DOI:10.2214/AJR.05.5148
AJR 2005; 185:1369-1370
© American Roentgen Ray Society
Diagnosis of Tailgut Cysts
Musturay Karcaaltincaba,
Deniz Karcaaltincaba and
Ali Ayhan
Hacettepe University School of Medicine Ankara 06100,
Turkey
We recently read the article by Yang et al.
[1] with great interest. The MR
findings described in their study are useful for the diagnosis of this rare
condition. In addition to the described findings, extension from the
retrorectal region toward the ischiorectal fossa can be helpful in diagnosis
[2].
Radiologists can provide preoperative diagnosis so that the patient can
avoid undergoing aggressive surgery. Although malignant transformation of
these cysts has been described, it is rare. Radiologic findings such as mural
nodule and asymmetric wall thickening may help in the diagnosis of malignant
changes. Debris within a cyst can mimic a mural nodule; however, the absence
of enhancement and dependent localization are helpful in discriminating
between a cyst and a mural nodule (Fig.
3).
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Fig. 3 —38-year-old woman with constipation and urinary frequency.
Sagittal T2-weighted MR image shows giant cyst extending from adnexal region
toward ischiorectal fossa and perineum. Note dependent debris within cyst
characterized by no enhancement on postcontrast images (not shown).
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We present a 38-year-old woman with a giant tailgut cyst measuring 23
x 15 x 14 cm and extending from the retrorectal region toward the
ischiorectal fossa. MRI was performed preoperatively and suggested the
diagnosis of a tailgut cyst located inferior in relation to the right ovary.
Although the cyst was unilocular, a small cyst was noted adjacent to the giant
cyst at the anorectal region. Both ovaries were clearly visualized. There was
no evidence of malignancy. The patient underwent internal genitalia-preserving
surgery, and the cyst was completely removed. Pathology revealed fibrotic wall
with no discernible epithelium surrounded by a layer of smooth muscle and
adipose tissue.
The absence of epithelium on pathologic examination should not exclude the
diagnosis of a tailgut cyst. Epithelium may breakdown because of a rapid
increase in the size of the lesion in addition to infection or inflammation,
as suggested by Yang et al.
[1]. Characteristic location
and radiologic findings can be helpful in diagnosing tailgut cysts, even in
cases of giant tailgut cysts.
References
- Yang DM, Park CH, Jin W, et al. Tailgut cyst: MRI evaluation.
AJR 2004; 184:1519
-1523
- Dahnert W, ed. Radiology review, 4th ed.
Baltimore, MD: Lippincott Williams Wilkins, 1999
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