Abstract
Developmental cysts are very rare lesions occurring in the retrorectal space, and include epidermoid, dermoid, tailgut cysts and teratomas. There is little information on their natural history and biologic behavior, although a recent paper reported a greater incidence of malignant transformation than previously thought. The diagnosis requires high-resolution imaging, and complete surgical excision is the treatment of choice. In this paper we analyzed short- and long-term results of surgical excision of six retrorectal developmental cysts observed at our institution over a period of 11 years. All patients were women, three were referred with an infected perineal fistula/pelvic abscess after having undergone drainage surgery elsewhere. In these three patients, excision was attempted through a trans-perineal approach, which was technically demanding and ultimately incomplete because of the intense surrounding inflammation. Multiple re-interventions were required for tumor recurrence, and two of them still present an occasional perineal discharge. In the other three patients, a trans-perineal or trans-anal route was employed according to tumor location, without any recurrence at a median follow-up of 118.5 months. Final pathologic diagnosis included five tailgut cysts and one teratoma. This paper shows that the treatment of developmental cysts may be very challenging, especially when they are associated with a concomitant fistula/abscess and are not correctly diagnosed at presentation. In our experience, healing was finally achieved in four patients out of six. All the lesions were benign, and no malignant transformation was observed during follow-up, even in tumors partially resected.
Similar content being viewed by others
References
Hobson KG, Ghaemmaghami V, Roe JP, Goodnight JE, Khatri VP (2005) Tumors of the retrorectal space. Dis Colon Rectum 48:1964–1974
Dahan H, Arrivé L, Wendum D, Docou le Pointe H, Djouri H, Toubiana JM (2001) Retrorectal developmental cysts in adults: clinical and radiologic-histopathologic review, differential diagnosis, and treatment. Radiographics 21:575–584
Glasgow SC, Birnbaum EH, Lowney JK, Fleshman JW, Kodner IJ, Mutch DG, Lewin S, Mutch MG, Dietz DW (2005) Retrorectal tumors: a diagnostic and therapeutic challenge. Dis Colon Rectum 48:1581–1587
Mathis KL, Dozois EJ, Grewal MS, Metzger P, Larson DW, Devine RM (2010) Malignant risk and surgical outcomes of presacral tailgut cysts. Br J Surg 97:575–579
Buchs N, Taylor S, Roche B (2007) The posterior approach for low retrorectal tumors in adults. Int J Colorectal Dis 22:381–385
Wolpert A, Beer-Gabel M, Lifschitz O, Zbar AP (2002) The management of presacral masses in the adult. Tech Coloproctol 6:43–49
Gönül II, Bağlan T, Pala I, Menteş B (2007) Tailgut cysts: diagnostic challenge for both pathologists and clinicians. Int J Colorectal Dis 22:1283–1285
Hall DA, Pu RT, Pang Y (2007) Diagnosis of foregut and tailgut cysts by endosonographically guided fine-needle aspiration. Diagn Cytopathol 35:43–46
Au E, Anderson O, Morgan B, Alarcon L, George ML (2009) Tailgut cysts: report of two cases. Int J Colorectal Dis 24:345–350
Aflalo-Hazan V, Rousset P, Mourra N, Lewin M, Azizi L, Hoeffel C (2008) Tailgut cysts: MRI findings. Eur Radiol 18:2586–2593
Pidala MJ, Eisenstat TE, Rubin RJ, Salvati EP (1999) Presacral cysts: transrectal excision in select patients. Am Surg 65:112–115
Losanoff JE, Sauter ER (2003) Retrorectal cysts. J Am Coll Surg 197:879–880
Pappalardo G, Frattaroli FM, Casciani E, Moles N, Mascagni D, Spoletini D, Fanello G, Gualdi G (2009) Retrorectal tumors: the choice of surgical approach based on a new classification. Am Surg 75:240–248
Gunkova P, Martinek L, Dostalik J, Gunka I, Vavra P, Mazur M (2008) Laparoscopic approach to retrorectal cyst. World J Gastroenterol 14:6581–6583
Lev-Chelouche D, Gutman M, Goldman G, Even-Sapir E, Meller I, Issakov J, Klausner JM, Rabau M (2003) Presacral tumors: a practical classification and treatment of a unique and heterogeneous group of diseases. Surgery 133:473–478
Woodfield JC, Chalmers AG, Phillips N, Sagar PM (2008) Algorithms for the surgical management of retrorectal tumours. Br J Surg 95:214–221
Prasad AR, Amin MB, Randolph TL, Lee CS, Ma CK (2000) Retrorectal cystic hamartoma: report of 5 cases with malignancy arising in 2. Arch Pathol Lab Med 124:725–729
Hjermstad BM, Helwig EB (1988) Tailgut cysts. Report of 53 cases. Am J Clin Pathol 89:139–147
Conflict of interest
None.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Rosa, G., Lolli, P., Vergine, M. et al. Surgical excision of developmental retrorectal cysts: results with long-term follow-up from a single institution. Updates Surg 64, 279–284 (2012). https://doi.org/10.1007/s13304-012-0168-x
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s13304-012-0168-x