Disclosures: Kristen D. De Vries, DO, MS: Nothing to disclose

Case Description: The patient had a past medical history of chronic pain syndrome and fibroids and was following with an interventional pain management physician. She presented with new onset buttock pain and received gluteal trigger point injections without improvement. She later received two ganglion impar blocks with significant relief. However, 3 months after the injection, patient presented with recurrent, significant pain, prompting her to go to the emergency department. Further imaging revealed a 4.3 cm heterogeneous enhancing mass anterior to the left hemisacrum, extending into the left sacral neural foramen. CT-guided biopsy revealed a spindle cell lesion. Patient’s pain was managed medically pending further immunohistochemistry.

Setting: Tertiary Care Center, Inpatient medical floor

Patient: A 60-year-old female with buttock pain found to have a presacral mass with core biopsy revealing a spindle cell lesion.

Assessment/Results: The patient’s medical team had difficulty managing the patient’s pain and pain management was consulted for further input. Pain was likely coccydynia with contributing neuropathic component due to the newly found mass.

Discussion: Coccydynia, or pain localized to the tailbone that often radiates to the lower sacrum and perineum, can be managed with ganglion impar blocks when patients are not responsive to conservative management. However, the etiology of this common pain syndrome should be evaluated to rule out potentially serious causes. Spindle cell lesions can vary from benign to neoplastic. Low-grade pelvic masses with spindle cells are rare and can be associated with a number of different histologic subtypes but are not well described in the literature. Clinical presentation may be variable depending on location and subtype.

Conclusion: Coccydynia is a relatively common presentation in the outpatient and emergency setting. However, coccydynia is a symptom and the etiology must be further investigated to rule out serious causes, especially when the pain is recurrent and refractory to standard treatment.

Level of Evidence: Level V

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PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/coccydynia-of-unusual-etiology-a-case-report-of-a-spindle-cell-lesion/