Cystic lesions of the retrorectal space

Brown, Ian; Sokolova, Anna; Rosty, Christophe; Graham, Rondell P.

doi:10.1111/his.14769

Cited by 8 publications

(21 citation statements)

References 60 publications

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“…Retrorectal cystic lesions in adults are rare and most cases are congenital. Developmental cysts are the most common congenital entities found in the retrorectal space and include tailgut cysts (also known as retrorectal hamartomas), epidermoid cysts, and dermoid cysts [ 66 ].…”

Section: T1-hyperintense Differential Diagnosis and Pitfalls For Pelv...mentioning

confidence: 99%

Endometriosis MR mimickers: T1-hyperintense lesions

Ruaux,

Nougaret,

Gavrel

et al. 2024

Insights Imaging

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Endometriosis is a chronic and disabling gynecological disease that affects women of reproductive age. Magnetic resonance imaging (MRI) is considered the cornerstone radiological technique for both the diagnosis and management of endometriosis. While MRI offers higher sensitivity compared to ultrasonography, it is prone to false-positive results, leading to decreased specificity. False-positive findings can arise from various T1-hyperintense conditions on fat-suppressed T1-weighted images, resembling endometriotic cystic lesions in different anatomical compartments. These conditions include hemorrhage, hyperproteic content, MRI artifacts, feces, or melanin. Such false positives can have significant implications for patient care, ranging from incorrect diagnoses to unnecessary medical or surgical interventions and subsequent follow-up. To address these challenges, this educational review aims to provide radiologists with comprehensive knowledge about MRI criteria, potential pitfalls, and differential diagnoses, ultimately reducing false-positive results related to T1-hyperintense abnormalities.Critical relevance statementMRI has a 10% false-positive rate, leading to misdiagnosis. T1-hyperintense lesions, observed in the three phenotypes of pelvic endometriosis, can also be seen in various other causes, mainly caused by hemorrhages, high protein concentrations, and artifacts.Key points• MRI in endometriosis has a 10% false-positive rate, leading to potential misdiagnosis.• Pelvic endometriosis lesions can exhibit T1-hyperintensity across their three phenotypes.• A definitive diagnosis of a T1-hyperintense endometriotic lesion is crucial for patient management.• Hemorrhages, high protein concentrations, lipids, and artifacts are the main sources of T1-hyperintense mimickers. Graphical Abstract

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Section: T1-hyperintense Differential Diagnosis and Pitfalls For Pelv...mentioning

confidence: 99%

Endometriosis MR mimickers: T1-hyperintense lesions

Ruaux,

Nougaret,

Gavrel

et al. 2024

Insights Imaging

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“… Retrorectal space Broadly, the retrorectal space refers to the space between the posterior rectal wall and ventral surface of the sacrum/coccyx/posterior pelvic floor [ 54 ]. Others use this term more strictly, referring only to the lower aspect of that space [ 55 ]. The most specific use of this term would be to refer the space defined by the posterior MRF anteriorly, the lower sacrum and coccyx posteriorly, the levator ani inferiorly, the coccygeal muscle laterally, and the peritoneal reflection superiorly [ 56 ] .…”

Section: General Anatomymentioning

confidence: 99%

Rectal cancer lexicon 2023 revised and updated consensus statement from the Society of Abdominal Radiology Colorectal and Anal Cancer Disease-Focused Panel

et al. 2023

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The Society of Abdominal Radiology’s Colorectal and Anal Cancer Disease-Focused Panel (DFP) first published a rectal cancer lexicon paper in 2019. Since that time, the DFP has published revised initial staging and restaging reporting templates, and a new SAR user guide to accompany the rectal MRI synoptic report (primary staging). This lexicon update summarizes interval developments, while conforming to the original lexicon 2019 format. Emphasis is placed on primary staging, treatment response, anatomic terminology, nodal staging, and the utility of specific sequences in the MRI protocol. A discussion of primary tumor staging reviews updates on tumor morphology and its clinical significance, T1 and T3 subclassifications and their clinical implications, T4a and T4b imaging findings/definitions, terminology updates on the use of MRF over CRM, and the conundrum of the external sphincter. A parallel section on treatment response reviews the clinical significance of near-complete response and introduces the lexicon of “regrowth” versus “recurrence”. A review of relevant anatomy incorporates updated definitions and expert consensus of anatomic landmarks, including the NCCN’s new definition of rectal upper margin and sigmoid take-off. A detailed review of nodal staging is also included, with attention to tumor location relative to the dentate line and locoregional lymph node designation, a new suggested size threshold for lateral lymph nodes and their indications for use, and imaging criteria used to differentiate tumor deposits from lymph nodes. Finally, new treatment terminologies such as organ preservation, TNT, TAMIS and watch-and-wait management are introduced. This 2023 version aims to serve as a concise set of up-to-date recommendations for radiologists, and discusses terminology, classification systems, MRI and clinical staging, and the evolving concepts in diagnosis and treatment of rectal cancer. Graphical abstract

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“…This cyst mainly affects middle-aged females. Lower back or lower abdominal pain, or urinary symptoms are the common presentations, and incidental detection of the lesion without any symptoms is also not uncommon (1,2). The cysts are usually multilocular and smooth muscle bundles are irregularly distributed in numerous cases (1,2).…”

Section: Introductionmentioning

confidence: 99%

“…Lower back or lower abdominal pain, or urinary symptoms are the common presentations, and incidental detection of the lesion without any symptoms is also not uncommon (1,2). The cysts are usually multilocular and smooth muscle bundles are irregularly distributed in numerous cases (1,2). The wall is covered by several types of epithelia, including columnar, ciliated, keratinizing or non-keratinizing squamous, and transitional types (1,2).…”

Section: Introductionmentioning

confidence: 99%

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Analysis of the clinicopathological features of tailgut cyst with emphasis on the development of neoplastic lesions

Kobayashi,

Ishida,

Miki

et al. 2024

Oncol Lett

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Tailgut cyst is a rare congenital cyst occurring in the retrorectal space and development of neoplastic lesions in tailgut cyst has been reported. Due to the rarity of the tumor, the histogenesis of neoplastic lesions in tailgut cyst has remained elusive. In the present study, the clinicopathological features of tailgut cyst were analyzed with a particular focus on the development of neoplastic lesions. The clinicopathological features of four patients with tailgut cyst (one female and three males) were retrospectively reviewed. No symptoms were present in two patients. Perineal discomfort, and constipation and urinary retention, were described in the other two patients, respectively. Magnetic resonance imaging showed that the cystic lesions were hypointense on T1-and hyperintense on T2-weigted images in all patients. Histopathological analysis revealed that all lesions were multilocular, and cystic walls were covered by squamous and ciliated epithelia without nuclear atypia. The development of neoplastic lesions was noted in two patients. Dysplastic change composed of piling-up proliferation of glandular cells with mild to moderate nuclear atypia was present in one patient, and invasive adenocarcinoma with a dysplasia component was observed in another patient. Dysplasia of the glandular cells, as seen in two patients in the present series, may be a precursor lesion of invasive adenocarcinoma; therefore, adenocarcinoma arsing in tailgut cyst may show a dysplasia-carcinoma sequence. While the reported incidence of neoplastic lesions in tailgut cysts is ~9% or less, their frequency remains to be accurately determined. Therefore, complete surgical resection is important for the management of patients with tailgut cyst. Additional clinicopathological and molecular studies with large cohorts may be required to clarify the histogenesis of neoplastic lesion in tailgut cyst.

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Cystic lesions of the retrorectal space

Cited by 8 publications

References 60 publications

Endometriosis MR mimickers: T1-hyperintense lesions

Endometriosis MR mimickers: T1-hyperintense lesions

Rectal cancer lexicon 2023 revised and updated consensus statement from the Society of Abdominal Radiology Colorectal and Anal Cancer Disease-Focused Panel

Analysis of the clinicopathological features of tailgut cyst with emphasis on the development of neoplastic lesions

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