Tailgut cyst associated with a pilonidal sinus: an unusual case and a review

Abstract

Tailgut cysts are rare congenital abnormalities in the retrocaecal/presacral region. Clinical diagnosis is difficult and delayed and they can present in childhood and adult life with a variety of clinical symptoms and complications. Differential diagnoses include, rectal duplication cysts, cystic teratoma, epidermal cyst, anal gland cyst and anal gland carcinoma. Magnetic resonance imaging has recently become the modality of choice to image these cysts. Although Tailgut cysts rarely undergo malignant transformation, early surgical resection is presently considered the treatment of choice. Here we report the case of a 34 year old gentleman with a Tailgut cyst associated with a Pilonidal sinus, and review of the literature. We believe that the high incidence of complications associated with operations in the presacral region should be weighed against the generally benign course of these lesions, especially with the quality of modern imaging technology.

A Rare Cause of Low Back Pain: Report of a Tailgut Cyst

“…MR imaging typically demonstrates a retrorectal lesion with low signal intensity on T1-weighted images and high signal intensity on-T2 weighted images although this may vary depending on cyst content. Malignancy is suspected if there is focal irregular wall thickening and intermediate signal intensity before contrast on both T1- and T2-weighted images with enhancement after contrast [8, 12, 14, 15]. …”

Hamartoma cístico retro-retal: relato de 2 casos e revisão da literatura

“…Quando atingem dimensões significativas, as lesões causam efeitos de massa local, com sintomas proctológicos do tipo constipação intestinal, desconforto às evacuações, dor retal e sensação de evacuação incompleta, além de dor lombar e sacral 1,3,5,9,12,20,21 . Quadros inicialmente sugestivos de cisto pilonidal, cisto ovariano e tumor sacral, são descartados após a abordagem cirúrgica e análise histopatológica da lesão 1,14,15,16,17,18 . Cisto de duplicação retal (outro tipo de cisto entérico retro-retal) pode causar sangramento se apresentar ilhas de tecido ectópico (mucosa gástrica, pancreática ou urotelial) 1,2 .…”

“…A realização de biópsias diagnósticas é controversa, devido ao risco de contaminação, meningite, sangramento da artéria sacral, recidivas locais e disseminação de lesões malignas, exceto nas lesões irressecáveis, na tentativa de decidir a terapia adjuvante a ser adotada 1,3,19,21 . Dentre os diagnósticos diferenciais dos hamartomas císticos estão : cisto de duplicação retal, cisto dermóide, cisto epidermóide sacrococígeo, meningocele sacral anterior, cistos de glândulas anais, endometrioma, leiomiossarcoma retal necrótico, linfangioma cístico, abscesso piogênico, cisto neurogênico e cordoma sacral necrótico 1,9,18 . Em estudo retrospectivo por Glasgow et al, endometrioma foi o diagnóstico inicial mais comum de lesões retro-retais 1 , fato ocorrido no segundo caso aqui descrito.…”

3.0T MRI with a high resolution protocol for the study of benign disease of the anus and rectum. Part 2: Anorectal inflammatory disease. Postsurgical anatomy and complications after treatment

“…It can be associated with lumbosacral bone anomalies and intraraquideal injuries. Its extension toward the ischiorectal space 16 has rarely been described and even one association to pathology to perianal fistula pathology or other presacral injuries 17 (Fig. 8).…”