A case report and a literature review of primary retroperitoneal mucinous cystadenoma: the importance of imaging in diagnosis and management

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 cystic tumour of borderline malignancy mimicking kidney duplicate: cases report and literature review

BACKGROUND

Primary retroperitoneal mucinous cystic tumours with borderline malignancy (PRMC-BM) are rare and difficult to diagnose preoperatively. We are the first to report two cases of PRMC-BM which mimic a duplex kidney and evaluate the outcomes of different surgical procedures.

CASE PRESENTATION

We describe two cases of retroperitoneal cystic tumours. Both were diagnosed with duplex kidney with hydronephrosis on computed tomography scan. The first patient underwent robot-assisted laparoscopic surgery and was found to have a retroperitoneal cystic tumour. The other patient underwent an ultrasound-guided puncture before surgery and was diagnosed with retroperitoneal lymphangioma. Retroperitoneal cystectomy was performed using an open transperitoneal procedure. The final pathologic diagnosis in both cases implies PRMC-BM. The open surgical approach was associated with a shorter operation time, less intraoperative blood loss, and protected cyst wall integrity by comparing the different surgical approaches. During follow-up, the patient in the first case had tumour recurrence six months post-surgery, and the other patient was healthy without recurrence or metastasis 12 months post-surgery.

CONCLUSIONS

Primary retroperitoneal mucinous cystic tumours with borderline malignancy can be enclosed within the kidney and misdiagnosed as other cystic diseases of the urinary system. Thus, an open surgical approach may be more suitable for this type of tumour.

Primary retroperitoneal mucinous cystadenoma: A case report with review of literature

Introduction and importance

Primary Retroperitoneal mucinous cystadenoma (PRMC) is an extremely rare benign tumor, predominantly occurring in women, with unclear pathogenesis.

Case presentation

A 31-year-old woman, with no medical or surgical history, presented with left flank pain.

Clinical discussion

An abdominal computed tomography (CT) scan revealed an 11cm retroperitoneal cyst. Due to its large size, percutaneous CT-guided drainage followed by a laparotomy surgical resection, were performed. Post-operative course was uneventful. Histological and immunohistochemical findings were consistent with PRMC. The patient was disease-free after a 6-month follow-up.

Conclusion

Mucinous cystadenoma is a very odd finding in the retroperitoneum. Multiple differential diagnoses are to be considered beforehand, as most of cystic lesions in this anatomical region are malignant and require a different surgical approach. Radical resection, by laparotomy or laparoscopy, is the treatment of choice.

Clinical characteristics, treatment strategies and oncologic outcomes of primary retroperitoneal tumours: a retrospective analysis in the Chinese population

INTRODUCTION

Primary retroperitoneal tumours (PRTs) are rare soft tissue tumours originating from the retroperitoneum. Although there has been considerable progress recently in diagnosis and treatment, the overall survival rate has not improved qualitatively. This study aimed to explore the clinical features, therapeutic strategies and prognosis of PRTs.

METHODS

Retrospective analysis of clinical data for 121 PRT patients admitted to Peking University Shenzhen Hospital from April 2003 to February 2017.

RESULTS

A total of 113 patients underwent surgery and 8 chose nonsurgical palliative treatment. There were 53 males and 68 females (ratio, 1:1.3; average age, 40.75 years), and the average tumour diameter was 9.69(2-40)cm. A total of 104 patients (92.04%) underwent complete resection, 5 (4.42%) underwent palliative resection and 21 (18.58%) underwent combined visceral resection. The pathological diagnosis was benign in 88 cases (72.73%) and malignant in 33 cases (27.27%). A total of 101 patients (83.47%) were followed for an average of 5.82 years. At the end of follow up, the recurrence and survival rates were 2.63% and 93.42% for benign tumours, respectively, and 24.00% and 60.00% for malignant tumours (p<0.01).

CONCLUSIONS

Imaging plays important roles in localising and characterising tumours, guiding treatment strategies. Complete tumour resection is key to reducing postoperative recurrence and improving survival. According to the postsurgical pathological results, combinations including radiotherapy, chemotherapy or targeted therapy are beneficial for improving prognosis.

Mesenteric and Retroperitoneal Mucinous Cystic Neoplasms: A Case Series

Aims. Mucinous cystic neoplasms (MCNs) are cystic neoplasms with mucinous epithelium surrounded by ovarian-like stroma. Extraovarian MCN occurring in the liver and pancreas have been well characterized. However, only rare case reports of MCN arising outside of these locations have been reported. MCNs arising in unusual locations should enter the differential diagnosis of mucinous intra-abdominal tumors and must be distinguished from more common mimics. Therefore, we aimed to examine a series of MCNs of the retroperitoneum and mesentery to characterize the clinicopathologic features of this entity. Methods and results. Seven MCNs arising in the abdominal mesentery or retroperitoneum were retrospectively identified. A clinicopathologic, histologic, and immunohistochemical (keratin 7, keratin 19, keratin 20, calretinin, inhibin-α, steroidogenic factor-1 (SF-1), estrogen receptor (ER), progesterone receptor (PR), PAX8, CDX2, and CD10) analysis was performed. All 7 MCNs were from females with a median age of 41 years old and a median size of 8 cm. All cases demonstrated mucinous with or without concomitant non-mucinous epithelium overlying spindle cell ovarian-like stroma. Luteinized cells were noted. The epithelium was positive for keratin 7 and keratin 19 in all 7 cases, while the stroma expressed ER, PR, and SF-1 in all cases stained. Calretinin was focally positive in the stroma of 3 of 7 cases, while inhibin-α was focally expressed in 5 of 6 cases. Conclusions. These results highlight the clinicopathologic, histologic, and immunophenotypic similarities between MCNs of the mesentery, retroperitoneum, pancreas, and liver. Overlapping features suggest a common histogenesis for all MCNs, which could include periductal fetal mesenchyme, aberrant migration of primordial germ cells, or abnormal differentiation or metaplasia of the embryonic coelomic epithelium.

Laparoscopic Resection and Pre-Operative Imaging of Primary Retroperitoneal Mucinous Neoplasms: A Retrospective Case Series

Purpose

The purpose of this paper is to present the clinicopathological features of primary retroperitoneal mucinous neoplasms (PRMNs), to evaluate the diagnostic role of pre-operative radiological examinations, and to determine the feasibility of total resection using the laparoscopic approach.

Methods

We retrospectively analysed the clinicopathological and radiological features of 10 PRMN cases who underwent surgical resection from January 2000 to December 2019.

Results

Ten PRMN cases were evaluated in this study, including 1 malignant case, 4 borderline cases, and 5 benign cases. The most common primary complaints were pain (60%) and palpable mass (60%). Of the 8 cases with pre-operative CT results, 75% of the borderline or malignant cysts and none of the benign cysts were large in size (size>11.6 cm). Half of the non-benign masses and none of the benign ones were lobulated. Thick wall (≥3 mm) and irregular wall were found in 25% and 50% of the non-benign cases, respectively. Wall enhancement was detected in 75% of the non-benign cases and 25% of the benign cases. Enhanced mural nodules were identified in 50% of the non-benign patients. Septa were found in 25% of the non-benign cases. Complete dissection of the tumour without rupture or post-operative complications was achieved laparoscopically in 90% of the cases. All patients were alive with no recurrence at the last follow-up at an average of 28.1±26.6 months.

Conclusion

Larger size and lobulation of the cyst, presence and contrast enhancement of thick and irregular cyst walls, mural nodules, and internal septa may be imaging features suggestive of malignancy. Complete resection of PRMN through the laparoscopic approach is feasible in experienced institutions.

First Report of Retroperitoneal Mucinous Cystadenoma in a Patient with Hirsutism

Primary retroperitoneal mucinous cystadenomas (PRMC) are rare benign neoplasms with only 55 documented cases in the English literature so far. A 19-year-old female exhibited hirsutism and was found to have a cystic mass measuring 5.8 cm × 3.9 cm × 5.8 cm in the left retroperitoneum. During subsequent work up, a high pre-operative value of dehydroepiandrosterone sulfate (DHEA-S) was noted. The patient was referred to surgical oncology and underwent an uneventful laparoscopic cystectomy. Pathology classified the cyst as PRMC. Post-operatively, the patient's DHEA-S levels normalized, though there was no appreciable decrease in the patient's hirsutism in the short-term follow-up. The origin of PRMC is uncertain. Due to their unknown biological potential, surgical resection is usually recommended. To the best of our knowledge, this is the first report documenting a PRMC and elevated levels of androgens in conjunction with hirsutism.

A rare case of a primary retroperitoneal mucinous cystic tumour with borderline malignancy and literature review

Primary retroperitoneal mucinous cystic neoplasms (PRMCN) with borderline malignancy are exceptionally rare tumours with lack of pathognomonic clinical and imaging-specific features. Here, we report a case of PRMCN with borderline malignancy in a 62-year-old woman who presented with abdominal pain. Imaging studies revealed a well-defined cystic mass on the right flank in close relation with the cecum and caecal appendix, without other findings suggestive of malignancy. A possible diagnosis of an ovarian epithelial tumour was ruled out intraoperatively. After surgical excision, microscopic examination allowed the final diagnosis. As there is no evidence of disease during follow-up, complete tumour resection without cystic rupture appears to be the best therapeutic option. Thus, although rare, this tumour should be considered when imaging findings suggest an ovarian mucinous neoplasm in women with normal ovaries. An international registry for rare tumours and longer follow-ups may contribute for more consistent approach for managing these patients.

Incidentally discovered huge retroperitoneal mucinous cystadenoma with successful laparoscopic management: Case report

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Retroperitoneal cystic lesions are uncommon heterogeneous clinical entities with no clear pathogenesis.

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Their clinical presentations are different with challenging diagnosis. Many cases may be discovered incidentally.

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Care must be taken during the operation not to cause spillage of its content.

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Laparoscopic excision is technically challenging but can be done safely by experienced laparoscopic surgeon.

Introduction

Retroperitoneal cystic lesions are uncommon heterogeneous clinical entities with no definite incidence. Their clinical presentations are different and their diagnosis is challenging. The management necessitates complete surgical excision, usually via laparotomy. Recently, laparoscopic approach is being increasingly used.

Case presentation

A 29-year-old female patient was referred for an incidentally-discovered huge retroperitoneal cyst. Imaging studies revealed a retroperitoneal cyst, measuring 13 * 11 cm. Diagnostic laparoscopy showed a retroperitoneal cyst displacing the small bowel and the right colon to the left side. The peritoneal covering was dissected from the cyst with caution not to cause cyst rupture. The cyst was removed partially using Endobag, then aspiration of its content to facilitate its delivery. The patient had a smooth uneventful postoperative course.

Discussion

The retroperitoneal space is large, expandable space which enables retroperitoneal cystic lesions to grow asymptomatic. CT scan remains the best imaging modality. Aspiration of its content is not routinely done as its sensitivity and specificity has been reported low. Moreover, it carries the risk of leakage of the cyst content into the peritoneal space. Open surgical complete excision is the traditional management and remains of choice. However, laparoscopic management can be tried with caution not to cause content spillage. Intraoperatively, controlled aspiration of the cyst helps in its retrieval.

Conclusion

Primary retoperitoneal mucinous cystadenoma is a rare clinical entity that is usually incidentally discovered. Laparoscopic excision is safe and feasible if done by an expert laparoscopic surgeon. Care should always be taken not to cause spillage of its content.