Retrorectal Developmental Cysts in Adults: Clinical and Radiologic-Histopathologic Review, Differential Diagnosis, and Treatment

Abstract

Developmental cysts are the most common retrorectal cystic lesions in adults, occurring mostly in middle-aged women. They are classified as epidermoid cysts, dermoid cysts, enteric cysts (tailgut cysts and cystic rectal duplication), and neurenteric cysts according to their origin and histopathologic features. Although developmental cysts are often asymptomatic, patients may present with symptoms resulting from local mass effect (eg, constipation, rectal fullness, lower abdominal pain, dysuria), with a palpable retrorectal mass at digital rectal examination, or with a complication. Infection with fistulization, bleeding, and malignant degeneration are the major complications of developmental cysts. A well-defined, unilocular or multilocular, thin-walled cystic lesion is the main imaging feature. Uncommonly, a sacral bone defect and calcifications are associated with developmental cysts. The differential diagnosis includes cystic sacrococcygeal teratoma, anterior sacral meningocele, anal duct or gland cyst, necrotic rectal leiomyosarcoma, extraperitoneal adenomucinosis, cystic lymphangioma, pyogenic abscess, neurogenic cyst, and necrotic sacral chordoma. Complete surgical excision is indicated to establish the diagnosis and avoid complications.

Clinical, histopathological, radiological diagnosis of retro rectal developmental cysts, its review and differential diagnosis - A rare case report

“…They are classified as epidermoid cysts, dermoid cysts, enteric cysts (tailgut cysts or hamartomas and cystic rectal duplication), and neuroenteric cysts, according to their origin and histopathologic features [5][6] . The diagnosis of retro rectal cysts can be accomplished with greater than 90% accuracy with computed tomography (CT) and magnetic resonance imaging (MRI) if the rectum is contrasted [3][4][5][6] . Such lesions warrant surgical excision to establish the diagnosis and to avoid complications.…”

“…There are two types of enteric cysts: tail gut cysts (so-called retro rectal cyst-hamartomas or mucinsecreting cysts) and cystic rectal duplication 4 . Neurenteric cysts have also been reported [5][6][7] .…”

Sindrome de currarino associada ao Tailgut Cyst: ressecção abdômino-sacral

“…Inflamação aguda ou crônica é a complicação mais comum, ocorrendo em 30% a 50% dos casos. Apesar de ser normalmente benigna, a degeneração carcinomatosa pode ocorrer em até 7% dos cistos entéricos (tailgut cyst e cisto de duplicação intestinal) 3 .…”

Robotic resection of retrorectal tumor: an alternative to the Kraske procedure

“…The most common presacral masses are developmental cysts [2][3][4] , which histologically can be classified as epidermoid, dermoid, and enteric cysts. The latter can be subdivided into mucus-secreting and duplication cysts [3,5] .…”

“…Although, it is estimated that about half of patients are asymptomatic, symptoms at presentation are usually associated with size (mass effect) and the presence of infections [3] .…”