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Benign Presacral Tumor Mimicking a Pilonidal Abscess: A Diagnostic Pitfall.

Amram Kupietzky1, Yehonatan Bar-Moshe2, Ido Mizrahi1

  • 1Department of Surgery, Hadassah Medical Center, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel.

The Israel Medical Association Journal : IMAJ
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Summary

A rare presacral tumor was misdiagnosed as a pilonidal abscess in a 43-year-old woman. Surgical excision confirmed it as a benign retrorectal epidermal cyst, highlighting diagnostic challenges of presacral neoplasms.

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Area of Science:

  • Surgical Oncology
  • Gastroenterology
  • Pathology

Background:

  • Presacral tumors are rare, heterogeneous neoplasms complicating diagnosis and management due to low prevalence and diverse origins.
  • A 43-year-old woman presented with a misdiagnosed pilonidal abscess, later identified as a presacral tumor.
  • The patient had a gradually enlarging, non-tender mass in the coccygeal region without typical pilonidal symptoms.

Purpose of the Study:

  • To report a case of a benign presacral tumor initially misdiagnosed as a pilonidal abscess.
  • To illustrate the diagnostic challenges and successful surgical management of presacral neoplasms.
  • To emphasize the importance of advanced imaging in differentiating presacral masses.

Main Methods:

  • Magnetic Resonance Imaging (MRI) to characterize the presacral mass.
  • Surgical excision using the Kraske approach due to the mass's low anatomical position.
  • Pathological evaluation of the excised specimen.

Main Results:

  • MRI revealed a large, well-defined, thin-walled cystic presacral mass without enhancement.
  • Surgical excision via the Kraske approach was successful, removing the tumor en-bloc with the coccyx.
  • Pathology confirmed the diagnosis of a retrorectal epidermal cyst, a benign presacral tumor.

Conclusions:

  • Benign presacral tumors can mimic other conditions like pilonidal abscesses, necessitating thorough diagnostic evaluation.
  • Advanced imaging like MRI is crucial for accurate presacral mass characterization.
  • The Kraske approach is a viable surgical option for low-lying presacral tumors, leading to favorable outcomes.