Infarcted mesothelial cyst: A case report
| Autor: | Eric Schmieler, Fernando Navarro, Walter Beversdorf |
|---|---|
| Rok vydání: | 2017 |
| Předmět: |
Encountered problems
Abdominal pain Pathology medicine.medical_specialty business.industry Radiography Case Case Report 03 medical and health sciences Cyst 0302 clinical medicine Report 030220 oncology & carcinogenesis Infarcted medicine Mesothelial cyst Abdominal Surgery Mesothelial 030212 general & internal medicine Radiology Differential diagnosis Ct imaging medicine.symptom business |
| Zdroj: | International Journal of Surgery Case Reports |
| ISSN: | 2210-2612 |
| DOI: | 10.1016/j.ijscr.2016.11.013 |
| Popis: | Highlights • Mesenteric cystic masses account for a very small fraction of abdominal pain cases. • Symptoms arise likely as a result of mass effect, even when these lesions are small. • On detection of these lesions by imaging, it is important to exclude neuroendocrine tumors. • Complete surgical excision is curative of symptoms caused by local mass effect. • Histopathological examination of specimens is the definitive means to differentiate between such lesions, that appear similarly on imaging. Introduction Mesenteric and omental mesothelial cysts are rare, accounting for only 1 in 100,000 hospital admissions for abdominal pain (Tan Jane et al., 2009) [1]. They are often discovered only on CT imaging, which is frequently non-definitive in identifying an exact tissue source owing to overlapping radiographic features with other masses (Stoupis et al., 1994) [2]. The symptoms manifested by such masses are also nonspecific, favoring consideration of more frequently encountered problems in the scope of general surgery over cystic masses in the differential diagnosis. Definitive diagnosis of a mesothelial cyst in this case was made on histopathologic examination of a surgically resected specimen. This case is reported in line with SCARE criteria (Dragoslav et al., 2007) [6]. Presentation of case A 41 year-old male patient presented to an academic teaching hospital with several days of abdominal pain with nausea and vomiting. Initial workup was unremarkable, save for abdominal CT revealing a central mesenteric focus of inflammation. Neuroendocrine tumor was excluded by normal serum octreotide, 5-HIAA, and chromogranin A. A 4 × 2 cm mass was identified and resected on laparoscopy. Histopathologic diagnosis of the specimen was infarcted mesothelial cyst. The patient reported resolution of symptoms and remains well on most recent follow-up. Discussion The rapid diagnosis of intra-abdominal cystic masses is obscured by their rarity, nonspecific symptomatology, and radiographic features that overlap among such masses (Stoupis et al., 1994) [2]. The etiology of symptoms is likely owed to local mass effect exerted by the cyst on surrounding tissues. Continued resolution of symptoms on resection of such a cyst supports this conclusion. Conclusion imaging following an overall unremarkable physical and laboratory workup for this patient’s abdominal pain directed our further workup and management efforts towards surgical excision of an intra-abdominal cystic mass. Histopathologic examination of the cyst was ultimately diagnostic of an infarcted mesothelial cyst. |
| Databáze: | OpenAIRE |
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