直肠后囊性火腿肠瘤的诊断和治疗:临床病例

S. A. Zvezda, D. G. Dimitriadi, P. I. Tamrazov, A. V. Simonov, E. M. Frank, N. M. Fedorov, L. N. Komarova
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摘要

背景。直肠后肿瘤是一类罕见的肿瘤,可为良性或恶性,多数情况下无症状。它们主要发生在骶前间隙,该间隙后部受限于 Waldeyer 筋膜,前部受限于直肠筋膜,侧面受限于输尿管和直肠外侧韧带,下部受限于提肛肌和尾骨,上部受限于第二和第三骶段之间的骨盆腹膜过渡。磁共振成像(MRI)对诊断和手术规划至关重要。大多数直肠后肿瘤无需术前活检即可进行手术治疗。在此,我们介绍一例通过手术治疗的直肠后囊性火腿肠瘤。患者 N,45 岁,疑似盆腔畸形。患者称自 2023 年 5 月起骶骨部位疼痛,无外伤史。她到当地一家综合医院就诊,盆腔器官超声检查发现盆腔肿块。随后,患者被转诊至 "医学城 "多学科临床医学中心的肿瘤学家处。体格检查没有发现任何特殊特征,只是在直肠检查时沿直肠后壁摸到了一个长达 2 厘米的非移位肿瘤。盆腔器官核磁共振检查证实,在直肠下端膀胱后面有一个肿块。随后进行了手术治疗,并通过形态学和免疫组化研究确诊为畸胎瘤。早期综合诊断和经验丰富的手术团队是成功治疗直肠后肿瘤患者的关键因素。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Diagnosis and treatment of retrorectal cystic hamartoma: clinical case
Background. Retrorectal tumors are a rare group of tumors that can be benign or malignant in origin; in most cases, they are asymptomatic. They mainly arise in the presacral space, which is limited by Waldeyer’s fascia posteriorly, the rectal fascia proper anteriorly, the ureters and lateral ligaments of the rectum laterally, the levator ani muscles and coccyx inferiorly, and the transition of the pelvic peritoneum between the second and third sacral segments superiorly. Magnetic resonance imaging (MRI) is crucial for diagnosis and surgical planning. Most retrorectal tumors require surgical treatment without preoperative biopsy. Here, we present a case of a retrorectal cystic hamartoma that was treated with surgery.Clinical case. Patient N., 45 years old, presented with suspected pelvic malformation. The patient reported experiencing pain in the sacrum area since May 2023, with no history of trauma. She sought medical help at a local polyclinic, where an ultrasound of the pelvic organs revealed a pelvic mass. The patient was then referred to an oncologist at the Multidisciplinary Clinical Medical Center “Medical City”. Physical examination showed no specific features, except upon rectal examination, where a non-displaced tumor measuring up to 2 cm was palpated along the posterior rectal wall. MRI of the pelvic organs confirmed the presence of a mass behind the lower ampullary rectum. Surgical treatment was subsequently performed, and the diagnosis of teratoma was confirmed through morphological and immunohistochemical studies.Conclusion. Early comprehensive diagnostics and an experienced surgical team are key factors for successful treatment of patients with retrorectal tumors.
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