Peritoneal inclusion cysts with mural mesothelial proliferation. A clinicopathological analysis of six cases.
ABSTRACT The clinical and pathological features of six cases of a rare, hitherto unreported type of pelvic cyst are described. The cysts occurred in female patients (15-51 years of age) who presented with lower abdominal pain and evidence of a pelvic mass. All but one of the patients had a history of prior pelvic surgery. Laparotomy revealed dense pelvic adhesions and a cystic lesion that was interpreted by the surgeon as ovarian in origin. On gross examination, the cysts measured up to 15 cm in diameter, were uni- or multilocular and thin-walled, and contained bloody or serous fluid. They were adherent to the surface of the ovaries, but did not involve the ovarian parenchyma. On microscopic examination, the cyst walls were composed of markedly inflamed granulation and fibrous tissue in which were embedded mesothelial cells arranged in glands, nests, cords, and single cells. Because of this infiltrative pattern, as well as cytological atypia and mitotic activity within the mesothelial cells, a diagnosis of cancer was considered in several cases. All patients are alive with no evidence of disease at postoperative intervals of 6 months to 5 years. We propose that these cysts represent peritoneal inclusion cysts (benign cystic mesotheliomas) in which the histological appearance has been altered by an unusual degree of inflammation, fibrosis, and entrapment of mesothelial cells.
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ABSTRACT: Benign cystic mesothelioma or peritoneal inclusion cysts are rare benign abdominal tumors usually occurring in females of reproductive age. These cysts present as abdominopelvic pain or masses but are often found on imaging or incidentally at surgery. They are commonly associated with pelvic inflammatory disease, endometriosis, or ovarian cysts. We report what is, to the best of our knowledge, the first case of a benign cystic mesothelioma complicating a presentation of acute appendicitis. A 19-year-old Irish Caucasian woman presented with abdominal pain. Imaging suggested appendicitis with abscess formation. She was treated with antibiotics and scheduled for interval appendicectomy. At laparoscopy, an unusual cystic mass was found arising from the appendix. Histology revealed benign cystic mesothelioma. We report what is, to the best of our knowledge, the first case of a benign cystic mesothelioma arising from the appendix and complicating a presentation of acute appendicitis. This is a benign pathology, but recurrences are not uncommon. Benign cystic mesothelioma should be included in the differential when investigating pelvic masses or abscesses associated with either appendicitis or pelvic inflammatory disease in women.Journal of Medical Case Reports 01/2010; 4:394.
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ABSTRACT: The imaging findings, clinical presentation, and outcome in post liver transplantation patients with hepatic arterial collaterals are reviewed. Adult post orthotopic liver transplantation patients who underwent an angiography at our institution for suspected hepatic arterial abnormality during an approximately 10-year period were included in our study. A retrospective review of all cases that had hepatic arterial collaterals detected on angiography was then performed. Angiographic findings were correlated with the findings on ultrasound and other imaging studies. Liver function at the time of angiography was recorded. Clinical outcomes were reviewed. Of the 129 angiographies performed in the approximately 10-year period, 24 (19.4%) were found to have collaterals on angiography. Maximum size of the collaterals seen on angiography was 3 mm. Twenty patients (83%) with collaterals are currently alive. Twelve patients (50%) had a normal outcome and did not develop any complications on follow-up; however, the rest developed complications. Eleven patients (41.7%) had complication related to the liver ischemia and 2 patients (8.3%) developed malignancy (posttransplant lymphoproliferative disease). Collaterals seen in patients with chronic hepatic artery occlusion are usually small in caliber and their significance is unclear. Recognition and understanding of this phenomenon is important as this subset of patients may not need urgent surgical re-exploration/vascular intervention.Transplantation Proceedings 06/2011; 43(5):1770-6. · 0.95 Impact Factor
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ABSTRACT: Benign multicystic mesothelioma (BMM) is a rare tumoral lesion of the peritoneum often discovered incidentally upon surgery, laparoscopy, or radiographical imaging in females of childbearing age. The etiology and question as to whether these lesions occur via a neoplastic or reactive process still remain unknown. In this report, we present two cases of BMM detected in females with concurrent colonic adenocarcinoma arising in the ileocecal region. The tumors were present in the serosa surrounding the colonic adenocarcinoma in one case, and in the omentum in the other case, which grossly mimicked peritoneal seeding of carcinoma. An immunohistochemical analysis revealed that the cells lining the cystic spaces in both lesions were positive for keratin and calretinin, confirming their mesothelial origin. To the best of our knowledge, these cases represent the first documented examples of multicystic mesothelioma concurrent with colonic adenocarcinoma.Surgery Today 12/2011; 42(10):978-82. · 0.96 Impact Factor