Figure 2. A: Cyst wall containing smooth muscle bundles and lined by
squamous and columnar epithelium (H&E, x100). B: The stroma is
infiltrated by nests of neoplastic cells with vesicular nuclei and
abundant eosinophilic cytoplasm with foci of keratin-like material.
A Post-operative CT scan reveals no gross tumor residue. According to
the multidisciplinary team’s recommendation, the patient was decided to
undergo radiation therapy similar to the anal canal radiation fields; 36
Gy in 20 fractions to the pelvic and inguinal lymph nodes and then up to
54 Gy to the surgical bed, concurrently with Capecitabine.
Three months after the treatment was completed, she complained of
continued pelvic pain. On the pelvic MRI, there was a 23*20*28 mm
multi-loculated cystic, solid lesion in the pre-coccygeal space in the
midline posterior cavity suspicious of residual disease or recurrence.
These results were confirmed by FDG-PET/CT scan; high SUV (17) presacral
mass indicating malignancy and also a small soft tissue lesion in the
anterior pelvic wall (SUV=6.3) suspicious for metastatic disease.
(Figure 3)