A 46-year-old woman was referred to the emergency department for diffuse abdominal pain of two weeks duration associated with dysuria, constipation, hematochezia of distal semiology and anal pain with defecation in recent days.
Physical examination is anodyne except for rectal examination in which an imprint corresponding to the uterus is located.
Laboratory tests, ultrasound and rectoscopy showed no abnormalities.
Located on the persistence of a moderate clinical effect CT scan does not show apparent structures dependence where an oval mass (6.3 x 8 x 6 cm) is described, well delimited, located in the left ischiorectal fossa
The lesion is essentially hypodense, with a solid pole located posteriorly (2 x 1.5 cm) with moderate enhancement after intravenous contrast administration; areas of fat density and calcifications within it are not identified.
The study was completed by endorectal ultrasound where at the right pararectal level, imposed on the right rectal wall, identified a cystic occupational image with internal echoes (probable mucinous component).
Pelvic MRI was also requested to confirm these findings and to show in the posterior region a pole with a hyperintense signal on T1 and hypointense signal on T2 suggestive of small subacute bleeding (2 cm HR).
Surgery is performed, finding a tumor of soft consistency and whitish outer surface, approximately 10 x 8 cm occupying the entire right ischiorectal fossa.
Histological analysis reveals the opening exit of pasty, thickened and parish-colored material. Cystic wall internal lining consists of multiple pearly-nacarcoloured rectal tissue scams.
