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Retrorectal Developmental Cysts in Adults: Clinical and Radiologic-Histopathologic Review, Differential Diagnosis, and Treatment¹

¹ From the Departments of Radiology (H. Dahan, L.A., H. Djouhri, J.M.T.) and Pathology (D.W.), Hôpital Saint-Antoine, 184 Rue du Faubourg Saint-Antoine, 75571 Paris Cedex 12, France; and the Department of Pediatric Radiology, Hôpital d’Enfants Armand Trousseau, Paris, France (H.D.l.P.). Presented as a scientific exhibit at the 1999 RSNA scientific assembly. Received April 13, 2000; revision requested June 1 and received July 28; accepted August 3. Address correspondence to H. Dahan (e-mail: herve.dahan@sat.ap-hop-paris.fr).

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.

Index Terms: Dermoid, 875.313 • Epidermoid, 875.369 • Pelvic organs, cysts, 875.31 • Pelvis, neoplasms, 875.31, 875.313, 875.369

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