Nakano Masato, Shimada Yoshifumi, Ozeki Hikaru, Matsumoto Akio, Nakano Mae, Kondo Shuhei, Goto Ryosuke, Yachida Nozomi, Yoshihara Kosuke, Wakai Toshifumi
Division of Digestive and General Surgery, Niigata University Graduate School of Medical and Dental Sciences, 1-757 Asahimachi-dori, Chuo-ku, Niigata, 9518510, Japan.
Division of Molecular and Diagnostic Pathology, Niigata University Graduate School of Medical and Dental Sciences, 1-757 Asahimachi-dori, Chuo-ku, Niigata, Japan.
Clin J Gastroenterol. 2025 Apr;18(2):330-336. doi: 10.1007/s12328-025-02100-7. Epub 2025 Feb 12.
Cysts occurring in the presacral space may become malignant and therefore require surgical removal. A wide variety of cystic lesions can occur in the presacral space, such as tailgut cysts, dermoid cysts, and duplication cysts. However, deep endometriosis with cyst formation in the presacral space is extremely rare. Here, we report a case of deep endometriosis that presented characteristic imaging and pathological findings and required a differential diagnosis of rectal duplication cyst. A 49-year-old female was referred with a chief complaint of lower abdominal pain. Magnetic resonance imaging (MRI) revealed a cystic lesion with a three-layered wall structure on the right side of the rectum, suggesting a rectal duplication cyst. The lesion had a maximum diameter of 8 cm and extended from the lower end of the second sacral vertebra to the levator ani muscle. The cystic lesion was removed laparoscopically, and intraoperative findings revealed no communication between the cystic lesion and the rectum. We found that the wall of the deep endometriosis with cyst formation had a histopathological three-layered structure and considered that the layered structure closely resembled the intestinal wall on MRI. Deep endometriosis should be recognized as a differential diagnosis of cystic lesions in the presacral space.
发生于骶前间隙的囊肿可能会恶变，因此需要手术切除。骶前间隙可出现多种囊性病变，如尾肠囊肿、皮样囊肿和重复囊肿。然而，骶前间隙形成囊肿的深部子宫内膜异位症极为罕见。在此，我们报告一例深部子宫内膜异位症病例，该病例呈现出特征性的影像学和病理学表现，需要与直肠重复囊肿进行鉴别诊断。一名49岁女性因下腹部疼痛为主诉前来就诊。磁共振成像（MRI）显示直肠右侧有一个具有三层壁结构的囊性病变，提示直肠重复囊肿。该病变最大直径为8 cm，从第二骶椎下端延伸至肛提肌。通过腹腔镜手术切除了该囊性病变，术中发现该囊性病变与直肠之间无连通。我们发现形成囊肿的深部子宫内膜异位症的壁具有组织病理学三层结构，并认为该分层结构在MRI上与肠壁极为相似。深部子宫内膜异位症应被视为骶前间隙囊性病变的鉴别诊断之一。
