Case Report
Copyright ©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Surg. Dec 27, 2022; 14(12): 1425-1431
Published online Dec 27, 2022. doi: 10.4240/wjgs.v14.i12.1425
Malignant transformation of perianal tailgut cyst: A case report
Yuan Fang, Yong Zhu, Wei-Zhen Liu, Xia-Qing Zhang, Yu Zhang, Kang Wang
Yuan Fang, Yong Zhu, Wei-Zhen Liu, Xia-Qing Zhang, Yu Zhang, Colorectal Surgery Center, Nanjing Hospital of Chinese Medicine Affiliated to Nanjing University of Chinese Medicine, Nanjing 210022, Jiangsu Province, China
Kang Wang, Department of Pathology, Nanjing Hospital of Chinese Medicine Affiliated to Nanjing University of Chinese Medicine, Nanjing 210022, Jiangsu Province, China
Author contributions: Fang Y contributed to data curation and writing of the original draft; Liu WZ, Zhang XQ, and Zhang Y contributed to data curation; Zhang Y contributed to manuscript review and editing; Wang K contributed to evaluation of the histopathology; all authors have read and approved the final manuscript.
Informed consent statement: Informed written consent was obtained from the patient and her family for publication of this report and any accompanying images.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Yong Zhu, MD, Doctor, Colorectal Surgery Center, Nanjing Hospital of Chinese Medicine Affiliated to Nanjing University of Chinese Medicine, No. 157 Daming Road, Nanjing 210022, Jiangsu Province, China. zhuyong839@sina.com
Received: August 19, 2022
Peer-review started: August 19, 2022
First decision: September 4, 2022
Revised: September 17, 2022
Accepted: October 25, 2022
Article in press: October 25, 2022
Published online: December 27, 2022
Processing time: 129 Days and 21.6 Hours
Abstract
BACKGROUND

Tailgut cyst is a congenital enterogenous cyst that rarely undergoes malignant transformation. Its clinical manifestations mainly correlate to the mass effect caused by the development of cysts and the infections that originate from these. Furthermore, the complete resection of this cyst is curative. We report our diagnostic and treatment experience with one case of malignant transformation of a perianal tailgut cyst, which was initially misdiagnosed as perianal abscess.

CASE SUMMARY

A 72-year-old woman visited our institution with complaints of a refractory nonhealing lesion on the right hip, which repeatedly broke and suppurated for more than 70 years, and aggravated in 4 mo. The patient was given a diagnosis of refractory perianal abscess with repeated incision and drainage procedures. Computed tomography of the pelvic cavity revealed a giant perianal cyst. Subsequent biopsy revealed a tumor with moderate-to-severe glandular epithelial dysplasia, and suggested that this was derived from the developmental cysts in the posterior rectal space. After further clarifying the nature and extent of the tumor by magnetic resonance imaging, total cystic resection was performed. Postoperative histopathological examination confirmed the malignancy, dictating the investigators to add postoperative chemotherapy to the treatment regimen.

CONCLUSION

The malignant transformation of perianal tailgut cysts is very uncommon, and this should be differentiated from perianal abscess. Complete surgical removal is curative, and postoperative pathology may determine the necessity of additional postoperative chemotherapy or radiotherapy, which may be beneficial for preventing local recurrence and metastasis.

Keywords: Tailgut cyst; Perianal cyst; Perianal abscess; Adenocarcinoma; Chemotherapy; Case report

Core Tip: We report our diagnostic and treatment experience with a unique case of malignant transformation of perianal tailgut cyst. Since perianal tailgut cysts are difficult to differentiate from other perianal diseases, the reported case was initially misdiagnosed as perianal abscess with repeated incision and drainage procedures. The patient underwent complete resection and received salvage chemotherapy for 3 mo after the surgery.