Abstract
Objective: To present a case of retrorectal chordoma and a literature review of this condition. Introduction: Tumors of the retrorectal area are rather rare. Retrorectal lesions can be cystic or solid, benign or malignant, and can be classified as congenital, neurogenic, osseous or miscellaneous. Diagnosis is frequently delayed until the tumors reach considerable size. Wide en bloc resection should be performed once the diagnosis is made. Case report: A 63 year old male patient, who complaint of progressive and recent onset constipation, and light pain at the coccigeal area. At the digital examination of the rectum we appreciate a firm, smooth presacral mass swelling the posterior rectal wall, with intact rectal mucosa. The MRI showed a multilobulated retrorectal mass; and the patient underwent to a wide en bloc resection of the tumor. The histopathological study of the specimen corroborates the presence of chordoma. Conclusions: Retrorectal tumors are rare; their diagnosis is difficult and late. Treatment is surgical with wide resection; chordomas have poor sensitivity to radiotherapy and chemotherapy.
Highlights
Tumors of the retrorectal area are rather rare
Diagnosis is frequently delayed until the tumors reach considerable size
The histopathological study of the specimen corroborates the presence of chordoma
Summary
The retrorectal space can harbor heterogeneous and rare lesions that may be silent and are difficult to diagnose. Due to the presence of a presacral mass we perform a MRI that showed a multilobulated retrorectal mass localized below S5, with this findings our preoperative impression was limited to a retrorectal tumor, (biopsy should be avoided unless the lesion seems unresectable) (Figure 1) At pulmonologist evaluation they founded in chest films hyperinflation with increased lucency of the lungs, and low flattened diaphragms, SaO2 84% and at spirometry forced expiratory volume in one second (FEV1) of 38%, and recommend pulmonary physiotherapy prior to a surgical procedure. We decide both with the patient planning a surgical treatment and perform a posterior sagittal approach, with wide en bloc tumor and coccyx resection (Figures 2-4) under spinal anesthesia (due to his respiratory condition), thrombosis prophylaxis. The histopatological study of the piece confirms chordoma (conventional type) (Figure 5)
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