Presacral Tumors

Presacral tumors represent a rare group of both benign and malignant lesions. Most benign lesions have malignant potential and must be followed carefully if nonoperative treatment is chosen. Magnetic resonance imaging (MRI) is the best imaging study to assist in diagnosis and operative planning. When performed, biopsy may assist in management of solid and heterogeneous cystic lesions. Observation of simple cystic lesions is acceptable when a dedicated surveillance protocol is in place. Given the broad differential and significant implications of mismanagement, presacral tumors should be evaluated and treated by surgeons at centers that have a large experience in managing these complex tumors.