Ischiorectal Mass Excision Using Ultrasound-Guided, Wire-Needle Localization.

INTRODUCTION: In this work, we describe an unusual presentation of a nuchal-type fibroma, presenting as a mass in the ischiorectal space in an adult male. Since this lesion was not palpable and was in close proximity to the anal sphincter complex, we describe a novel multidisciplinary approach using wire-needle localization with interventional radiology to allow for a directed dissection, similar to an approach used in breast partial mastectomy surgeries. CASE PRESENTATION: A 56-year-old male presented with an incidentally found 2.1 × 2.7 × 1.8 cm ischiorectal mass that abutted the anal sphincter complex. Interventional radiology performed an ultrasound-guided wire needle localization which allowed for a directed dissection down to the lesion. Pathology was consistent with nuchal-type fibroma with negative margins. The patient now undergoes surveillance with semi-annual MRIs. CONCLUSIONS: This case report describes a novel application of a hybrid surgical approach utilizing intraoperative image-guided localization for the safe excision of a rare soft tissue mass in an atypical, difficult-to-access location.