Pre-sacral glomangioma: a rare localization of glomus tumors: case report.

Introduction and importance: Deep-located glomangiomas are rarely reported. Because of their scarcity, treatment strategy is hard to establish. Herein, the authors report the first case to our knowledge of pre-sacral glomangioma.

Case presentation: A 34-year-old female patient, with no previous medical history, consulted for 2-month-old pelvic abdominal pain, vomiting and delayed menstruation. Her physical and biological parameters were with no abnormalities. MRI of the pelvis demonstrated a 14 cm mixed heterogeneous pre-sacral lesion pushing the rectum anteriorly. She was operated on via a laparoscopic approach. Division of Douglas' pouch and pelvic peritoneum laterally to the bladder showcased a cystic lesion of 13×8 cm occupying the pelvis while deviating the rectum anteriorly. Its content was aspirated and left membrane was extracted in a sac. The postoperative course was uneventful.

Discussion: Pre-sacral masses are hard to treat because of their large heterogeneity. Surgical resection should be tempted to retrieve the definitive histological diagnosis and relieve the patient. However, the surgical route is controversial as each approach has its advantages. Thus, the surgical route should take into consideration the lesion's size, height and surrounding contacts, the patient's functional state and surgeon's expertise.

Conclusion: Pre-sacral glomangiomas carries a low malignant pattern but should be resected to offer histological diagnosis. The surgical route remains at the surgeon's decision, with the main objective to totally resect the encountered lesion without causing functional and sexual complications or harm to surrounding viscera.