Peritoneal Inclusion Cysts with Mural Mesothelial Proliferation

Vancouver General Hospital, Vancouver, British Columbia, Canada
American Journal of Surgical Pathology (Impact Factor: 5.15). 01/1987; 10(12):844-54. DOI: 10.1097/00000478-198612000-00003
Source: PubMed


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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    • "Peritoneal inclusion cysts (PIC), also known as “peritoneal mesothelial cysts,” “peritoneal pseudocysts,” and “inflammatory cysts of the pelvic peritoneum,” have been described in females of reproductive age [1]. Reports of this entity occurring in adolescent females have largely focused on the clinical and pathological features of this entity [2, 3]. The literature describing the imaging findings of peritoneal inclusion cysts in the pediatric population on multiple modalities is scant. "
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    ABSTRACT: We report the multimodality imaging findings of peritoneal inclusion cysts in two adolescent females each with a prior history of abdominal surgery. The few reports of peritoneal inclusion cysts in the pediatric population have largely focused on the clinical and pathological features of this entity. We wish to emphasize the imaging findings of peritoneal inclusion cysts on multiple modalities, the advantage of MRI in confirming the diagnosis, and the need to keep considering this diagnosis in patients who present with a pelvic cystic mass, with a history of surgery, even if remote. Additionally, we review the pathology, pathophysiology, differential diagnosis, and treatment options of peritoneal inclusion cysts.
    Full-text · Article · Jul 2014
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    • "Peritoneal inclusion cyst was first described in 1979 by Mennemeyerand Smith.1 It usually occurs in young to middle-aged women with a history of pelvic surgery,2 endometriosis3,4 or pelvic inflammatory disease.5,6 Approximately 150 cases of benign multicystic peritoneal mesothelioma, with various presentations have been reported since 1979.7 Peritoneal inclusion cysts represent a non-neoplastic reactive mesothelial proliferation. "
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    ABSTRACT: Benign multicystic peritoneal mesothelioma (BMPM) is an uncommon lesion. It presents as a lump in abdomen or a finding seen on imaging modalities. Surgery is the primary modality of treatment. However, it has a high recurrence rate; this results in adhesions and subsequent surgeries difficult. We present a case of recurrent BMPM in a female operated twice earlier in a rural centre. Imaging modalities showed majority of the lesion in paracolic and retroperitoneal region. Hence, retroperitoneal approach for surgery was taken. This avoided previous surgical adhesions. A brief case report on this novel approach and review of literature is presented.
    Full-text · Article · Jan 2013
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    • "Previous reports have suggested that aspiration is a safe and effective nonsurgical treatment for PICs (7, 8, 15, 17); simple aspiration is, however, associated with a high recurrence rate (1-3, 5, 14, 25, 26), as in the aspiration of simple renal cysts, hepatic cysts and postoperative lymphocele (19, 20, 23). We therefore believe that sclerotherapy following drainage is essential for the treatment of PICs. "
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    ABSTRACT: To evaluate the technical feasibility and the clinical effectiveness of sclerotherapy for the treatment of peritoneal inclusion cysts (PICs). Between June 1996 and February 2001, eight PICs in seven female patients aged 28-43 (mean, 36) years were instilled with sclerosant (povidone-iodine in three, ethanol in three, both povidone-iodine and ethanol in one). All seven patients subsequently experienced less abdominal pain. After drainage via an 8.5-Fr pigtail catheter inserted in the PICs (transabdominally in six cases, transvaginally in one), sclerosant equivalent in volume to about one-third that of drained fluid was introduced daily until the drained volume was less than 5ml. Follow-up by means of clinical procedures and ultrasound was performed every three months, at which time the success rate, possible complications and recurrence were determined. Sclerotherapy was technically successful in all seven patients, though immediately after the procedure, minor complications were noted in three patients (mild pain in two, mild fever in one). During the follow-up of 4-60 (mean, 24.7) months, sclerotherapy proved successful and without long-term complications in all seven patients: lower abdominal pain disappeared and the diameter of the cysts decreased more than 50%, with complete regression in four cases. During the follow-up period there was no recurrence. Sclerotherapy following catheter insertion is technically feasible and effective for the treatment of PICs.
    Full-text · Article · Sep 2001 · Korean Journal of Radiology
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