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R1 Chiang, Kuan-Yu

Supervisor Chen, Ming-Jen

A 40 y/o female

Anal itching

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DigitalSoft mass in left lower pelvis

No mucosa involved

ه Left lower pelvis

4 x 3.3 x 5 cm well-defined cystic mass

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4

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Low signal intensity

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High signal intensity

Mild deviation of the rectum to right side

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Presacral space: Left side of rectum and vagina

A well-encapsulated tumor

5.5 x 5 x 3.5 cm

Soft and yellowish

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Pathology Finding

The surface are smooth

Lined by keratinized squamous epithelium

No skin appendages

No evidence of malignancy

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Ectoderm Seeding

Tail-gut regression failure

Monodermal teratoma

Trauma implant (EIC)

~

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Christina M. Riojas. 2010

ه Often asymptomatic

ه Local mass effect

Constipationى

Rectal fullnessى

Chronic pelvic painى

Dysuriaى

ه Infection

A perianal abscess or a draining sinusى

13V Jain, S Misra,. 2013

surgery

*Yang DM, Yoon MH, Kim HS, et al. 2001

Presacral epidermoid cyst: imaging findings with histopathologic correlation

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Tools Findings

CT scan

*Contrast enhanced

A well-defined hypodense presacral mass

With a thin wall.

Sonography Heterogeneous low echogenicity

MRI T1-weighted Heterogeneous low signal intensity

T2-weighted High signal intensity

With multiple small hypointense foci

Tailgut Cyst

Brochogenic cyst

Mullerian cyst

Dermoid cyst

Congenital

Urinoma

Hemotoma

Traumatic

Cystic lymphangioma

Cystic teratoma

Cystic Mesothelioma

Perianal mucinous carcinoma

Neoplastic

Dal Mo Yang,MD et al, RadioGraphics 2004

Martina, medicina fluminensis 2011

History

Location

Content

Contrast

ه The heterogeneous nature

17David M. Sherer. J Ultrasound Med 2006

18Christina M. Riojas et al. 2010

ه Surgical ablation

ه Transperineal Posterior Approach

ه Trans-rectal excision

ه Laparotomy

ه Laparoscopic excisionى Pneumoperitoneum can erase the risk

ه Laparoscopic excision and perineal surgery ى For giant pararectal tumors*

ه *Maysoon Al-Khattabi 2009

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ه Stratified squamous cyst lining

ه Keratinaceous debris, cholesterol,

keratin and water within the cyst

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ه Rupture cases recurrent infection

ه Rare cases of malignant change

ه SCC, CA19-9, CA125 and CEA

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ه HPV may play a role, and cause

malignancy**Egawa K et al.

ى Human papillomavirus 57 identified in a plantar epidermoid

cyst. (1998)

*Kato N, Ueno H.

ى Two cases of plantar epidermal cyst associated with human

papillomavirus. (1992)

*Morgan MB et al

ى Carcinoma arising in epidermoid cyst: a case series and a

etiological investigation of human papillomavirus. (2001)

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ه Presacral epidermoid cyst

ه Rare, occurred more in women

ه Asymptomatic and occasionally found in

routine check

ه Image studies can help deferential

diagnosis

ه En-bloc resection are curative

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ه Thank for your attention

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