Wu Xiaocai, Chen Chunqiu, Yang Muqing, Yuan Xiaoqi, Chen Hong, Yin Lu
Center for Difficult and Complicated Abdominal Surgery, Shanghai Tenth People's Hospital Affiliated to Tongji University, Shanghai, China.
Front Oncol. 2020 Apr 3;10:458. doi: 10.3389/fonc.2020.00458. eCollection 2020.
Presacral tumors are rare space occupying lesions that arise in the presacral space. The incidence of presacral tumor has been reported to be 1 in 40,000 to 63,000 patients. An even rarer occurrence is the transformation of a presacral tumor into a squamous cell carcinoma (SCC). A 61 years old man was referred to our hospital for a palpable mass near anus and appeared repeatedly in last 10 years. The patient previously underwent two surgeries at another hospital. A posterior approach was implemented in the first two surgeries, and the diagnosis was benign presacral epidermoid cyst. Two months before his admission to our department in 2017, the patient complained of a mass measuring ~2 cm around his anus. Physical examination revealed a 2 cm mass at the 12 o'clock direction in chest-knee position. A digital rectal examination indicated a rubbery lesion located in the presacral space. The Pre-operative pelvic magnetic resonance imaging (MRI) confirmed the presence of a 6.8 cm * 5.2 cm * 7.3 cm mass located at the presacral space. In contrast phase, the center of the lesion exhibited homogenous density without enhancement. The mass was then excised via posterior para-sacral approach with pathological report showing a benign epidermoid cyst after operation. The patient was discharged with full recovery without fecal incontinence. Fifteen months after being discharged from our hospital, the patient discovered a recurrence at the original site of where the mass previously appeared. Unlike the previous instance, the mass was accompanied with swelling, pain, and localized increased skin temperature. Pelvic MRI showed a 3.2 cm * 7.2 cm * 5.8 cm located at the same place, with no enhance in the core of mass. However, a speckled enhancement was observed on the margin of the lesion. The lesion was completely resected using the same procedure as before with a pathological diagnosis of SCC. The patient underwent chemoradiation therapy and remained disease free for more than 1 year. Although very rare, benign cyst from presacral space can become malignant transformation. This highlights the importance of pre-operative diagnostic tests and evaluation to correctly identify the source of the primary cancer, which is crucial prior to starting adjuvant therapy.
骶前肿瘤是发生于骶前间隙的罕见占位性病变。据报道，骶前肿瘤的发病率为每40000至63000名患者中有1例。更罕见的情况是骶前肿瘤转变为鳞状细胞癌（SCC）。一名61岁男性因肛门附近可触及肿块前来我院就诊，该肿块在过去10年中反复出现。患者此前在另一家医院接受过两次手术。前两次手术采用后路入路，诊断为良性骶前表皮样囊肿。2017年入院前两个月，患者主诉肛门周围有一个约2厘米大小的肿块。体格检查发现在胸膝位12点钟方向有一个2厘米大小的肿块。直肠指检显示在骶前间隙有一个橡皮样病变。术前盆腔磁共振成像（MRI）证实骶前间隙存在一个6.8厘米×5.2厘米×7.3厘米的肿块。在增强期，病变中心密度均匀，无强化。然后通过后骶旁入路切除肿块，术后病理报告显示为良性表皮样囊肿。患者出院时完全康复，无大便失禁。从我院出院15个月后，患者在肿块先前出现的原部位发现复发。与之前不同的是，肿块伴有肿胀、疼痛和局部皮肤温度升高。盆腔MRI显示在同一位置有一个3.2厘米×7.2厘米×5.8厘米的肿块，肿块核心无强化。然而，在病变边缘观察到斑点状强化。采用与之前相同的手术方法将病变完全切除，病理诊断为SCC。患者接受了放化疗，无病生存超过1年。虽然非常罕见，但骶前间隙的良性囊肿可发生恶性转化。这凸显了术前诊断检查和评估以正确识别原发癌来源的重要性，这在开始辅助治疗之前至关重要。
