Benign Presacral Tumor Mimicking a Pilonidal Abscess: A Diagnostic Pitfall

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.