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Primary neuroendocrine tumor in the presacral region: A case report

World Journal of Clinical Cases 2019年第14期7卷 1884-1891页

作者： Rui Zhang Yong Zhu Xiao-Bo Huang Chris Deng Min Li Guang-Shu Shen Shu-Liang Huang Shao-Hua Huangfu Yan-Ni Liu Chun-Gen Zhou Ling Wang Qi Zhang Youping Deng Bin Jiang Department of Integrated Traditional Chinese and Western Medicine Nanjing University of Chinese MedicineNanjing 210023Jiangsu ProvinceChina Department of Colorectal Surgery the Nanjing Hospital of Chinese Medicine Affiliated to Nanjing University of Chinese MedicineNanjing 2100022Jiangsu ProvinceChina Bioinformatics Core Department of Complementary and Integrative MedicineUniversity of Hawaii John A. Burns School of MedicineHonoluluHI 96813United States Department of Medical Oncology the Nanjing Hospital of Chinese Medicine Affiliated to Nanjing University of Chinese MedicineNanjing 2100022Jiangsu ProvinceChina Department of Medical Imaging the Nanjing Hospital of Chinese Medicine Affiliated to Nanjing University of Chinese MedicineNanjing 2100022Jiangsu ProvinceChina Department of Pathology the Nanjing Hospital of Chinese Medicine Affiliated to Nanjing University of Chinese MedicineNanjing 2100022Jiangsu ProvinceChina

BACKGROUND Primary neuroendocrine tumors (NETs) in the presacral region are extremely rare, some of which are caused by other primary tumors or metastatic rectal carcinoids. Nevertheless, cases of NETs have been increasing in recent years. This report describes the first primary neuroendocrine tumor in the presacral region that was found at our hospital within the last five years. CASE SUMMARY The patient was identified as a 36-year-old woman with a presacral mass and pelvic floor pain. A digital rectal examination revealed a presacral mass with unclear margins and obvious tenderness. Magnetic resonance imaging (MRI) demonstrated a 57 mm × 29 mm presacral lump. An ultrasound-guided needle biopsy confirmed a well-differentiated neuroendocrine tumor. No other primary or metastatic tumors were found. CONCLUSION Comprehensive consideration of our case report and literature reported by others suggests that a conclusive diagnosis of NETs should be based on computed tomography/MRI and pathological examinations. The treatment of primary NETs in the presacral region mainly relies on surgical procedures with follow-up.

关键词： Neuroendocrine tumor presacral Biopsy Case report

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Massive presacral bleeding during rectal surgery: From anatomy to clinical practice

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World Journal of Gastroenterology 2013年第25期19卷 4039-4044页

作者： Zheng Lou Wei Zhang Rong-Gui Meng Chuan-Gang Fu Department of Colorectal Surgery Changhai Hospital

AIM: To investigate control of two different types of massive presacral bleeding according to the anatomy of the presacral venous system. METHODS: A retrospective review was performed in 1628 patients with middle or low rectal carcinoma who were treated surgically in the Department of Colorectal Surgery, Changhai Hospital, Shanghai, China from January 2008 to December 2012. In four of these patients, the presacral venous plexus (n = 2) or basivertebral veins (n = 2) were injured with massive presacral bleeding during mobilization of the rectum. The first two patients with low rectal carcinoma were operated upon by a junior associate professor and the source of bleeding was the presacral venous plexus. The other two patients with recurrent rectal carcinoma were both women and the source of bleeding was the basivertebral ***: Two different techniques were used to con-trol the bleeding. In the first two patients with massive bleeding from the presacral venous plexus, we used suture ligation around the venous plexus in the area with intact presacral fascia that communicated with the site of bleeding (surrounding suture ligation). In the second two patients with massive bleeding from the basivertebral veins, the pelvis was packed with gauze, which resulted in recurrent bleeding as soon as it was removed. Following this, we used electrocautery applied through one epiploic appendix pressed with a long Kelly clamp over the bleeding sacral neural foramen where was felt like a pit Electrocautery adjusted to the highest setting was then applied to the clamp to "weld" closed the bleeding point. Postoperatively, the blood loss was minimal and the drain tube was removed on days 4-7. CONCLUSION: Surrounding suture ligation and epiploic appendices welding are effective techniques for controlling massive presacral bleeding from presacral venous plexus and sacral neural foramen, respectively.

关键词： Massive presacral bleeding Rectal surgery Suture ligation Welding

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A novel transperineal approach for surgical resection of presacral tumors with an arc-shaped incision in front of the apex of the coccyx(with video)

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Gastroenterology Report 2022年第1期10卷 603-605页

作者： Guo-Qiang Zhang Gang-Cheng Wang Zhi Zhang Liang-Liang Ding You-Cai Wang Yin-Jun Liu Department of General Surgery Affiliated Cancer Hospital of Zhengzhou University and Henan Cancer HospitalZhengzhouHenanP.R.China

Introduction presacral cystic tumors are rare and are composed of many types of tumors located in the presacral space[1].The mainstay of treatment is total excision without preoperative biopsy[2].In recent years,the number of patients with presacral cystic tumors who have been treated in the Affiliated Cancer Hospital of Zhengzhou University has *** particular,>25%of patients have presented with residual presacral cystic walls with perineal refractory sinuses due to the failure of presacral tumor operations in other *** studied the surgical records of patients with failed primary procedures and suggested that inadequate surgical exposure due to a lack of proper surgical approach was the main ***.

关键词： presacral surgical shaped

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Pain Management in a Parturient with presacral Mass

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Open Journal of Anesthesiology 2017年第11期7卷 364-370页

作者： Tan Yan Ru John Paul Lew Ong Yee Yian Antonia Zeng Singapore General Hospital Singapore Singapore

presacral masses are rare lesions and due to obscure anatomic location and etiological heterogeneity, they pose a diagnostic and therapeutic challenge. Literature is limited on the pain management of a parturient with presacral mass. We describe here a parturient in her second trimester with severe pain from a presacral mass. A high clinical acumen with early multidisciplinary involvement are needed to establish a diagnosis and provide treatment options for the well-being of the patient, minimize fetal teratogenicity, avoid chronic symptoms and long-term disability.

关键词： presacral Mass Pregnancy Pain Management Analgesics

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Surgical treatment of retrorectal(presacral) tumors

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World Journal of Surgical Procedures 2015年第1期5卷 127-136页

作者： Ahmet Deniz U?ar Nazif Erkan Mehmet YιldιrιmAhmet Department of General Surgery Izmir Bozyaka Educational and Research Hospital35320 NarlidereIzmirTurkey

Retrorectal(also known as presacral) tumor(RT) is a rare disease of retrorectal space. They can be classified as congenital, inflammatory, neurogenic, osseous, or miscellaneous. The most common presentation is an asymptomatic mass discovered on routine rectal examination, but certain nonspecific symptoms can be elicited by careful history and physical examination. The primary and only satisfactory treatment is surgery for RTs. Three approaches commonly used for resection are abdominal, transsacral, or a combined abdominosacral approach. Prognosis is directly related primary local control, which is often difficult to achieve for malignantlesions.

关键词： Retrorectal presacral Tumor

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

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Case Reports in Clinical Medicine 2013年第1期2卷 5-8页

作者： Ji Won Kim Jae Woong Han So Young Jung Seung Chul Lee Byung Chun Kim Hye Kyung Ahn Han Myun Kim Departments of Pathology Kangnam Sacred Heart Hospital Hallym University College of Medicine Seoul Korea Departments of Radiology Kangnam Sacred Heart Hospital Hallym University College of Medicine Seoul Korea Departments of Surgery Kangnam Sacred Heart Hospital Hallym University College of Medicine Seoul Korea

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.

关键词： Tailgut Cyst Retrorectal Hamartoma presacral Tumor Retrorectal Tumor Retrectal Developmental Cysts

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Posterior approach (Kraske procedure) for surgical treatment of presacral tumors

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World Journal of Gastrointestinal Surgery 2012年第5期4卷 126-130页

作者： José Manuel Aranda-Narváez Antonio Jesús GonzálezSánchez Custodia Montiel-Casado Belinda Sánchez-Pérez Carolina Jiménez-Mazure Marta Valle-Carbajo Julio Santoyo-Santoyo Department of General Digestive Surgery and Abdominal Organs TransplantationUniversity Hospital Carlos HayaCarlos Haya Avenue29010MálagaSpain

presacral tumors are rare,but can comprise a great variety of histological *** tumors are the most *** the diagnosis is established,surgical resection is essential because of the potential for malignancy or *** biopsy is not necessary or may be even *** decide the best surgical approach(abdominal,sacral or combined) an individual and multidisciplinary analysis must be carried *** report three cases of cystic presacral masses in which a posterior approach(Kraske procedure) enabled complete resection,the only way to decrease local *** patients had a satisfactory recovery.A brief overview of retrorectal tumors is presented,focusing on classification,clinical presentation,diagnosis and surgical management.

关键词： presacral tumors Posterior approach Surgical management

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Retrorectal tumors in adults:Magnetic resonance imaging findings

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World Journal of Gastroenterology 2010年第46期16卷 5822-5829页

作者： Bo-Lin Yang,Yun-Fei Gu,Wan-Jin Shao,Hong-Jin Chen,Gui-Dong Sun,Department of Coloproctology,The Affiliated Hospital of Nanjing University of Chinese Medicine,Nanjing 210029,China Hei-Ying Jin,Department of Coloproctology,The 3rd Affiliated Hospital of Nanjing University of Chinese Medicine,Nanjing 210029,China Xin Zhu,Department of Radiology,The Affiliated Hospital of Nanjing University of Chinese Medicine,Nanjing 210029,China Department of Radiology The Affiliated Hospital of Nanjing University of Chinese Medicine No.155 Hanzhong Road Nanjing 210029 China.

AIM:To retrospectively evaluate the magnetic resonance imaging (MRI) features of adult retrorectal tumors and compare with histopathologic ***:MRI features of 21 patients with preoperative suspicion of retrorectal tumors were analyzed based on the histopathological and clinical ***:Fourteen benign cystic lesions appeared hypointense on T1-weighted images,and hyperintense on T2-weighted images with regular peripheral *** or dermoid cysts were unilocular,and tailgut cysts were *** of intracystic intermediate signal intensity was observed in one case of tailgut cyst with a component of *** solid tumors were malignant lesions and showed heterogeneous intensity on *** adenocarcinomas showed high signal intensity on T2-weighted and mesh-like enhancing areas on fat-suppressed T2-weighted *** was a fistula between the mass and anus with an internal opening in mucinous adenocarcinomas arising from anal *** stromal tumors displayed low signal intensity on T1-weighted images,and intermediate to high signal intensity on T2-weighted *** necrosis could be seen as a high signal on T2-weighted ***:MRI is a helpful technique to define the extent of the retrorectal tumor and its relationship to the surrounding structures,and also to demonstrate possible complications so as to choose the best surgical approach.

关键词： Retrorectal tumor presacral lesions Magnetic resonance imaging Congenital cyst Malignant tumor Diagnosis

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Retrorectal Cystic Hamartoma with Malignant Transformation

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Journal of Cancer Therapy 2020年第1期11卷 18-25页

作者： Andreia Cruz Sarah Lopes Maria Leitao Sonia Carvalho Olga Sousa Manuela Machado Medical Oncology Department Portuguese Institute of OncologyIPO PortoPortugal Pathology Department IPO PortoPortugal Radiotherapy Department IPO PortoPortugal

Retrorectal cystic hamartomas are rare congenital lesions that can undergo malignant transformation, and adenocarcinoma is the most frequently described histological type. The authors describe a case of a 53-year-old female patient with a localized well-differentiated adenocarcinoma that developed in a retrorectal cystic hamartoma. The patient was submitted to surgery (a Kraske procedure), with an R1 resection, followed by adjuvant radio-chemotherapy. After 23 months of follow up, the patient remains free from disease recurrence. Given the rarity of this entity, this case allows us to reflect on the differential diagnosis, therapeutic approach and patients’ follow-up.

关键词： Retrorectal Cystic Hamartoma Tailgut Cyst presacral Malignant Transformation Adenocarcinoma

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A Single Center Retrospective Analysis of Kraske’s Transsacral Approach: A Review

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Surgical Science 2014年第10期5卷 454-466页

作者： Cédric Bouts Kurt Van der Speeten Department of Surgical Oncology Ziekenhuis Oost-Limburg Genk Belgium

Aim: presacral lesions are uncommon and represent a diagnostic and surgical challenge. The aim of this study is to present our experience with Kraske’s transsacral resection and to review current literature. Methods: Seven patients who had a transsacral resection between 2001 and 2013?were reviewed retrospectively. Results: Two men and five women with a mean age of 39 (range 17?- 60) years were diagnosed with a presacral lesion. The clinical presentation was nonspecific;pain was the most common symptom. All lesions were palpable on digital rectal examination. Magnetic resonance imaging (MRI) was necessary to assess the tumor’s extent, biological behavior and relationship to adjacent structures. MRI predicted malignancy with 100% accuracy. All lesions were located below S3 and underwent a transsacral resection. Pathological examination revealed four tailgut cysts, two epidermoid cysts and one chordoma. Postoperative complications included wound infections (two cases) and spasms of the gluteus muscle (one case). We reported no recurrence or mortality. Conclusion: Clinical awareness, the use of MRI in the routine work-up and avoidance of an incisional biopsy result in a good outcome after surgical resection of presacral lesions. Kraske’s approach can be used for presacral lesions below S3, resulting in low morbidity, no recurrence and no mortality.

关键词： presacral Tumor Magnetic Resonance Imaging Transsacral Approach Kraske

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