**3.3 Clinical presentation**

Most external tumors are asymptomatic, with the exception of the presence of a visible exophytic large mass at the sacral region with occasional surface ulceration and hemorrhage and with anus displaced anteriorly (**Figure 2**). Sometimes, rupture of the tumor may occur as a result of a difficult delivery. Pelvic tumors or tumors that extend into the abdominal cavity may present with compression of the rectum or recto-sigmoid and urinary tract obstruction (constipation, frequent stools, obstruction of the bladder neck).
