Robert J Czuprynski, MD, Grace Montenegro, MD. Saint Louis University Hospital
Presacral masses are a rare entity, with an incidence of 0.014% and can be classified in several categories, including inflammatory, neurogenic, congenital, osseous and miscellaneous. In this case, a neuroendocrine tumor was identified with concern for iliac chain lymphatic and gluteal metastasis. The patient underwent abdominoperineal resection, excision of presacral mass, lymph node biopsy and omental flap. Final pathology returned as a grade II neuroendocrine tumor arising from a tailgut cyst.
A 29 year old female with a ten year history of recurrent perianal, ischiorectal and deep postanal abscesses presents with a presacral mass biopsy proven well-differentiated neuroendocrine tumor. Octreotide scan demonstrated avidity for presacral mas as well as left intergluteal lymph node and two internal iliac lymph nodes. Chromogranin A, neuron-specific enolase and serotonin markers were all negative. The patient was taken to the operating room and underwent abdominoperineal resection, resection of presacral mass and internal iliac nodes with an omental flap.
Neuroendocrine tumors arising from tailgut cysts of the presacral space are rare in nature. In a retrospective study from Great Britain, four of thirty one tailgut cysts had malignant transformation, so it is generally recommended to resect the cysts. In this case, the patient’s tumor was a moderately differentiated, Grade II with extensive lymphovascular and perineural invasion. There are no prospective studies showing neoadjuvant therapies in neuroendocrine tumors of the presacral space. According NCCN guidelines, patient is currently asymptomatic with low tumor burden. Recommended treatment at this time is observation with surveillance tumor markers every 3-12 months or octreotide.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 86855
Program Number: P274
Presentation Session: iPoster Session (Non CME)
Presentation Type: Poster