Recent Advancements in the Morphologic Description of Cloacal Development Have Implications for Oncologic Resection of Tailgut Cysts

Abstract

Tailgut cysts are rare para-rectal lesions thought to arise from incomplete involution of the tailgut during ontogenesis. They commonly present to gastroenterologists with tenesmus, extra-luminal compression, disturbance of bowel habit or rectal bleeding and carry significant threat of malignant transformation; particularly adenocarcinoma.

Guidelines on treatment of colonic adenocarcinoma are well established internationally. However, there are no guidelines on tailgut cyst management which can make onward referral for consideration of resection challenging. This problem is compounded by the inaccessibility of these cysts to visualisation or biopsy by endoscopy.

A significant barrier to consensus on the approach to these lesions is that there is presently scant explanation on their morphogenesis. Ontogenesis is the guiding principle in resection of colonic adenocarcinoma, where the lesions are resected en bolc with their embryonic mesentery, which contains their draining lymphatics. Recent developments in the description of the embryology of the anorectal region have resolved old morphogenic controversies and point the way to a rational approach to resection of tail gut cysts.

 

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