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Mucinous cystic neoplasms of the mesentery: a case report and review of the literature.

Metaxas G, Tangalos A, Pappa P, Papageorgiou I - World J Surg Oncol (2009)

Bottom Line: Mucinous cystic neoplasms arise in the ovary and various extra-ovarian sites.A cystic mass of uncertain origin was demonstrated radiologically in a 22 year old female with chronic abdominal pain.Only full histological examination of a mucinous cystic neoplasm can exclude a borderline or malignant component.

View Article: PubMed Central - HTML - PubMed

Affiliation: University Hospital of South Manchester, The Nightingale and Genesis Prevention Centre, Southmoor Road, M239LT, Manchester UK. geometa@hotmail.com

ABSTRACT

Background: Mucinous cystic neoplasms arise in the ovary and various extra-ovarian sites. While their pathogenesis remains conjectural, their similarities suggest a common pathway of development. There have been rare reports involving the mesentery as a primary tumour site.

Case presentation: A cystic mass of uncertain origin was demonstrated radiologically in a 22 year old female with chronic abdominal pain. At laparotomy, the mass was fixed within the colonic mesentery. Histology demonstrated a benign mucinous cystadenoma.

Methods and results: We review the literature on mucinous cystic neoplasms of the mesentery and report on the pathogenesis, biologic behavior, diagnosis and treatment of similar extra-ovarian tumors. We propose an updated classification of mesenteric cysts and cystic tumors.

Conclusion: Mucinous cystic neoplasms of the mesentery present almost exclusively in women and must be considered in the differential diagnosis of mesenteric tumors. Only full histological examination of a mucinous cystic neoplasm can exclude a borderline or malignant component. An updated classification of mesenteric cysts and cystic tumors is proposed.

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Lateral view of mesentery, cyst enucleation in an avascular plane.
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Figure 3: Lateral view of mesentery, cyst enucleation in an avascular plane.

Mentions: A 22 year old white-Caucasian female, with otherwise unremarkable history, presented with chronic, left sided, vague abdominal pain. There were no abnormal findings on clinical examination. Ultrasound (US), computerized tomography (CT) and magnetic resonance (MR) scans (Fig. 1a, b) demonstrated a unilocular cystic mass measuring 8.5 × 6 × 3.5 cm and lying medially to the descending colon. No definite preoperative diagnosis could be established. At laparotomy the mass was fixed within the descending and sigmoid colonic mesentery (Fig. 2). As there were no firm adhesions or shared blood supply (Fig. 3), enucleation was easily performed. The cyst had a macroscopically thin and smooth wall and contained white-yellowish fluid. The cyst wall was examined in its entirety. Histology demonstrated two distinct components: an outer ovarian-like stromal layer, composed of densely packed spindle-shaped cells (Fig. 4) and an inner epithelial layer, consisting of cuboidal and columnar mucinous cells (Fig. 5, 6). Immunohistochemical study of the stromal cells demonstrated positivity for vimentin, actin, and desmin. The epithelial cells showed positivity for cytokeratin-7 (Fig. 6), CA-125 (Fig. 7), CEA, and CA 19-9 and negative expression of cytokeratin-20. There was no cellular atypia. The overall features suggested a benign neoplasm of epithelial origin with the appearance of an ovarian mucinous cystadenoma. The patient recovered uneventfully and remained well on annual follow-up with abdominal US.


Mucinous cystic neoplasms of the mesentery: a case report and review of the literature.

Metaxas G, Tangalos A, Pappa P, Papageorgiou I - World J Surg Oncol (2009)

Lateral view of mesentery, cyst enucleation in an avascular plane.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2691402&req=5

Figure 3: Lateral view of mesentery, cyst enucleation in an avascular plane.
Mentions: A 22 year old white-Caucasian female, with otherwise unremarkable history, presented with chronic, left sided, vague abdominal pain. There were no abnormal findings on clinical examination. Ultrasound (US), computerized tomography (CT) and magnetic resonance (MR) scans (Fig. 1a, b) demonstrated a unilocular cystic mass measuring 8.5 × 6 × 3.5 cm and lying medially to the descending colon. No definite preoperative diagnosis could be established. At laparotomy the mass was fixed within the descending and sigmoid colonic mesentery (Fig. 2). As there were no firm adhesions or shared blood supply (Fig. 3), enucleation was easily performed. The cyst had a macroscopically thin and smooth wall and contained white-yellowish fluid. The cyst wall was examined in its entirety. Histology demonstrated two distinct components: an outer ovarian-like stromal layer, composed of densely packed spindle-shaped cells (Fig. 4) and an inner epithelial layer, consisting of cuboidal and columnar mucinous cells (Fig. 5, 6). Immunohistochemical study of the stromal cells demonstrated positivity for vimentin, actin, and desmin. The epithelial cells showed positivity for cytokeratin-7 (Fig. 6), CA-125 (Fig. 7), CEA, and CA 19-9 and negative expression of cytokeratin-20. There was no cellular atypia. The overall features suggested a benign neoplasm of epithelial origin with the appearance of an ovarian mucinous cystadenoma. The patient recovered uneventfully and remained well on annual follow-up with abdominal US.

Bottom Line: Mucinous cystic neoplasms arise in the ovary and various extra-ovarian sites.A cystic mass of uncertain origin was demonstrated radiologically in a 22 year old female with chronic abdominal pain.Only full histological examination of a mucinous cystic neoplasm can exclude a borderline or malignant component.

View Article: PubMed Central - HTML - PubMed

Affiliation: University Hospital of South Manchester, The Nightingale and Genesis Prevention Centre, Southmoor Road, M239LT, Manchester UK. geometa@hotmail.com

ABSTRACT

Background: Mucinous cystic neoplasms arise in the ovary and various extra-ovarian sites. While their pathogenesis remains conjectural, their similarities suggest a common pathway of development. There have been rare reports involving the mesentery as a primary tumour site.

Case presentation: A cystic mass of uncertain origin was demonstrated radiologically in a 22 year old female with chronic abdominal pain. At laparotomy, the mass was fixed within the colonic mesentery. Histology demonstrated a benign mucinous cystadenoma.

Methods and results: We review the literature on mucinous cystic neoplasms of the mesentery and report on the pathogenesis, biologic behavior, diagnosis and treatment of similar extra-ovarian tumors. We propose an updated classification of mesenteric cysts and cystic tumors.

Conclusion: Mucinous cystic neoplasms of the mesentery present almost exclusively in women and must be considered in the differential diagnosis of mesenteric tumors. Only full histological examination of a mucinous cystic neoplasm can exclude a borderline or malignant component. An updated classification of mesenteric cysts and cystic tumors is proposed.

Show MeSH
Related in: MedlinePlus