A Rare Presacral Tumor – Case Report

Abstract

Background

Anatomically, the presacral space is a virtual cavity confined superiorly by the peritoneal reflection and inferiorly by the retrosacral fascia, close to the anorectal junction; the anterior aspect is formed by the mesorectum and the posterior side by the anterior sacral face; the lateral border is comprised of the ureters, iliac vessels, alae recti and sacral nerve roots. Embryologically, this space is the fusion of the neuroectoderm and hindgut, thus has a potential for developing tumors of various histologic type. About 50-70% of presacral tumors are congenital and originate from embryologic remnants. Surgical treatment is the mainstay treatment of choice, as it estabilishes a definitive diagnosis, prevents further tumor development or infection. The surgical approach, however, is entirely at the discretion of the surgeon via anterior abdominal route or posterior trans-sacrococcygeal route.

Case presentation

A 36 years old female patient was diagnosed with a presacral tumor of 6cm in size during a gynaecological consult for the complain of lower abdominal pain. It had grown to 7cm in the last 8 months. Imaging studies show no involvement of the pelvic vessels and clear margins form the vagina and presacral muscles. A surgical intervention is proposed and patient consent obtained. Via an anterior, transabdominal approach the complete extirpation of the presacral mass is performed. The patient made a full recovery and was referred for an oncological consult. Histopathology report confirms a liposarcoma.

Discussion

Imaging studies such as CT and MRI play an important role in determining the nature and extent of the lesion. They ought to be used in a complementary fashion rather than exclusive. MRI is superior in detailing soft tissues and determining the planes of resection, whereas CT can help with the nature of the lesion, the involvement of bone or other surrounding tisues. However, these should be aided with fibro-colonoscopy, fistulograms or transrectal ultrasound where applicable. With regards to the operative strategy, it is at the discretion of the surgeon to choose the best strategy for excision, whether it is anterior transabdominal or posterior trans-sacrococcygeal. The involvement of other specialists in the operating team may be necessary due to possible unexpected tumor type organ involvement.

Conclusion

In conclusion, presacral tumors have a relatively high potential for malignancy or complications, thus surgical resection is recommended, especially in symptomatic patients. Surgeons should take all the information available from different imaging studies such as CT and MRI to device the correct surgical strategy.

Keywords: General Surgery, Presacral Tumor, Liposarcoma, Liposarcoma Extirpation.

DOI: 10.7176/JEP/14-32-04

Publication date: November 30^th 2023