CARCINOID-TUMOR - AN EXTREMELY UNUSUAL PRESACRAL LESION - REPORT OF ACASE

PURPOSE: Use of endorectal ultrasonography in preoperative evaluation of a presacral lesion is demonstrated. METHOD: The natural history, pr esentation, evaluation, and treatment of presacral lesions in adult pa tients are presented. The case of a female patient with a presacral ca rcinoid tumor is presented and discussed. RESULTS: The patient underwe nt preoperative evaluation including physical examination, hematologic studies, proctosigmoidoscopy, magnetic resonance imaging, computed to mographic scanning, and endorectal ultrasonography. Ultrasonography pr oved to be extremely valuable in differentiating tumor compression fro m tumor invasion of the rectal wall. The patient underwent en bloc exc ision of the lesion, surrounding tissue, and coccyx. Pathologic diagno sis was carcinoid tumor, possibly replacing a presacral lymph node. Po stoperative complete gastrointestinal tract work-up and urinary 5-hydr oxyindoleacetic acid analysis along with preoperative imaging revealed no evidence of synchronous lesions or additional metastases. CONCLUSI ONS: Presacral lesions are extremely rare entities. The role of endore ctal ultrasonography has not been clearly defined. This case demonstra tes the value of this simple and safe imaging procedure in detecting b owel wall compression vs. invasion, greatly assisting in planning an o perative approach.