Mesenteric cyst

Case contribution: Dr Radhiana Hassan

Clinical:

  • A 46 years old lady
  • Nulliparous
  • Presented with sudden onset of severe LIF pain for 2 days
  • Spontaneously resolved
  • No per vaginal or per rectal bleed
  • No bowel symptoms
  • Colonoscopy normal
  • Ultrasound showed cystic lesion at left flank
CT scanogram show a mass lesion at left lumbar region.

CT Findings:

  • A well defined oval hypodense lesion at left lumbar region measuring about 9.3 cm x 3.8 cm.
  • Density consistent with fluid.
  • No calcification within the lesion.
  • No septae.
  • No solid component.
  • Displaces the descending colon (DC) anteriorly

Intra-operative findings:

  • A left retroperitoneal mesenteric cyst.
  • Cyst arising from descending mesocolon
  • The cyst is benign looking
  • Uterus, fallopian tubes and ovaries are normal.
  • Colon, small bowel, stomach, liver, gall bladder are normal
  • Pelvic cavity normal, no adhesion

Histopathological findings:

  • Macroscopy: specimen labelled as descending colon cyst consists of a cyst measuring 135x100x80 mm and weighing 500 gm. Cut section shows a unilocular cyst containing serous fluid. The wall is about 1 mm in thickness.
  • Microscopy: section of the cyst wall shows to be lined by ciliated pseudostratified epithelium. There is no cytological or architectural atypia.

Diagnosis: Benign mesenteric cyst.

Discussion:

  • Mesenteric cysts are rare, reported incidence of 0.5-1 per 100,000 admissions
  • a very rare cause of abdominal pain
  • have wide range of underlying causes
  • It can occur anywhere in the mesentery, from the duodenum to the rectum and may extend into the retroperitoneum.
  • The pathologic features¬† vary considerably. They can be single or multiple, unilocular or multilocular; they can have serous, chylous, hemorrhagic, or mixed fluid contents; and their lining can vary from a flattened endothelial monolayer to a cuboidal or columnar epithelium to patchy fibrosis.
  • Rarely the cyst wall contains calcium
  • Differential diagnosis: ovarian cyst, pancreatic pseudocyst, meconium pseudocyst, urachal cyst, peritoneal hydatidosis
  • The case illustrate the importance to document the origin of the lesion, extent and the nature of the cystic mass in the abdomen.

Progress of patient:

  • As initial diagnosis was an ovarian cyst, patient was operated by O&G team
  • On-table referral was done to surgical team
  • Patient had uneventful post operative recovery
  • Discharged well

 

 

Author: radhianahassan