Surgical Excision of Ischiorectal Fossa Tumors

Abstract

Background: Ischiorectal Fossa Tumors are rare and their management has not been protocolized. Patients: We retrospectively review four consecutive cases treated in our department, from January 2015 to July 2015. All of them were discussed in a multidisciplinary team meeting. None of them were secondary to an inflammatory process. Results: A Magnetic Resonance Imaging was performed in all the four patients, and as it was not a malignant diagnosis made in any of them, we proceeded to resecate the lesions. None biopsies were performed and the benign diagnoses were confirmed by the pathologist. All the patients underwent a local posterior or perineal approach, because all the lesions (epidermoid cyst, hamartoma, lipoma and an aggressive angiomyxoma) were localized purely in the ischiorectal fossa, under the levator ani muscle and not invading any adjacent structures. In all of them, an R0 resection was performed. Conclusions: Ischiorectal fossa tumors are rare and there are few cases already published. Non-inflammatory lesions located in the ischiorectal fossa, with none invasion of rectum or levator ani muscle, are mainly benign lesions prone to their complete excision by a posterior approach. Biopsy is not always necessary unless there's a suspicion of a malignancy or invasion of adjacent structures, and only in that case a biopsy should be made, because in some of them, a neo-adjuvant treatment can be useful to reduce the tumor and to perform an R0 resection.

Rare case of giant ischiorectal leiomyosarcoma

“…Around 5 to 10 % of all soft tissue sarcomas are leiomyosarcoma [ 8 ]. Ischiorectal fossa tumors are rare, and only a few cases have been published [ 9 ]. Leiomyosarcomas with a size of >5 cm in their longest dimension are considered giant.…”

“…The selection of the surgical approach is an important issue and we must select a posterior approach except if there's a levator ani infiltration or the tumor extends superiorly, in which case an abdomino-perineal approach should be performed. The decision should be based according to the radiological findings [ 9 ]. Resection margin of 1–2 cm is adequate and further wider margin does not give added benefit [ 4 ].…”

Pelvic Lipoblastoma with Extension into Ischiorectal Fossa and Abdominal Lipoblastoma - Complete Excision by Laparoscopy in Children - A Report of Two Cases

“…The first case was challenging as it was a dumbbell-shaped tumor extending into the left ischiorectal fossa. We were prepared to do abdominoperineal approach,[ 10 ] but to our surprise, we could completely remove it by laparoscopic method. Immediate postoperative recovery was uneventful.…”

Rare finding of a giant ischioanal lipoma

“…Tumours in this region usually present as perineal or labial masses. Large lesions that compress the rectum or urogenital organs can cause symptoms such as constipation, dysuria, dyspareunia or obstructed defaecation . Tumours can be congenital, acquired or neoplastic.…”