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Case report
peer-reviewed

A Rare Case of Presacral Epidermoid Cyst in an Adult Male: Emphasis on Diffusion Weighted Magnetic Resonance Sequences in Preoperative Imaging



Abstract

Epidermoid cyst of the presacral space is a rare congenital lesion of ectodermal origin. Presacral epidermoid cysts have been previously reported in women, however are extremely rare in males. We report a case of presacral epidermoid cyst in a 55-year-old male who presented to our emergency department with acute urinary retention and history of chronic constipation. A non-contrast computed tomography scan was performed with suspicion of urolithiasis, which revealed a well circumscribed low attenuation presacral mass. Magnetic resonance imaging (MRI) of the pelvis was subsequently performed to further characterize the lesion. The mass was returning hypointense T1 and hyperintense T2 signals with few foci of T2 hypointensities. There was no post-contrast enhancement; however the lesion was showing diffusion restriction, appearing hyperintense on diffusion weighted imaging (DWI) and hypointense on the corresponding apparent diffusion coefficient map. These imaging features were consistent with an epidermoid cyst. Laparotomy with complete surgical excision of the cyst and preservation of the adjacent structures was performed. The histopathology confirmed the diagnosis. This case highlights the importance of MRI with additional sequences of diffusion weighted imaging which can be helpful to differentiate, to a good degree of confidence, among different pelvic tumors, therefore obviating the need of biopsy before surgery.



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Case report
peer-reviewed

A Rare Case of Presacral Epidermoid Cyst in an Adult Male: Emphasis on Diffusion Weighted Magnetic Resonance Sequences in Preoperative Imaging


Author Information

Muhammad I. Alvi

Department of Radiology, The Aga Khan University, Karachi.

Fatima Mubarak

Radiology, The Aga Khan University

Kumail Khandwala Corresponding Author

Department of Radiology, The Aga Khan University, Karachi.

Muhammad D. Barakzai

Department of Radiology, The Aga Khan University, Karachi

Aisha Memon

Department of Pathology & Laboratory Medicine, The Aga Khan University, Karachi.


Ethics Statement and Conflict of Interest Disclosures

Human subjects: Consent was obtained by all participants in this study. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work.


Case report
peer-reviewed

A Rare Case of Presacral Epidermoid Cyst in an Adult Male: Emphasis on Diffusion Weighted Magnetic Resonance Sequences in Preoperative Imaging


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Case report
peer-reviewed

A Rare Case of Presacral Epidermoid Cyst in an Adult Male: Emphasis on Diffusion Weighted Magnetic Resonance Sequences in Preoperative Imaging

  • Author Information
    Muhammad I. Alvi

    Department of Radiology, The Aga Khan University, Karachi.

    Fatima Mubarak

    Radiology, The Aga Khan University

    Kumail Khandwala Corresponding Author

    Department of Radiology, The Aga Khan University, Karachi.

    Muhammad D. Barakzai

    Department of Radiology, The Aga Khan University, Karachi

    Aisha Memon

    Department of Pathology & Laboratory Medicine, The Aga Khan University, Karachi.


    Ethics Statement and Conflict of Interest Disclosures

    Human subjects: Consent was obtained by all participants in this study. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work.

    Acknowledgements


    Article Information

    Published: January 10, 2018

    DOI

    10.7759/cureus.2050

    Cite this article as:

    Alvi M I, Mubarak F, Khandwala K, et al. (January 10, 2018) A Rare Case of Presacral Epidermoid Cyst in an Adult Male: Emphasis on Diffusion Weighted Magnetic Resonance Sequences in Preoperative Imaging. Cureus 10(1): e2050. doi:10.7759/cureus.2050

    Publication history

    Received by Cureus: December 26, 2017
    Peer review began: December 29, 2017
    Peer review concluded: January 04, 2018
    Published: January 10, 2018

    Copyright

    © Copyright 2018
    Alvi et al. This is an open access article distributed under the terms of the Creative Commons Attribution License CC-BY 3.0., which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

    License

    This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Abstract

Epidermoid cyst of the presacral space is a rare congenital lesion of ectodermal origin. Presacral epidermoid cysts have been previously reported in women, however are extremely rare in males. We report a case of presacral epidermoid cyst in a 55-year-old male who presented to our emergency department with acute urinary retention and history of chronic constipation. A non-contrast computed tomography scan was performed with suspicion of urolithiasis, which revealed a well circumscribed low attenuation presacral mass. Magnetic resonance imaging (MRI) of the pelvis was subsequently performed to further characterize the lesion. The mass was returning hypointense T1 and hyperintense T2 signals with few foci of T2 hypointensities. There was no post-contrast enhancement; however the lesion was showing diffusion restriction, appearing hyperintense on diffusion weighted imaging (DWI) and hypointense on the corresponding apparent diffusion coefficient map. These imaging features were consistent with an epidermoid cyst. Laparotomy with complete surgical excision of the cyst and preservation of the adjacent structures was performed. The histopathology confirmed the diagnosis. This case highlights the importance of MRI with additional sequences of diffusion weighted imaging which can be helpful to differentiate, to a good degree of confidence, among different pelvic tumors, therefore obviating the need of biopsy before surgery.



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Create a free account to continue reading this article.

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Muhammad I. Alvi, Resident Physician

Department of Radiology, The Aga Khan University, Karachi.

Fatima Mubarak

Radiology, The Aga Khan University

Kumail Khandwala

Department of Radiology, The Aga Khan University, Karachi.

For correspondence:
kumail.khandwala@gmail.com

Muhammad D. Barakzai

Department of Radiology, The Aga Khan University, Karachi

Aisha Memon

Department of Pathology & Laboratory Medicine, The Aga Khan University, Karachi.

Muhammad I. Alvi, Resident Physician

Department of Radiology, The Aga Khan University, Karachi.

Fatima Mubarak

Radiology, The Aga Khan University

Kumail Khandwala

Department of Radiology, The Aga Khan University, Karachi.

For correspondence:
kumail.khandwala@gmail.com

Muhammad D. Barakzai

Department of Radiology, The Aga Khan University, Karachi

Aisha Memon

Department of Pathology & Laboratory Medicine, The Aga Khan University, Karachi.