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Special Feature
June 2010

Image of the Month—Diagnosis

Arch Surg. 2010;145(6):596. doi:10.1001/archsurg.2010.93-b

Presacral neoplasms are rare, with an incidence of 1 in 40 000 hospital admissions.1,2 Following Uhlig and Johnson’s1 classification scheme, presacral tumors are categorized as congenital, neurogenic, or osseus. Several other types of soft tissue tumors such as lipomas or sarcomas fall into the miscellaneous category. Two-thirds of all presacral tumors are congenital, and this patient's pathology was consistent with one such congential tumor, a cystic hamartoma. Two-thirds of congenital tumors are benign, and other examples include epidermoid and dermoid cysts and anterior sacral meningoceles. Sacrococcygeal chordoma, a solid tumor, is the most common malignant congenital lesion in the presacral space.3