Based on the radiological and cytological findings, which did not rule out a potential malignancy, the patient underwent surgical excision of the mass. An arcuate incision was performed, extending from the posterior midline of the anal margin, with preservation of the sphincter complex to the right of the coccyx. The coccyx was excised to achieve adequate exposure, the anococcygeal ligament was divided, and the retrorectal space was entered. A 5-cm calcified mass involving the posterior aspect of the retrorectal space adjacent to the tip of the coccyx extending toward the right was identified and excised to normal healthy tissue, confirmed by multiple frozen sections. At gross examination, the specimen consisted of a well-circumscribed mass of rubbery consistency with a cystic component and a 1-cm calcified area (Figure 2).