case_images: PMC11029106_01
case_images: Magnetic resonance imaging sagittal view showed T2 iso to hypointense 7.7 cm x 8 cm x 8.4 cm with intrathecal extension through widened neural foramina at S1-S5 levels (a). The mass had moderate contrast enhancement (b). T1 axial imaging with gadolinium contrast showing the mass involving S2 vertebral body to coccyx (c). T2 w fat-suppressed imaging showed that the mass was infiltrating the mesorectal fascia (d). Computed tomography bone sagittal view showed that the mass extended from the S2 vertebra to the coccyx, destroying the vertebral bodies and occupying the presacral space (e)
case_images: JCVJS-15-110-g001.jpg
case_images: PMC11029106_01_JCVJS-15-110-g001.jpg
case_images: jcvjs_162_23-f001
case_images: The mass was infiltrating the mesorectal fascia and the left lumbosacral plexus [Figure 1a-d]. A computed tomography (CT) scan showed extensive lytic destruction of the S2-S5 vertebral bodies and coccyx, including the sacral ala and posterior elements [Figure 1e].
case_images: Mercedes Benz incision
case_images: JCVJS-15-110-g002.jpg
case_images: PMC11029106_01_JCVJS-15-110-g002.jpg
case_images: jcvjs_162_23-f002
case_images: We made a Mercedes Benz incision [Figure 2] with the superior limit being the L2 spinous process.
case_images: Intraoperative image showing the surgical cavity after en bloc excision of tumor. The bilateral S2 nerve roots (denoted by yellow areas) are seen traversing through the superior aspect of the surgical cavity
case_images: JCVJS-15-110-g003.jpg
case_images: PMC11029106_01_JCVJS-15-110-g003.jpg
case_images: jcvjs_162_23-f003
case_images: The ventral sacrum was detached from the mesorectum, after which the entire lesion was excised in one piece [Figure 3].
case_images: Magnetic resonance T1 sagittal gadolinium contrast imaging at 2-year follow-up showed no residual or recurrent lesion
case_images: JCVJS-15-110-g004.jpg
case_images: PMC11029106_01_JCVJS-15-110-g004.jpg
case_images: jcvjs_162_23-f004
case_images: MR gadolinium imaging at 2-year follow-up did not show any residual lesion [Figure 4].