Carcinoid tumor: An extremely unusual presacral lesion. Report of a case

PURPOSE: Use of endorectal ultrasonography in preoperative evaluation of a presacral lesion is demonstrated. METHOD: The natural history, presentation, evaluation, and treatment of presacral lesions in adult patients are presented. The case of a female patient with a presacral carcinoid tumor is presented and discussed. RESULTS: The patient underwent preoperative evaluation including physical examination, hematologic studies, proctosigmoidoscopy, magnetic resonance imaging, computed tomographic scanning, and endorectal ultrasonography. Ultrasonography proved to be extremely valuable in differentiating tumor, compression from tumor invasion of the rectal wall. The patient underwent en bloc excision of the lesion, surrounding tissue, and coccyx. Pathologic diagnosis was carcinoid tumor, possibly replacing a presacral lymph node. Postoperative complete gastrointestinal tract work-up and urinary 5-hydroxyindoleacetic acid analysis along with preoperative imaging revealed no evidence of synchronous lesions or additional metastases. CONCLUSIONS: Presacral lesions are extremely rare entities. The role of endorectal ultrasonography has not been clearly defined. This case demonstrates the value of this simple and safe imaging procedure in detecting bowel wall compression vs. invasion, greatly assisting in planning an operative approach.