An Unusual Perianal Presentation of a Tailgut Cyst

Abstract

Tailgut cysts or retrorectal cystic hamartomas are rare, congenital, development lesions arising from the remnants of the hindgut during embryogenesis. It is most often misdiagnosed due to its rarity, variable clinical presentation, and malignant potential. The following report describes an unusual case of a tailgut cyst in a 60-year-old male with a history of a perianal mass for 12 years. Surgical resection was done, and histopathological examination revealed a multiloculated cyst filled with brownish fluid, grossly, and a cyst lined by various epithelia such as stratified squamous epithelium, pseudostratified columnar epithelium, and flattened to cuboidal and mucin-secreting columnar epithelium along with cyst wall made up of bundles of smooth muscles, microscopically. Several lesions mimic a tailgut cyst and need to be excluded from the differentials. Although no malignancy was documented in this case, these cysts have been known to undergo malignant transformation into adenocarcinoma and neuroendocrine carcinoma, to name a few. This warrants a thorough and accurate histopathological assessment and mandatory follow-up.

Tail gut cyst adenocarcinoma: A rare entity diagnosed on cytology

“…(1) the epithelial lining of the luminal surfaces of the cysts must contain transitional and/or glandular-type (columnar) epithelium, with or without stratified squamous components; and (2) the underlying stroma must be composed of fibrous connective tissue containing scattered, discontinuous bundles of smooth muscle fibers, without a well-defined muscular layer containing a myenteric plexus and serosa. 8 Although radiological tools such as transrectal ultrasonography (TRUS), computed tomography (CT)/ magnetic resonance imaging (MRI) provide sufficient information for the differential diagnosis of most presacral TGCs, histopathological examination is always required for a definite and accurate diagnosis. 9 Many patients with tailgut cysts probably remain asymptomatic till adulthood.…”

“…6,7 The first case of a tailgut cyst with malignant epithelial transformation was described by Ballantine in 1932 and since then about 17 cases of this rare phenomenon have been documented; the cases described were all adenocarcinomas or carcinoid tumours. 8,9 Adenocarcinoma arising in TGC has been associated with an elevated serum CEA and/or serum CA 19-9 levels. However, CEA elevation as such is not specific enough to permit a diagnosis of TGC adenocarcinoma.…”

“…Hence these lesions should be excised early and completely to reduce the risk of malignant change and other complications. 8,9 The outcome of tail gut cysts (TGC) associated malignancies has varied from case to case. The factors that determine the prognosis have been thought to be the age at diagnosis, completeness of resection, tumour histology and grade; with neuroendocrine (or carcinoid) tumors having better prognosis than adenocarcinomas.…”

Estimativa do perfil biológico pelo palato: estudo transversal em crânios secos

“…Das medidas realizadas, PD-PE apresentou-se como a mais relevante para a EI no IMLAR: quanto maior a idade menor a medida. Está bem estabelecido que o arco maxilar (arco ao redor do palato duro) tende a se estreitar à medida que envelhecemos e a região que apresenta a maior redução é a dos dentes molares, exatamente o local de referência para a medida PD-PE [19]. Reforça-se que as alterações nas dimensões do palato feminino durante o envelhecimento tendem a ser mais pronunciadas, em decorrência de múltiplos fatores, com destaque para a tendência à osteopenia observada neste sexo após a menopausa [19].…”