Presacral (Retrorectal) Tumors: Optimizing the Management Strategy

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A 67-year-old healthy man presents with a recent history of an elevated prostate-specific antigen that resulted in biopsies (negative for malignancy) and imaging of the pelvis with MRI that revealed 2 tumors in the presacral space low in the pelvis. He admits to constipation for the past year that has resolved with stool softeners. He endorses a history of Parkinson disease, throat cancer (remote) treated with chemoradiation therapy, and asbestos exposure; he carries no additional diagnoses and denies any reports specifically to pain, rectal bleeding, or other defecatory dysfunction. On examination, he has a palpable mass that is soft to touch, nontender, and mobile, and it has components that exist both above and below the levator ani located right posterior-laterally. The top of the tumor is not palpable.
Additional workup included an MRI of the pelvis with true coronals and 3-mm slices that demonstrate 2 large, homogeneous, cystic masses that may represent a single mass that is connected traversing the levator ani muscle and does not involve the rectal wall (Fig. 1).
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