The Treatment Efficacy of Transparasacral Approach For Presacral Tumor: A Single Center Experience

Background: Presacral tumors, also known as retrorectal tumors, locate in the presacral space and are clinically rare and the approaches for the diagnosis and treatment of presacral tumors are still deficient. The four accepted surgical approaches for presacral tumors include transabdominal approach, sacrococcygeal approach, perineal approach, and combined approach. This study aims to evaluate the treatment efficacy of transparasacral approach for presacral tumors.Methods: 23 patients (7 males and 16 females) who are diagnosed with presacral tumors and receive surgery in transsacral approach at our department were chosen. The gender, age, body mass index (BMI), and clinical symptoms were recorded. The clinical data, postoperative complications, and short and long-term rehabilitation data were recorded and analyzed. Results: The surgery was performed smoothly and the patients recovered well without signs of intestinal fistula, abdominal and pelvic infection, lung infection, organ dysfunction, or organ failure. The incision edema occurred in only one patient. In terms of the histopathological types, presacral tumors can be classified into tailgut cyst (n=10), epidermoid cyst (n=5), teratoma (n=3), and lipoma (n=10). One patient diagnosed with tailgut cyst was accompanied by adenocarcinoma transition. Tumor recurrence didn’t occur in any patients. In addition, no patients complained about dysuria, sacrococcygeal sensory disturbance, or sacrococcygeal and perineal discomfort.Conclusions: Surgical resection with transparasacral approach is effective for the treatment of presacral tumors with the advantages of high safety, good treatment efficacy, few complications, good oncological prognosis, and fast recovery.

Expression of Estrogen and Progesterone Receptors in a Tailgut Cyst with Carcinoid Tumor

Introduction/Objective Tailgut cysts (TC) are congenital lesions that arise in the presacral space. They originate from the embryonic hindgut and usually present between the ages of 30-60, with female predominance. TCs are usually asymptomatic or can present with lower back, perianal or pelvic pain. Malignant transformation of a TC is a rare complication, with adenocarcinoma being the most common, followed by carcinoid tumor. About thirty cases of carcinoid tumors arising in a TC have been reported in the literature so far with a slight female predominance (1.5:1). Methods/Case Report We describe a 40-year-old Hispanic woman with a 9-year history of cyclic pelvic pain related to her menstrual cycles. She was diagnosed with adenomyosis and underwent hysterectomy that did not completely resolve her symptoms. Follow-up serial imaging showed a growing complex-cystic presacral mass, which was eventually excised. Grossly, there was a 3.6×3.1×2.5 cm multiloculated cystic mass filled with mucoid material. Microscopically, there were multiple cystic spaces lined by benign squamous and mucinous columnar epithelium and surrounded by smooth muscle cells. A 6-mm carcinoid tumor was found within a cyst wall and confirmed by positive synaptophysin and chromogranin staining with a Ki-67 proliferation index of <2%. Estrogen and progesterone receptor immunostains were positive in the epithelial cyst linings and the stromal cells but not in the carcinoid tumor cells. Results (if a Case Study enter NA) NA Conclusion We conclude that the diagnosis of TC should be considered in the differential of gynecologic patients with unresolved cyclic pelvic pain and that estrogen and progesterone could have an important role in the pathogenesis of TCs. Furthermore, estrogen receptors can be a therapeutic target in patients with this entity.

304 First Reported Case of Metachronous Tumours With Delayed Recurrence from The Neuroendocrine Tumour Arising in A Tailgut Cyst

Background Malignant transformation of tailgut cysts (benign retrorectal cysts) into Neurodendocrine tumours (NETS) is extremely rare with less than 30 reported cases in the literature. A tiny proportion of these cases report early recurrence (within 2 years) and to our knowledge none have reported delayed recurrence 6 years after primary resection. Case history We report a 55-year-old male who underwent laparoscopic excision of a 5 cm presacral tumour found incidentally and confirmed histologically to be a G1 NET (WHO Classification) arising from a pre-existing tail gut cyst, with no evidence of metastasis.16 months later the patient presented with bowel obstruction secondary to adenocarcinoma of the colon at the splenic flexure. The patient underwent laparoscopic left hemicolectomy; histology confirming a moderately differentiated adenocarcinoma (TNM stage pT3pN0). The patient underwent adjuvant chemotherapy post-operatively based upon immunohistochemistry. The patient was followed up for both tumours with CEA, serum chromogranin A, colonoscopies, and CT scans. At 5th year post hemicolectomy, CT scan revealed a new asymptomatic 18 mm left internal iliac lymph node which was avid on octreotide scan consistent with metastasis secondary to NET resected previously. He, therefore, underwent 30Gy sabre radiotherapy. Conclusions There is no consensus regarding follow up duration post early NET resection. The recurrent NET was picked up incidentally as part of the 5-year colorectal adenocarcinoma follow up at our unit. The recurrent NET would not have been identified had this not been a metachronous case. Thus, consideration must be given to both radiological and biochemical follow up post NET resections.

The Treatment Efficacy of Transparasacral Approach for Presacral Tumor: A Single Center Experience

Background Presacral tumors, also known as retrorectal tumors, locate in the presacral space and are clinically rare and the approaches for the diagnosis and treatment of presacral tumors are still deficient. The four accepted surgical approaches for presacral tumors include transabdominal approach, sacrococcygeal approach, perineal approach, and combined approach. This study aims to evaluate the treatment efficacy of transparasacral approach for presacral tumors. Methods 23 patients (7 males and 16 females) who are diagnosed with presacral tumors and receive surgery in transsacral approach at our department were chosen. The gender, age, body mass index (BMI), and clinical symptoms were recorded. The clinical data, postoperative complications, and short and long-term rehabilitation data were recorded and analyzed. Conclusions The surgery was performed smoothly and the patients recovered well without signs of intestinal fistula, abdominal and pelvic infection, lung infection, organ dysfunction, or organ failure. The incision edema occurred in only one patient. In terms of the histopathological types, presacral tumors can be classified into tailgut cyst (n = 10), epidermoid cyst (n = 5), teratoma (n = 3), and lipoma (n = 10). One patient diagnosed with tailgut cyst was accompanied by adenocarcinoma transition. Tumor recurrence didn’t occur in any patients. In addition, no patients complained about dysuria, sacrococcygeal sensory disturbance, or sacrococcygeal and perineal discomfort. Surgical resection with transparasacral approach is effective for the treatment of presacral tumors with the advantages of high safety, good treatment efficacy, few complications, good oncological prognosis, and fast recovery.