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Histopathological examination. (a) Hematoxylin and eosin (H&E) 40× duplication cyst wall with colonic type lining and submucosal glands. (b) H&E 40× foci of mucinous and serrated mucosal changes without high-grade dysplasia. (c) H&E 100× higher power field of colonic type mucosa with epithelial changes compatible with low-grade mucinous neoplasia, limited to the mucosa. (d) H&E 200× hyalinized wall with mucin dissection
Citations
... The most common malignancy is adenocarcinoma, followed by squamous cell carcinoma and carcinoid tumor with mean age at diagnosis being 48.8 years (range of 23-72 years). The preoperative diagnosis of malignant transformation is difficult, but should be considered when a solid component is found within a duplication accompanied by high serum levels of CA19-9 or carcinoembryonic antigen (CEA) (10). ...
Colonic duplication is an uncommon congenital anomaly within the alimentary tract which may be missed on clinical examination. Clinical symptoms are generally related to the involved site, size of duplication, or the associated ectopic mucosa. This is a case report of a 7-month-old female patient admitted in septic and hypovolemic shock, with severe anemia. Ultrasonography and computed tomography (CT) scans showed a left flank mass suggesting intussusception. The patient was first stabilized with intravenous fluids, intravenous antibiotics, oxygen, and blood transfusion. At laparotomy, the findings were a left paracolic cystic mass and an adjacent, complex retroperitoneal hemorrhagic mass. The histopathology report was consistent with a colonic duplication cyst with ectopic gastric and pancreatic mucosa. The patient improved after surgery and was discharged for routine outpatient follow-up. Colonic duplication should be included in the differential diagnoses in children presenting with palpable abdominal masses. Complete surgical removal of the symptomatic duplication is the treatment of choice.
... To understand the clinical features of the disease, we searched the PubMed database cases of retroperitoneal IEDC. We identified 18 adult cases reports, including our case, between 1990 and 2020 and summarized these cases with the detailed clinical course (Table 1) [12][13][14][15][16][17][18][19][20][21][22][23][24][25][26][27]. The ages of the adult patients, including the present case, varied widely, with a median age of 39.9 years (range 19-75 years), and there was a female predominance, with women outnumbering men by a ratio of approximately 2:1. ...
... The ages of the adult patients, including the present case, varied widely, with a median age of 39.9 years (range 19-75 years), and there was a female predominance, with women outnumbering men by a ratio of approximately 2:1. Surgical resection was performed in all reported cases, and laparoscopic surgery was reported to be associated with safe outcomes in recent cases [19,22,23,[25][26][27]. Since no patients have been accurately diagnosed preoperatively (including the present case), surgery was performed under diagnoses of cystic lesion of the retroperitoneal and pelvic organs, lymphangioma, teratoma, and infectious disease (e.g., retroperitoneal abscess). ...
Background
Adult cases of retroperitoneal isolated enteric duplication cyst (IEDC) are rare, with only 17 case reports in the relevant literature. We herein present a case, which was characterized by changes in intra-cystic density on computed tomography (CT), which was safely resected by laparoscopic surgery.
Case presentation
The patient was a 60-year-old male who received abdominal CT to investigate the cause of increased serum CA19-9 levels. CT revealed a unilocular cystic mass located in the lower right retroperitoneum. The size increased from 5 to 10 cm in three and a half years and the CT value decreased from 101 Hounsfield Units (HU) to 20 HU. We performed laparoscopic surgical resection, because the possibility that the enlargement of the lesion represented malignant transformation could not be denied. The large cystic mass firmly adhered to the appendix and its mesentery via the retroperitoneum, the appendix was resected en bloc with the cystic lesion. Microscopically, it had no communication with the appendix, and had an intestinal wall structure of muscularis mucosae and muscularis propria. The final pathological diagnosis was IEDC in the retroperitoneal space. There was no histological evidence of malignancy.
Conclusion
When we encounter a retroperitoneal cystic lesion, we should consider the possibility of malignancy to determine the treatment strategy and perform a careful operation without breaking the cyst wall, irrespective of the preoperative diagnosis.
Rationale
Retroperitoneal benign cysts during pregnancy are extremely rare and often remain asymptomatic until they attain a very large size. Diagnosis typically relies on a pathological tissue biopsy. The decision to pursue 1-step or 2-step surgical treatment should be tailored to each individual case rather than generalized.
Patient concerns
This case report presents the unique scenario of a pregnant woman with a confirmed pregnancy complicated by a large retroperitoneal cyst. The patient had a retroperitoneal cyst during her initial pregnancy, which went undetected during the first cesarean section. However, it was identified during her second pregnancy by which time it had grown to 13.0 cm × 15.0 cm × 25.0 cm, and extended from the liver margin to right ovarian pelvic infundibulopelvic ligament. Consequently, it was removed smoothly during her second cesarean section.
Diagnoses
Postoperative pathology results indicated a massive retroperitoneal mucinous cystadenoma.
Interventions
The giant retroperitoneal cyst was smoothly excised during the second cesarean delivery for 1-step surgical treatment.
Outcomes
Under the combined spinal and epidural anesthesia, a live female infant was delivered at 38 3/7 gestational weeks and the neonatal weight was 3200g. Under general anesthesia with endotracheal intubation, the giant retroperitoneal cyst was excised smoothly without complications.
Lessons
The findings of this case report contribute to the understanding of the diagnostic modalities, surgical approaches and postoperative considerations of giant retroperitoneal cysts associated with pregnancy.
