Tos Salem M, Jobran Afnan W M, Alasafrah Anas, Bakri Izzeddin, Jubran Fahmi
Faculty of Medicine, Al Quds University, Jerusalem, Palestine.
Faculty of Medicine, Al Quds University, Jerusalem, Palestine.
Int J Surg Case Rep. 2023 Feb;103:107880. doi: 10.1016/j.ijscr.2023.107880. Epub 2023 Jan 9.
Epidermoid cyst is rare congenital lesion of ectodermal origin that arises from the remnants of the embryonic tissues. Although epidermal cysts are frequently observed throughout the body, they are rarely found in the presacral regions. It more commonly occurs in women of reproductive age as an asymptomatic, incidental finding during routine physical examination or imaging studies, or during obstetric and gynecologic events.
A 48-year-old female patient presented with intermittent constipation, lower abdominal and pelvic pain that had developed progressively during the previous six months, which was temporarily relieved with regular laxatives. Magnetic resonance imaging showed a presacral cystic tumor with a high signal intensity on T1-weighted images and, low signal on T2-weighted images with no significant enhancement post-contrast administration. The mass pushed the rectum laterally by external compression. This tumor was diagnosed as a developmental cyst, and total mass resection with negative margins was performed. After that, tumor was histopathologically diagnosed as an epidermoid cyst.
Epidermoid cyst is a common entity but is rare at presacral space. Also, an epidermoid cyst is an uncommon entity among cystic pathologies found in the presacral region, which includes benign and malignant pathologies. Due to the potential of subsequent infection or cancer, a meticulous clinical examination with correlated radiographic imaging, followed by total mass excision and histopathological evaluation are crucial.
表皮样囊肿是一种罕见的先天性外胚层来源病变，由胚胎组织残余物形成。尽管表皮样囊肿在全身各处都较为常见，但在骶前区域却很少见。它更常见于育龄女性，通常在常规体格检查、影像学检查或妇产科检查时作为无症状的偶然发现。
一名48岁女性患者出现间歇性便秘、下腹部和盆腔疼痛，在过去6个月中逐渐加重，使用常规泻药后可暂时缓解。磁共振成像显示骶前有一个囊性肿瘤，在T1加权图像上呈高信号强度，在T2加权图像上呈低信号，增强扫描后无明显强化。肿块通过外部压迫将直肠向外侧推移。该肿瘤被诊断为发育性囊肿，并进行了切缘阴性的肿物全切术。术后，肿瘤经组织病理学诊断为表皮样囊肿。
表皮样囊肿是一种常见病变，但在骶前间隙罕见。此外，在骶前区域发现的囊性病变（包括良性和恶性病变）中，表皮样囊肿并不常见。由于存在后续感染或癌变的可能性，进行细致的临床检查并结合相关影像学检查，随后进行肿物全切和组织病理学评估至关重要。
