An unusual presentation of acute abdomen: infarcted peritoneal cyst-a probable asbestos-related benign cystic mesothelioma

ABSTRACT This is a report of a rare case of an infarcted pelvic intra-abdominal cyst, having no mesenteric connection presenting as an acute abdomen. The patient had significant asbestos exposure. The cyst was treated successfully by surgical excision. Histopathology showed an infarcted cyst; the lining was destroyed, precluding marker studies. A diagnosis of benign cystic peritoneal mesothelioma (BCPM) was made by excluding other causes of solitary pelvic intra-abdominal cysts. BCPM has been classified as an asbestos-related neoplasm and is usually seen in the pelvis adjunct to the urinary bladder. One-year post-surgery, there was no recurrence. The case report shows that infarcted pelvic mesothelial cysts can present as an acute abdomen and can be treated successfully by total excision with no recurrence.

Mesothelial Cysts

Objectives Peritoneal mesothelial cysts have been reported under various terms, including benign cystic mesothelioma, usually in the form of case reports/series, whereas extraperitoneal cases are rarely reported. Our objective was to report the detailed characteristics of cystic lesions of the serosal cavities. Methods We retrospectively examined the clinicopathologic findings of a series of mesothelial cystic lesions (n = 79). Results Most cases (n = 68, 86%) concerned the peritoneum, whereas 11 (14%) concerned the pericardium. No pleural cases were found. A total of 51 (64.5%) lesions were solitary, whereas 28 (35.5%) were multiple. Peritoneal lesions harbored a plump eosinophilic mesothelium and a loose connective stroma, whereas pericardial lesions showed a cuboidal/flattened mesothelium, collagenous stroma, intense inflammation, and other tissue types, like adipose and muscle tissue. Solitary peritoneal lesions are usually extrapelvic and found in older patients incidentally during other surgeries, whereas multiple lesions are found in younger patients and usually in the pelvis. The lesions show a benign clinical course with rare recurrences but no malignant transformation. Conclusions Most mesothelial cysts are peritoneal and rarely pericardial. Peritoneal cysts differ from pericardial cysts. Peritoneal solitary lesions differ from multiple lesions, also suggesting their pathogenetic differences.

Mesenteric Paraganglioma-A Cyst in The Mist

Extraadrenal paraganglioma is rarely found in the mesentery. It accounts only for 5-10% of cases and may present incidentally as abdominal mass. We report a case of 30 year old male presented as mass per abdomen. A differential diagnosis of neurogenic tumor or cystic mesothelioma was considered based on CT-abdomen. Histopathological examination showed features of mesenteric paraganglioma and confirmed on immunohistochemistry. This case report highlighted several important key issues regarding diagnosis of paraganglioma, including malignant or metastatic potential, recurrence rate, pre and postoperative imaging study and lifelong follow-up of the patient.

An Interesting Case of a Large Cystic Mesothelioma of the Omentum in a Pediatric Patient

We present an interesting case of a large intra-abdominal cystic lesion in a 14-year-old girl who presented with abdominal discomfort and pain. The patient was evaluated with magnetic resonance imaging (MRI) and found to have a large septated cystic lesion arising from the gastrohepatic omentum. She underwent surgery, and the diagnosis of cystic mesothelioma was confirmed in the histopathology. To the best of our knowledge, only a few cases of benign omental mesothelial cysts have been reported.

Rare case of retroperitoneal cystic lymphangioma in an adult

Cystic lymphangioma is benign tumor originating from the lymphatic vessels. Most commonly occurs in childhood and in the head or neck regions, retroperitoneal localization and presentations in adulthood are rare. Making a pre-operative diagnosis is challenging, and only possible subsequent to the histological examination. En bloc resection is the recommended treatment for cystic lymphangioma, and recurrence occurs due to an incomplete excision. We here present a case of 40 year female presenting with progressive palpable lump associated with pain in right quadrant of abdomen, which on computed tomography revealed a large retroperitoneal cystic lesion probably lymphanigoma or cystic mesothelioma.