Abstract
A presacral mass can present a diagnostic dilemma for the surgical oncologist. Differential diagnoses include congenital causes such as teratoma or chordoma, neurological causes such as neurilemoma or neurofibroma or other malignancies such as lymphoma or sarcoma. Diagnosis usually requires imaging such as CT and MRI and tissue biopsy. We present an unusual cause of a presacral mass being extramedullary haematopoiesis, found incidentally in a 71 year old female. Extramedullary haematopoiesis is defined as the production of myeloid and erythroid elements outside of the bone-marrow. This diagnosis is extremely rare in the presacral area especially in a patient with no haematological abnormalities. A review of the literature is presented.
Highlights
Extramedullary haematopoiesis (EH) is defined as the production of myeloid and erythroid elements outside of the bone-marrow
It is usually a mechanism to compensate for haemolytic anaemia such as spherocytosis or thalassaemia, or as a response to abnormal bone-marrow function seen in disorders such as myelofibrosis or leukaemia [1,2,3,4]
The differential diagnosis of a presacral mass can be categorized as congenital (65%), neurogenic (12%), osseous
Summary
Extramedullary haematopoiesis (EH) is defined as the production of myeloid and erythroid elements outside of the bone-marrow. Developmental cysts tend to occur in middle-age, are associated with anorectal malformation and sacral bone defects and are generally benign They are usually asymptomatic, but can become infected, causing pain and discomfort. Except for the recently diagnosed rectal carcinoma and hypertension, she had no other medical issues Her CT scan revealed a suggestion of an ill-defined presacral mass, reported as possible oedema. The occurrence of EH in the presacral area is an extremely rare finding with only 17 reported cases in the literature This remarkable diagnosis was further investigated with the help of a haematologist. The patient subsequently underwent an uncomplicated resection of her rectal carcinoma This is only the second case reported in the literature of a prescaral site of extramedullary haematopoiesis with no obvious underlying cause.
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