions. The benign schwannoma rarely involves the vertebral bodies extensively. The authors report a case of giant intrasacral schwannoma in 30-year-old woman who had intermittent lower back pain during 3 years period. CT and MRI showed a destructive mass lesion within the upper part of sacrum with a large mass extending into the presacral space. The patient underwent combined surgery consisted of anterior transabdominal approach and posterior sacral laminectomy and total removal of tumor. The characteristics of the lesion were discussed with a review of literatures.

Giant Intrasacral Schwannoma

Sacral schwannoma is a rare lesion with a tendency to reach large proportions. The authors report a case of giant intrasacral schwannoma in a 49-year-old man who had persistent lumbago and sciatica over 15 years period. Plain spine X-ray revealed destruction of the sacrum and myelogram demonstrated a complete ampu-tation of the lumbosacral cul-de-sac at the L5/S1 level. CT and MRI showed a destructive mass lesion within the upper part of sacrum with a large mass extending into the presacral space. The patient underwent su rgery consisted of posterior lumbosacral laminectomy and subtotal removal of tumor. Pathologic examination revealed a benign schwannoma. The patient returned to work 1 month postoperatively with improvement of symptoms. Characteristics of this case with a pe rtinent literature are reviewed.