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by endoscopic ultrasound-guided fine needle aspiration: a retrorectal tailgut cyst A 42-year-old woman underwent a magnetic resonance imaging (MRI) scan for CA 19.9 elevation, noted during a routine evaluation. Endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) of a retrorectal cystic mass of unknown etiology was scheduled. A 5-cm multiseptated cystic lesion was noted (●" Fig.1). Under antibiotic prophylaxis, FNA was performed (19-gauge needle; single pass); the aspirate was thick and yellowish. Cytological examination showed squamous epithelial cells but no atypia (●" Fig.2). In-house MRI confirmed a multicystic lesion with a hyperintense signal on T1-weighted images (●" Fig.3). The patient opted for a laparoscopic resection, which confirmed a tailgut cyst (●" Fig.4), with later CA 19.9 normalization. The human embryo possesses a true tail as an extension of the primitive gut. A retrorectal cystic hamartoma (tailgut cyst) is a rare congenital lesion representing a nonregressed tail. Usually found in asymptomatic middle-aged women, local mass effect or complications, namely malignant degeneration, have been described [1]. Ultrasound shows multilocular cystic lesions with internal echoes due to mucoid material or inflammatory debris. Surgical excision is the gold-standard treatment, with the laparoscopic approach being the most recent option [2]. There is only one report of EUS-FNA with a flexible echoendoscope [3]. Puncture should be performed when other etiologies are considered or if malignant degeneration changes management. Finally, clinicians should be aware that benign tailgut cysts are a rare cause of mild CA 19-9 elevation [4].

Unusual cause of CA 19.9 elevation diagnosed by endoscopic ultrasound-guided fine needle aspiration: a retrorectal tailgut cyst