A retrorectal mass left undetected until labor: unexpected o
The present case has been reported in the American Journal of Obstetrics and Gynaecology.

A 29-year-old woman, at 40 weeks' gestation in her first pregnancy, was admitted to the maternity ward, and labor was induced with prostaglandins. Surprisingly, a subsequent vaginal examination revealed a mass behind the posterior vaginal wall. Although the patient had undergone routine vaginal examinations during her pregnancy, this was the first time the tumor was detected.

Its presence prevented progression of fetal descent, despite active pushing during the second stage of delivery. Assisted delivery was considered and then accomplished with a vacuum pump. The baby, a healthy boy, weighed 4300 g and had an Apgar score of 9/10.

Postpartum transvaginal ultrasound, computed tomography, and magnetic resonance imaging revealed a presacral ovoid tumor mass. The patient was self-referred to our department, where she underwent surgery. She was placed in a prone position and given general anesthesia.

A midline incision of approximately 4 cm was made over the distal part of her sacrum and coccyx. We carefully removed the coccyx and exposed the tumor, which contained a cheeselike material but no evidence of hair, nails, teeth, or other materials. The postoperative period was uneventful, and the patient was discharged 4 days after surgery.

A pathology examination revealed a fibrous capsule lined by keratinized, stratified, squamous epithelium without any cutaneous adnexal structures. The final diagnosis was epidermoid cyst.

Key takeaways:-

- Surgical excision of a presacral epidermoid cyst is advisable, due to an increased risk of malignant transformation, complications associated with pregnancy and labor, and the possibilities of rupture and infection.

- A biopsy should only be performed when resection is contraindicated because tumor cells might be disseminated.

- Retrorectal tumors might go undiagnosed because they are small, their locations are not readily visualized with ultrasound, a primary focus on the uterus and fetus allows them to go unnoticed during routine sonographic examinations, or the person performing the sonogram is inexperienced in identifying the growths

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