PMC2815842_01
Barium enema study showing left-anterior displacement of the posterior wall of the rectum (arrows).
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F1
A barium enema study demonstrated the left-anterior displacement of the posterior wall of the rectum (Fig. 1).
(A) Saggital T1-weighted MRI scan showing presacral lesion with intermediate signal intensity invading surrounding structures (arrow). (B & C) Axial T1- and T2-weighted MRI scan showing multicystic mass with intermediate signal intensity (thick arrow). The cyst shows hypointense and hyperintense signal, respectively (thin arrow).
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F2
T2-weighted magnetic resonance imaging (MRI) demonstrated an irregular cystic mass measuring 6 cm in diameter within the retrorectal space and it was involving coccygeal bone and right gluteous muscle tendon (Fig. 2A, 2B, 2C).
On sectioning, the mass displays a firm gray-white appearance (thick arrow) and contains several, discrete cysts (thin arrow) filled with yellow gelatinous material. The ill-defined mass impinges on the outer wall of rectum, presacral soft tissue and coccygeal bone.
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F3
The patient underwent enbloc resection of the mass and a Hartmann operation with coccygectomy and partial sacrectomy to the level of S4 through a combined abdominal/sacral approach. Upon gross examination, the specimen measured 10 x 7 x 8 cm; it was an ill-defined mass impinging on the outer wall of rectum, the presacral soft tissue and coccygeal bone. The mass displayed a firm gray-white appearance on sectioning and contained several small, unilocular cysts filled with a yellow gelatinous material (Fig. 3).
(A) The tumor consisits of many scattered malignant glandular components with infiltrative growth to surrounding tissue (x 100 H&E stain). (B & C) The wall of cysts are lined by benign-looking ciliated columnar (B), columnar (C) and focal cuboidal epithelium (not shown), which is consistent with TGC (x 200 H&E stain).
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F4
Microscopic examination revealed a poorly differentiated adenocarcinoma with infiltrative growth to the surrounding tissue (Fig. 4A). TGC (Fig. 4B, 4C). The resection margin was negative and the regional lymph nodes were free of carcinoma.