Presacral Tumors
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Presacral Tumors- Outcomes
- Key Concepts
- Conclusions
- References
- Introduction
- Anatomic Considerations
- Clinical Presentations
- Physical Examination
- Imaging Studies
- Preoperative Biopsy
- Classification
- Currarino Syndrome
- Epidermoid and Dermoid Cysts
- Tailgut Cysts
- Enterogenous Cysts
- Teratomas
- Chordomas
- Meningoceles
- Neurogenic Tumors
- Osseous Tumors
- Miscellaneous Lesions
- Management
Malignancy- An obese 55-year-old man underwent proctectomy with coloanal anastomosis for a distal locally advanced rectal tumor. He developed impotence and urinary retention after surgery. At which point in the dissection did this injury likely occur?
- A 65-year-old woman presents with a presacral mass incidentally identified on a lumbar spine magnetic resonance imaging scan. The patient reports back pain but denies any constitutional or gastrointestinal symptoms. On digital rectal examination, the mass is not palpable. Her most recent colonoscopy was 2 years ago and was negative for intraluminal pathology. Imaging reveals a 4-cm cystic lesion located above the S4 level (Figure). What is the best next step in management?
- A 45-year-old woman presents to the clinic with a 4-month history of progressively worsening low back pain, particularly with sitting. Rectal examination reveals a palpable posterior retrorectal mass 5 cm from the anal verge. Flexible sigmoidoscopy reveals a bulge in the posterior rectum, but normal overlying mucosa. Magnetic resonance imaging reveals a 4.5-cm well-circumscribed, solid mass in the presacral space, concerning for a neurogenic tumor. Which of the following is the most appropriate route of biopsy?
- A 40-year-old woman presents to your office with constipation and vague lower back pain. On digital rectal examination, you palpate a smooth mass posteriorly at the tip of your finger. Colonoscopy findings were normal, save for posterior bulging with smooth mucosa in the rectum. Magnetic resonance imaging (MRI) shows a solid mass in the rectorectal space with bony destruction of the sacrum. What is the next best management step for this patient?
Malignancy- A 34-year-old patient presents with vague pelvic discomfort. Digital rectal examination (DRE) reveals a 3-cm anterior soft, compressible lesion that is 4 cm from the anal verge. Pelvic magnetic resonance imaging (MRI) shows a presacral solid mass that measures 2.5 cm x 2 cm with its most proximal part at S3 level. There is a clear plane between the lesion and the rectum anteriorly and the sacrum posteriorly. What is the best next step in treatment of this patient?
- A 34-year-old female patient presents with an incidental imaging finding of the cyst, as seen in the figures below. Which of the following is the most appropriate approach for removal?
- An otherwise healthy 50-year-old patient reports rectal fullness and pain while sitting. On examination, the rectal mucosa is smooth; however, you can palpate a large firm mass that appears extraluminal and extends to the tip of your examining finger. Cross-sectional imaging reveals a large heterogeneous presacral mass that measures 7 cm x 10 cm. The best next step in management is
- A 60-year-old man is referred for a finding of a 4-cm presacral mass during the workup for leg pain. Magnetic resonance imaging (MRI) shows an enhancing, heterogenous 4-cm mass with irregular margins and osseous destruction. What is the most common cause of this lesion?
- A 68-year-old woman reports severe anal pain and bleeding. Examination demonstrates a 2-cm ulcerated lesion just proximal to the dentate line. Biopsies reveal BRAF mutation anal melanoma. Imaging demonstrates enlarged presacral and obturator lymph nodes. The best next step in management is
- A 63-year-old woman is diagnosed with a poorly differentiated microsatellite–stable rectal cancer 7 cm from the anal verge on screening colonoscopy. She denies trouble with continence. Staging computed tomography (CT) of the chest/abdomen/pelvis does not demonstrate distant disease; a mass is confirmed in the mid rectum with evidence of lymphadenopathy. Rectal magnetic resonance imaging (MRI) demonstrates this tumor is a T4aN2M0 with threatened circumferential radial margin. The multidisciplinary tumor board recommends total neoadjuvant chemotherapy with FOLFOX and long-course chemoradiation therapy. Six weeks after completing neoadjuvant therapy, flexible sigmoidoscopy demonstrates persistent tumor. Restaging MRI after total neoadjuvant therapy is consistent with persistently threatened posterior radial margin with tumor extending to the presacral fascia. The multidisciplinary tumor board’s best recommendation for her is
Management of Intraoperative Vascular and Urinary Complications- Proctectomy for Rectal Cancer
- Technique of Total Mesorectal Excision
- Locally Recurrent Rectal Cancer
- Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy
- About ASCRS Textbook of Colon and Rectal Surgery
- Colorectal Cancer: Minimally Invasive Surgery
- Rectal Anatomy
- Pelvic Floor
Laparoscopic Low Anterior Resection- Benign Disease
- Abdominoperineal Resection
- Surveillance After Rectal Cancer Treatment
- Anastomotic Complications