结直肠肛门外科 (Dec 2023)

Clinical characteristics and imaging data of ischiorectal fossa tumors: a series of 58 cases

  • Chen Yongcheng,
  • Zhang Di,
  • Zhou Jie,
  • Zou Qi,
  • Guo Yaoyu,
  • Zhou Qian,
  • Xian Zhenyu,
  • Hu Bang,
  • Su Dan,
  • Zhang Heng,
  • Ren Donglin,
  • Peng Hui

DOI
https://doi.org/10.19668/j.cnki.issn1674-0491.2023.06.004
Journal volume & issue
Vol. 29, no. 6
pp. 563 – 570

Abstract

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[Objectives] Ischiorectal fossa tumors are rare and have a high misdiagnosis rate, and limited reports discuss clinical symptoms, signs, treatments and diagnoses. This study focuses on the clinical characteristics and imaging data of 58 patients with primary ischiorectal fossa tumors receiving treatments at our center, aiming to provide references for clinical treatments and diagnoses. [Methods] Fifty-eight patients who underwent resection surgery for primary ischiorectal fossa tumors at The Sixth Affiliated Hospital, Sun Yat-sen University from July 2013 to July 2021 were studied. All patients had pelvic enhanced MRI, and some had had chest+abdomen+pelvic enhanced CT and PET/CT examination. Patient’s general information, clinical symptoms, signs and results of physical examination, imaging data, postoperative pathological results were collected and analyzed. [Results] Among the 58 patients, 12 were male and 46 were female, with a median age of 38.0 (29.8, 51.2) years. The median time from symptom onset to diagnosis was 7 (2, 13) months. Maximum tumor diameter in 48 patients was> 5 cm. Eighteen had a history of misdiagnosis, and 20 had previous surgeries. Malignant tumor patients were older, preseneted clincal symptoms, more likely to have local protrusions at initial visits, and had larger maximum tumor diameter on preoperative imaging. Benign tumor patients often complained of perineal dull pain. Malignant tumors on MRI showed solid lesions with uneven signal intensity, irregular boundaries, invasion, and post-contrast enhancement. Among them, preoperative MRI examination of one patient with malignant tumor suggested cystic lesion, but postoperative pathological diagnosis revealed mucinous adenocarcinoma. MRI and CT imaging diagnoses were consistent with postoperative pathological diagnosis (Kappa values were 0.713 and 0.635, respectively). [Conclusion] Ischiorectal fossa tumor nature can be initially determined based on clinical characteristics and imaging features. Older patients with clinical symptoms, visible local protrusions, and enhanced MRI suggesting non-cystic lesions or lesions with enhancement should be highly suspicious of malignancy.

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