Laparoscopic excision of a retroperitoneal mucinous cystic neoplasm: A case report

Laparoscopic peritoneal mucinous cystadenoma debulking: A case report

RATIONALE

Peritoneal mucinous cystadenoma is rare in the clinic, lacks specific clinical manifestations, tumor markers, and imaging features, and is easily misdiagnosed and missed. Clinical practitioners should maintain a high level of vigilance. Here, we report a case of laparoscopic peritoneal mucinous cystadenoma stripping to improve our understanding of the disease.

PATIENT CONCERNS

A 34-year-old woman was admitted to our hospital with a history of epigastric pain over the past year that had worsened over the previous 4 months. The patient had no history of trauma or surgery.

DIAGNOSES

A computed tomography scan of the whole abdomen, as well as hepatobiliary and pancreatic scans and magnetic resonance cholangiopancreatography examinations, showed a low-density mass of approximately 5.8 × 4.8 cm between the right lobe of the liver and the right kidney. The lesion showed no significant enhancement on the enhanced scan, and analysis of tumor markers was normal. The preoperative diagnosis was cholelithiasis with cholecystitis and hepatic cysts.

INTERVENTIONS

It was proposed to perform "laparoscopic cholecystectomy + hepatic cyst decapitation and decompression" under general anesthesia; however, intraoperative exploration revealed that the abdominal cyst had originated from the right side of the peritoneum and was located between the liver and kidney. The surgical procedure was thus changed to "laparoscopic abdominal cyst removal + cholecystectomy."

OUTCOMES

The patient recovered well and was discharged on the fourth postoperative day. Postoperative pathological examination (abdominal cyst) showed mostly serous cells partially covered with high columnar mucus cells, which was consistent with mucinous cystadenoma. The postoperative diagnosis was peritoneal mucinous cystadenoma and cholecystolithiasis with cholecystitis.

LESSONS

Clinical diagnosis of mucinous cystadenoma of the abdominal wall is difficult. The possibility of the disease should be considered when a cystic space is found in the abdominal cavity. Diagnosis depends on postoperative pathological examination, and surgery is the preferred treatment option. During the operation, attention should be paid to avoid rupture of the cyst wall and overflow of cyst fluid, and to avoid blind fenestration and drainage or puncture and aspiration sclerotherapy when the diagnosis is unclear.

Laparoscopic excision of a large retroperitoneal cyst: Case report and literature review

Retroperitoneal cysts, a rare surgical phenomenon, present diagnostic challenges due to their typically asymptomatic nature. A 62-year-old male presented with a 4-month history of abdominal distension and increased burping. Upon clinical examination, a soft, distended, nontender abdomen with a palpable mass extending from the epigastric region to 3 cm below the umbilicus was revealed. Imaging revealed a 14.6 cm × 15.8 cm × 16.4 cm nonenhancing retroperitoneal lesion, compressing the right ureter and causing mild right hydronephrosis. Multiple gall bladder calculi, an umbilical hernia, and lipomatous lesions associated with adrenal glands were also discovered. Laparoscopic retroperitoneal cystectomy, cholecystectomy, and umbilical hernia repair were performed. Intraoperatively, 150 ml ascitic fluid and 1200 ml cystic fluid were found. This case highlights the intricate clinical presentation of a retroperitoneal cyst, emphasizing the need for surgical exploration. Successful laparoscopic management contributes to the evolving understanding of optimal treatment strategies.

A Symptomatic Mucinous Cystic Neoplasm of the Mesentery: A Case Report

Mucinous cystic neoplasms (MCNs) are rare tumors primarily observed in the pancreas but occasionally found in other locations such as the retroperitoneum, ovary, liver, and spleen. These neoplasms are histologically classified based on the degree of dysplasia, with some associated with invasive carcinoma. Colorectal surgeons infrequently encounter MCNs. Mesenteric MCNs pose a diagnostic challenge secondary to their atypical location, subtle histology, and lack of specific biochemical markers. In this context, we present a case involving a 68-year-old female who initially presented with an assumed ovarian mass. Subsequent exploration revealed a 12 cm MCN situated in the sigmoid mesentery, a location seldom associated with these tumors. The patient underwent laparotomy with successful resection and recovery. Histopathological analysis confirmed the neoplasm's mucinous epithelium with a complex papillary architecture. Immunohistochemical staining supported the diagnosis, revealing positivity for CK7, SATB2, and CDX2.

An enormous benign primary retroperitoneal mucinous cystadenoma: a case report and literature review of a seldom seen abdominal pathology

Introduction and importance

Retroperitoneal neoplasia comprise less than 2% of all tumours. benign primary retroperitoneal mucinous cystadenoma (PRMC) is an extremely rare tumour. Their clinical course is overall silent unless the patient presents with a vague abdominal or pelvic pain, abdominal distention, or a palpable mass. Their aetiology remains theorized and since 1989, only 46 cases (excluding ours) worldwide were documented in the literature. The majority of cases were discovered in females but the overall tumour incidence rate is still undetermined due to its rarity. Well-timed recognition of this pathology permits the necessary curative surgical intervention to take place.

Case presentation

We hereby illustrate the rare case of a 23-year-old female who presented to the surgical clinic complaining solely of an unexplained gradual increase of the abdominal contour. Their presurgical radiological analysis yielded an intraabdominal large-sized well-demarcated retroperitoneal mass.

Clinical discussion

Thorough resection of the mass was accomplished via open surgery. The subsequent microscopic analysis of excised tumour yielded the diagnosis of primary retroperitoneal mucinous cystadenoma of benign nature.

Conclusion

Primary retroperitoneal mucinous cystadenoma is a seldom seen tumour. The scarcity of its occurrence is further highlighted by the published data. Based on their conclusive review of the available published English-based literature, ours is the 47th documented case of a benign PRMC and it is the first documented case from our country; Syria. The impact of these findings warrants raising awareness on the subject and considering PRMC as a differential diagnosis when presented with a similar case in the clinical practice.

Primary retroperitoneal mucinous cystadenoma in a female patient: A case report

Introduction

Primary retroperitoneal mucinous cystadenoma is an extremely uncommon tumor occurring mostly in females. The histogenesis of PRMC remains unclear and Open surgery is the most impressive treatment.

Case presentation

We present a 20-year-old Iranian woman with history of intermittent abdominal pain. In physical examination, her abdomen had a mildly asymmetrical distention and a round shape mass was palpated in right abdomen also she had a mild tenderness in right abdomen. Radiologic assessment revealed a right retroperitoneal smooth cystic mass (20 × 15 cm) without invasive features. The patient underwent complete surgical excision of the tumor by a laparotomic approach because of its size. The lesion was gently dissected from the contiguous organs and removed completely without spillage of its content. In microscopic investigations, sections showed a unilocular cyst with fibrous wall lined via monolayered bland looking columnar mucinous epithelium and no atypia or stromal invasion was presented. Diagnosis of a PRMC was made. The patient has discharged without any complications in 2 days' postoperative course.

Discussion

Generally, cysts are asymptomatic and are found fortuitously after a routine checkup assessment. Symptoms and signs related to this cyst are mainly because of their huge size and compression effect. Radiological assessments are effective in specifying the lesion preoperatively; although, the final diagnosis always needs histopathological verification.

Conclusion

When the tumor is diagnosed, full resection should be considered because of the infectious or malignant potential of the tumor.

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Full resection of retroperitoneal mucinous cystadenoma because of the infectious or malignant potential of the tumor

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Histological and macroscopical likeness of primary retroperitoneal cystadenoma to ovarian mucinous cystadenoma

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CK7 and CA125 positivity in retroperitoneal mucinous cystadenoma because of its Mullerian origin

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Symptoms and signs related to the cyst mainly because of its huge size and compression effect