Double tailgut cysts (presacral and precoccygeal hamartomas) with CA 19-9 elevation

Ji Won Kim,Hye Kyung Ahn,So Young Jung,Seung Chul Lee,Jae Woong Han,Byung Chun Kim,Han Myun Kim

doi:10.4236/crcm.2013.21002

Abstract

Tailgut cyst, also called retrorectal hamartoma, is a rare congenital lesion and is usually located anterior to the sacrum and posterior to the rectum. We report a case of double tailgut cyst (presacral and precoccygeal hamartoma). A 62-year- old female visited the hospital complaining of anal pain and pressure in the perianal area for one month. Digital rectal examination revealed a round mass with hard consistency in the lateral and posterior part of rectum 5 cm from the anal verge. Pelvic magnetic resonance imaging showed two cystic and solid presacral masses (lateral and posterior part of rectum) compressing the rectum. The patient underwent surgical resection for pathologic diagnosis. At operation, two masses were located in the left presacral space without invasion to adjacent organs and soft tissue. Pathologic examination revealed double tailgut cysts without malignant transformation. A differential diagnosis of perirectal cystic hamartoma includes epidermal cysts, cystic teratomas, dermoid cysts, anal gland cysts, sarcoma and rectal duplications. Regional inflammatory process frequently complicates this lesion and perirectal fistula can develop. Tailgut cyst also has a malignancy potential, with development of adenocarcinomas. To establish a definite diagnosis and prevent complication, complete surgical resection is recommended.

Highlights

Known as retrorectal hamartoma and mucus-secreting cyst, is a rare, congenital developmental disease that arises from the remnants of the embryonic postanal gut with incomplete regression during development
We report the case of a double tailgut cyst and present a review of the relevant literature to emphasize the importance of consideration of double tailgut cyst as a differential diagnosis in evaluating patients complaining of symptoms suggestive of benign anal inflammatory disease
Tailgut cysts, which are known as retrorectal cystic hamartomas, are rare congenital, multicystic, enteric lesions that lie between the rectum and the sacrum, and which are bounded superiorly by the peritoneal reflection, inferiorly by the levator ani and coccygeus muscles and laterally by the ureters and iliac vessels [5]

Summary

INTRODUCTION

Known as retrorectal hamartoma and mucus-secreting cyst, is a rare, congenital developmental disease that arises from the remnants of the embryonic postanal gut with incomplete regression during development. It almost invariably occurs within the retrorectal or presacral space, and rarely in the perirenal area, subcutaneous tissue in the anorectal area and prerectal region [1,2]. Tailgut cyst can be misdiagnosed because the symptoms are similar to those of inflammatory disease, such as pilonidal abscess, perianal abscess and complicated fistula. We report the case of a double tailgut cyst and present a review of the relevant literature to emphasize the importance of consideration of double tailgut cyst as a differential diagnosis in evaluating patients complaining of symptoms suggestive of benign anal inflammatory disease

CASE REPORT

DISCUSSION

Findings

CONCLUSION