A case of childhood presacral epidermoid cyst

Abstract

A 6-year-old girl visited our hospital because of right gluteal pain. An induration was noted, and a subcutaneous abscess was formed one month later. The abscess improved with drainage, however, because she had repeated episodes of the gluteal subcutaneous abscess from childhood, further examinations were performed. Magnetic resonance imaging (MRI) and computed tomography (CT) showed a cystic tumor located between the rectum and the coccyx. It was diagnosed as a presacral cystic tumor, and was resected via the posterior sagittal approach. The incision started at the inferior border of the coccyx and continued down through the midline, ending at the border of the anus. Incision continued through the center of the external sphincter and the levator muscle, the tumor was exposed and removed. Microscopically, the cyst wall was composed of keratinized squamous epithelium, and no cutaneous appendages were found. The pathological diagnosis was epidermoid cyst.
She has remained well without reccurence or bowel dysfunction in nine months since the operation. Posterior sagittal approach is thought to be one of the useful operations for the treatment of a presacral mass.