Management of Tumors of the Ischiorectal Fossa: The Role of Percutaneous Biopsy.
BACKGROUND
Noninflammatory masses in the ischiorectal fossa are rare.


OBJECTIVE
This study aimed to review our experience with ischiorectal fossa tumors and to address the question of whether percutaneous biopsy should be undertaken.


METHODS
This is a retrospective study.


METHODS
This study was conducted at a tertiary institution.


METHODS
From April 2007 to November 2014, all consecutive ischiorectal fossa masses treated in a referral center were retrospectively reviewed. They were all presented and discussed in a multidisciplinary team meeting. Magnetic resonance imaging was performed in all the patients. Inflammatory pathologies, such as abscess, were excluded from the analysis.


METHODS
Percutaneous biopsy and surgical excision of ischiorectal fossa tumors were reviewed.


METHODS
Perioperative, pathological, and oncological outcomes were measured.


RESULTS
Eleven patients were identified (8 female; median age, 50 years; range, 25-90). Percutaneous biopsy was undertaken in 8 patients. All biopsies were diagnostic and altered preoperative management in 3 cases (aggressive angiomyxoma (n = 2), desmoid fibromatosis (n = 1)). Overall final diagnosis was benign in 3 patients, locally aggressive neoplasm in 3, and malignant in 5 cases (leiomyosarcomas (n = 2), liposarcomas (n = 2), and angiomyosarcoma (n = 1)). Surgical approaches were perineal in 8 patients, abdominoperineal in 1 patient, and totally abdominal in 1 patient. One patient (age 90 years) was managed nonsurgically. After resection, 2 positive margins were observed (R1 rate, 20%). After a mean follow-up of 24.3 months, 3 patients have experienced local recurrence, which required further surgery in 2 cases.


CONCLUSIONS
This study is limited by the small number of patients.


CONCLUSIONS
Noninflammatory masses in the ischiorectal fossa are rare, but they are commonly malignant and should be imaged by MRI. Unless the radiological appearances are diagnostic, percutaneous biopsy is recommended and alters management in about one-third of cases.
1 Department of Colorectal Surgery, Churchill Hospital, University Hospitals of Oxford, Oxford, United Kingdom 2 Department of Orthopedic Surgery, Nuffield Orthopedic Center, University Hospitals of Oxford, Oxford, United Kingdom.
Nicolas C
NC
Buchs
Neil J
NJ
Mortensen
Richard J
RJ
Guy
Max
M
Gibbons
Bruce D
BD
George
D001706:Biopsy / Q000379:methods*; D003937:Diagnosis, Differential; D004210:Dissection / Q000009:adverse effects / Q000379:methods; D005260:Female; D018222:Desmoid Tumors / Q000473:pathology / Q000601:surgery; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods; D008297:Male; D008875:Middle Aged; D009232:Myxoma / Q000473:pathology / Q000601:surgery; D009364:Neoplasm Recurrence, Local / Q000517:prevention & control*; D017063:Outcome Assessment, Health Care; D010386:Pelvic Neoplasms / Q000175:diagnosis / Q000473:pathology / Q000601:surgery; D012086:Reoperation; D015203:Reproducibility of Results; D012189:Retrospective Studies; D006113:United Kingdom