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Adenocarcinoma originating from a completely isolated duplication cyst of the mesentery in an adult.

Shin SY, Cho MY, Ryu H, Kim JW, Kim HS, Kim JM, Ko AN, Yu TS, Park HJ - Intest Res (2014)

Bottom Line: Additionally, only 1 case of mucinous cystadenoma from an infected CIDC of the ileum has been reported.The latter was lined internally with malignant glandular cells and contained a smooth muscular outer layer as determined by microscopic examination of the tissue.We believe that this is the first reported case of an adenocarcinoma originating from a CIDC in an adult.

View Article: PubMed Central - PubMed

Affiliation: Department of Internal Medicine, Yonsei University Wonju College of Medicine, Wonju, Korea.

ABSTRACT
Alimentary tract duplications are uncommon congenital abnormalities that usually have an anatomical connection with some part of the gastrointestinal tract and have a common blood supply with the adjacent segment of intestine. A completely isolated duplication cyst (CIDC) is a very rare type of gastrointestinal duplication that does not communicate with the normal bowel segment and possesses its own exclusive blood supply. Only 5 CIDC cases in adults have been reported in the English medical literature. Additionally, only 1 case of mucinous cystadenoma from an infected CIDC of the ileum has been reported. This report describes a 52-year-old male patient with a peritoneal CIDC, which upon curative excision was found to have given rise to an adenocarcinoma. The latter was lined internally with malignant glandular cells and contained a smooth muscular outer layer as determined by microscopic examination of the tissue. We believe that this is the first reported case of an adenocarcinoma originating from a CIDC in an adult.

No MeSH data available.


Related in: MedlinePlus

Gross finding of removed cyst (A), and feature of gross section (B). The entire cyst was excised without disturbing the normal bowel or mesenteric anatomy (A). In a gross section analysis, it was determined to be a 4×3×3-cm-sized unilocular cyst filled with dark brown necrotic material that appeared to comprise hemorrhagic contents. The cyst wall was evenly thin with a focal, ill-defined, yellowish-brown mural nodule (red arrow) (B).
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Figure 2: Gross finding of removed cyst (A), and feature of gross section (B). The entire cyst was excised without disturbing the normal bowel or mesenteric anatomy (A). In a gross section analysis, it was determined to be a 4×3×3-cm-sized unilocular cyst filled with dark brown necrotic material that appeared to comprise hemorrhagic contents. The cyst wall was evenly thin with a focal, ill-defined, yellowish-brown mural nodule (red arrow) (B).

Mentions: On the basis of these findings, we diagnosed this case as a malignant gastrointestinal tumor or malignant lymph node and performed surgery. The entire cyst was excised without disturbing the normal bowel or mesenteric anatomy. The mass featured a well-encapsulated oval shape (Fig. 2A). During surgery, we found that the mass was located in the peritoneum, was not attached to the small bowel or stomach, and had a separate feeding vessel. Upon a gross sectional inspection, the mass was a 4×3×3-cm unilocular cyst filled with dark brown necrotic material that appeared to comprise hemorrhagic contents. The cyst wall was evenly thin with focally located, ill-defined yellowish-brown mural nodules (Fig. 2B). Upon microscopic examination, the cyst wall was found to be composed of an inner columnar epithelial lining, 2 smooth muscle layers, and serosa, thus mimicking the intestine. However, the epithelial lining of the entire cyst consisted of gland-forming neoplastic columnar epithelium, which was characterized by a loss of nuclear polarity, a high nuclear/cytoplasmic ratio, and hyperchromasia, without spared non-neoplastic epithelium (Fig. 3A). Focal areas of invasion into the smooth muscle were observed, and the cyst wall contained multifocal cholesterol granulomas that matched the yellowish nodules observed during the gross examination (Fig. 3B). The immunohistochemical stains were positive for cytokeratin 20 and negative for cytokeratin 7 in the neoplastic epithelial lining of the cyst (Fig. 3C, D). These findings were consistent with an adenocarcinoma that had arisen from the intestinal duplication cyst.


Adenocarcinoma originating from a completely isolated duplication cyst of the mesentery in an adult.

Shin SY, Cho MY, Ryu H, Kim JW, Kim HS, Kim JM, Ko AN, Yu TS, Park HJ - Intest Res (2014)

Gross finding of removed cyst (A), and feature of gross section (B). The entire cyst was excised without disturbing the normal bowel or mesenteric anatomy (A). In a gross section analysis, it was determined to be a 4×3×3-cm-sized unilocular cyst filled with dark brown necrotic material that appeared to comprise hemorrhagic contents. The cyst wall was evenly thin with a focal, ill-defined, yellowish-brown mural nodule (red arrow) (B).
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4214961&req=5

Figure 2: Gross finding of removed cyst (A), and feature of gross section (B). The entire cyst was excised without disturbing the normal bowel or mesenteric anatomy (A). In a gross section analysis, it was determined to be a 4×3×3-cm-sized unilocular cyst filled with dark brown necrotic material that appeared to comprise hemorrhagic contents. The cyst wall was evenly thin with a focal, ill-defined, yellowish-brown mural nodule (red arrow) (B).
Mentions: On the basis of these findings, we diagnosed this case as a malignant gastrointestinal tumor or malignant lymph node and performed surgery. The entire cyst was excised without disturbing the normal bowel or mesenteric anatomy. The mass featured a well-encapsulated oval shape (Fig. 2A). During surgery, we found that the mass was located in the peritoneum, was not attached to the small bowel or stomach, and had a separate feeding vessel. Upon a gross sectional inspection, the mass was a 4×3×3-cm unilocular cyst filled with dark brown necrotic material that appeared to comprise hemorrhagic contents. The cyst wall was evenly thin with focally located, ill-defined yellowish-brown mural nodules (Fig. 2B). Upon microscopic examination, the cyst wall was found to be composed of an inner columnar epithelial lining, 2 smooth muscle layers, and serosa, thus mimicking the intestine. However, the epithelial lining of the entire cyst consisted of gland-forming neoplastic columnar epithelium, which was characterized by a loss of nuclear polarity, a high nuclear/cytoplasmic ratio, and hyperchromasia, without spared non-neoplastic epithelium (Fig. 3A). Focal areas of invasion into the smooth muscle were observed, and the cyst wall contained multifocal cholesterol granulomas that matched the yellowish nodules observed during the gross examination (Fig. 3B). The immunohistochemical stains were positive for cytokeratin 20 and negative for cytokeratin 7 in the neoplastic epithelial lining of the cyst (Fig. 3C, D). These findings were consistent with an adenocarcinoma that had arisen from the intestinal duplication cyst.

Bottom Line: Additionally, only 1 case of mucinous cystadenoma from an infected CIDC of the ileum has been reported.The latter was lined internally with malignant glandular cells and contained a smooth muscular outer layer as determined by microscopic examination of the tissue.We believe that this is the first reported case of an adenocarcinoma originating from a CIDC in an adult.

View Article: PubMed Central - PubMed

Affiliation: Department of Internal Medicine, Yonsei University Wonju College of Medicine, Wonju, Korea.

ABSTRACT
Alimentary tract duplications are uncommon congenital abnormalities that usually have an anatomical connection with some part of the gastrointestinal tract and have a common blood supply with the adjacent segment of intestine. A completely isolated duplication cyst (CIDC) is a very rare type of gastrointestinal duplication that does not communicate with the normal bowel segment and possesses its own exclusive blood supply. Only 5 CIDC cases in adults have been reported in the English medical literature. Additionally, only 1 case of mucinous cystadenoma from an infected CIDC of the ileum has been reported. This report describes a 52-year-old male patient with a peritoneal CIDC, which upon curative excision was found to have given rise to an adenocarcinoma. The latter was lined internally with malignant glandular cells and contained a smooth muscular outer layer as determined by microscopic examination of the tissue. We believe that this is the first reported case of an adenocarcinoma originating from a CIDC in an adult.

No MeSH data available.


Related in: MedlinePlus