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Cystic lesions within the peritoneum have been classified classically according to their lining on histology into four categories-endothelial, epithelial, mesothelial, and others (germ cell tumors, sex cord gonadal stromal tumors, cystic mesenchymal tumors, fibrous wall tumors, and infectious cystic peritoneal lesions). In this article, we will pro...
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Objective: This study aims to determine surgical complications and graft outcome in children undergoing renal trans- plantation at Cayetano Heredia National Hospital (CHNH). Materials and Methods: A case study series focused on the incidence of surgical complications and graft outcome in pediatric patients with end stage renal disease (ESRD) who un...
Citations
... Non-pancreatic pseudocysts are rare and intriguing lesions that usually arise from the mesentery and omentum. These captivating lesions are believed to be the liquefied remains of an abscess or hematoma that did not completely heal [1]. Nonpancreatic pseudocysts have been discovered after surgical procedures such as ventriculoperitoneal shunts, major pelvic operations in premenopausal women with visible ovaries within the cysts, and intraperitoneal dialysis catheters-especially after an infection [2]. ...
... They often contain blood, pus, serous fluid, or chylous fluid. Non-pancreatic pseudocysts are usually caused by trauma, surgery, or infections [1]. There have been reports of non-pancreatic pseudocysts occurring after certain surgeries, such as those involving ventriculoperitoneal shunts and intraperitoneal dialysis catheters, especially when there is an infection. ...
... On CT and MRI scans, they appear as cystic masses with thick walls, which may contain fluid with hemorrhagic, pus, or chylous content. MRI can clearly visualize the fatty content of the cyst using frequency selective fat saturation or chemical shift imaging [1]. The typical findings on CT imaging of a nonpancreatic pseudocyst include a thick-walled cystic mass that may contain a fluid-fluid level. ...
Introduction
Non-pancreatic pseudocysts are rare lesions that typically form from the omentum and mesentery. These cysts have a thick fibrotic wall made up of fibrous tissue and may show signs of calcifications and inflammatory changes. The fluid inside them can vary, ranging from hemorrhage and pus to serous or sometimes chylous content. In most cases, these cysts appear as a result of trauma, surgery, or infection.
Case presentation
A 35-year-old male patient from Ethiopia presented with swelling in his lower abdomen that had been present for 2 years. Initially, the swelling was small but gradually increased in size. The patient experienced frequent urination but no pain or difficulty during urination, urgency, intermittent urination, or blood in the urine. The swelling was initially painless but became painful 2 months prior to his presentation. Abdominal computed tomography scans revealed a well-defined, lobulated peritoneal lesion measuring 16 × 12 × 10 cm, consisting primarily of fluid-filled cysts with a thick, enhancing wall and septa. Additionally, there was a large, heterogeneous enhancing soft tissue component measuring 8 × 6 cm. As a result, the cystic mass was surgically removed in its entirety with partial removal of the bladder wall, and the patient was discharged in an improved condition.
Conclusion
Primary non-pancreatic pseudocysts are extremely rare lesions that must be differentiated from other possible causes of cystic lesions within the peritoneal or retroperitoneal regions. Surgeons should be aware of the potential occurrence of these lesions, which may have an unknown origin.
... Lymphangiomas are more typical in the paediatric population and manifest mainly in the neck and axillary region in 75% and 20%, respectively. Retroperitoneal lymphangiomas are <1% and a pancreatic localization is even rarer [4]. ...
... On CT, pancreatic cystic lympangiomas appear as well-defined, homogenous cystic masses with multiple septation which may show enhancement [6]. Microcalcifications because of phleboliths, haemorrhaging content with high attenuation or chyle are uncommon but may be present [4,8]. MRI imaging generally reveal and strengthen US and CT findings. ...
... A cystic mass is observed with multiple septa which are enhanced after gadolinium administration. The cyst is hyperintense in T2 sequence and hypointense in T1 sequence [4,6,8]. Haemorrhage, infection or the presence of chyle may alter the cyst appearance on MRI, adding a solid component in its contents [4,6,8]. ...
Lymphangiomas are rare benign tumours of lymphatic vascular origin. They are more common in the paediatric population and manifest mainly in the neck and axillary region. Retroperitoneal lymphangiomas are <1% and pancreatic origin is even rarer. We present a case of a pancreatic cystic lymphangioma in a 60-year-old woman with chronic diffuse symptoms, diagnosed because of newly onset of diabetes mellitus. She was successfully managed with distal pancreatectomy and spleenectomy en-bloc with the cystic mass without any complications. Cystic lymphangioma of the pancreas is a rare entity presenting with a challenging preoperative diagnosis as imaging modalities may provide ambiguous information. The clinician should be aware of its complicated differential diagnosis and its persistent and subtle symptomatology.
... Ultrasound helps differentiate enteric duplications cysts from mesenteric and omental cysts in the abdomen. [6] The causes of collections are neoplastic, peritonitis, ascites, and hematomas or collections following invasive procedures of the peritoneal cavity. The patient had no previous peritoneal interventions such as peritoneal dialysis or drainage of ascitic fluid. ...
Mesenteric cysts of the abdomen affecting patients of end-stage renal disease (ESRD) are not common. In the absence of symptoms, they may remain undetected unless large in size. When present, the cysts have to be treated by surgical excision. In patients awaiting kidney transplantation, surgery for the cyst can be a potential hindrance in the planning of transplantation as morbidity and mortality of surgery in patients of ESRD is very high. We report a 27-year-old male awaiting kidney transplantation, who presented to us with a large mesenteric cyst. We conducted a simultaneous surgery of mesenteric cyst and kidney transplantation successfully.
... These are often recognized based on relevant clinical history like recent surgery or trauma. (Arraiza et al., 2015) Cystic peritoneal masses may be localized anywhere in the mesentery, from duodenum to rectum, however, these are mostly found in the ileum and right colon mesentery. (Huis et al., 2002) Complete surgical excision of the cyst is usually the treatment of choice, with no recurrence post excision. ...
Background
Primary cystic neoplasms of the peritoneum are rare lesions and not commonly encountered in practice. Many intra-abdominal processes may mimic cystic masses within the peritoneal cavity and pose a diagnostic challenge to both the pathologist and radiologist. Clinical presentation is diverse and varied. These lesions are usually benign. Hence complete surgical excision is the treatment of choice in most of the cases.
Methods
Study design: Descriptive Retrospective study.
Cystic peritoneal lesions were identified and studied from data over a period of 5 years in the Histopathology Section at a tertiary care hospital in Pune, India. Mode of presentation, imaging findings in addition to gross and histopathologic findings of these lesions were studied.
Results
Out of 50 peritoneal lesions studied over a period of 5 years, only 7 were identified to be cystic peritoneal masses.
Of these two were found to be peritoneal cysts, two mesenteric cysts, one an infected mesenteric cyst and one each a mucinous cystadenoma and lymphangioma.
Conclusions
Correct diagnosis rests in the hands of the pathologist and ensures that the patient receives appropriate and timely management. Hence knowledge of the spectrum of these rare cystic peritoneal masses is necessary to distinguish from other potential cystic abdominal mimicker masses and avoid a potential pitfall.
... Peripancreatic cystic lesion, even though rare, pose a great challenge in accurate diagnosis due to morphological overlapping at imaging. 3 The most common cystic lesion in the lesser sac is a pseudocyst, which is seen as unilocular, round or oval shaped cystic lesion. 4 5 These patients usually give history of acute or chronic pancreatitis. ...
... Other differential diagnosis for a calcified cystic lesion in lesser sac are hydatid cyst, cystic neoplasm of pancreas, lymphangioma and teratoma. 3 Echinococcal cyst in the lesser sac is rare, and presents as a rim like calcification, ...
Pseudocysts are localised fluid collections, usually developing as a complication of acute or chronic pancreatitis. Pancreatic ductal or parenchymal calcifications are commonly seen in routine radiological imaging, but calcification of pseudocyst is extremely rare. Calcified pseudocysts have been reported in literature as case reports, but a calcified pseudocyst in the lesser sac, without underlying pancreatic calcification, has not been reported. We report a case of a pancreatic pseudocyst with a calcified wall, requiring surgical excision and histological examination confirming the diagnosis.
... At imaging, they appear as unilocular cysts with a fluid-fluid level composed of nondependent chyle (Fig 2). When assessing with real-time US, the contents can be mixed by shaking or moving the patient, with reformation of the fluid-fluid Figure E1.) septa (Fig 3, Fig E1) (6,11). Calcifications are rare (11). ...
... It can mimic a solid lesion at noncontrast examinations. Lymphangiomas are locally infiltrative and tend to grow slowly along tissue planes (6). Because they can be insinuated between bowel loops, they might be mistaken for ascites; however, the presence of septa, mass effect on bowel loops, and lack of fluid in dependent recesses can offer important clues to make the distinction (Fig 3) (6). ...
... Pathologically, a lymphangioma is a thinwalled cystic mass with a yellow external surface and thin internal septa dividing the mass into multiple irregular spaces of varying size (Fig 3). The fluid contents are predominantly chylous but may be serous or hemorrhagic ( Fig E1) (6,12). They consist of endothelium-lined spaces surrounded by a connective tissue stroma of varying thickness containing lymphoid tissue and occasionally smooth muscle (Fig 3) (11). ...
Cystic lesions found in and around the peritoneal cavity can often be challenging to diagnose owing to significant overlap in imaging appearance between the different entities. When the cystic lesion can be recognized to arise from one of the solid abdominal organs, the differential considerations can be more straightforward; however, many cystic lesions, particularly when large, cannot be clearly associated with one of the solid organs. Cystic lesions arising from the mesentery and peritoneum are less commonly encountered and can be caused by relatively rare entities or by a variant appearance of less-rare entities. The authors provide an overview of the classification of cystic and cystic-appearing lesions and the basic imaging principles in evaluating them, followed by a summary of the clinical, radiologic, and pathologic features of various cystic and cystic-appearing lesions found in and around the peritoneal cavity, organized by site of origin. Emphasis is given to lesions arising from the mesentery, peritoneum, or gastrointestinal tract. Cystic lesions arising from the liver, spleen, gallbladder, pancreas, urachus, adnexa, or soft tissue are briefly discussed and illustrated with cases to demonstrate the overlap in imaging appearance with mesenteric and peritoneal cystic lesions. When approaching a cystic lesion, the key imaging features to assess include cyst content, locularity, wall thickness, and presence of internal septa, solid components, calcifications, or any associated enhancement. While definitive diagnosis is not always possible with imaging, careful assessment of the imaging appearance, location, and relationship to adjacent structures can help narrow the differential diagnosis. Online supplemental material is available for this article. ©RSNA, 2021.
... Mesenteric cysts are classified as mesothelial and omental cysts, lymphatic cysts, cysts with solid components (e.g. malignant cysts), infections and infestations (hydatid, tuberculosis and others), pseudocysts (pancreatic and non-pancreatic), enteral, urothelial cysts, teratomas and urachal cysts [5,6]. The case under study was a solitary cyst free from adjoining structures, having no solid components. ...
... In the absence of communication either with the urinary bladder, umbilicus or the anterior abdominal wall, a urachal cyst can be ruled out [6]. Lymphatic cysts are rarely solitary, may have septa, could insinuate between tissues precluding a complete excision, may have milky chylous fluid or debris, imaging may show enhancement of the cyst wall and histopathology would show clear spaces with lymphatic elements [5,6]. ...
... In the absence of communication either with the urinary bladder, umbilicus or the anterior abdominal wall, a urachal cyst can be ruled out [6]. Lymphatic cysts are rarely solitary, may have septa, could insinuate between tissues precluding a complete excision, may have milky chylous fluid or debris, imaging may show enhancement of the cyst wall and histopathology would show clear spaces with lymphatic elements [5,6]. A pseudocyst is associated with infections or trauma [6]. ...
This is a report of a rare case of an infarcted pelvic intra-abdominal cyst, having no mesenteric connection presenting as an acute abdomen. The patient had significant asbestos exposure. The cyst was treated successfully by surgical excision. Histopathology showed an infarcted cyst; the lining was destroyed, precluding marker studies. A diagnosis of benign cystic peritoneal mesothelioma (BCPM) was made by excluding other causes of solitary pelvic intra-abdominal cysts. BCPM has been classified as an asbestos-related neoplasm and is usually seen in the pelvis adjunct to the urinary bladder. One-year post-surgery, there was no recurrence. The case report shows that infarcted pelvic mesothelial cysts can present as an acute abdomen and can be treated successfully by total excision with no recurrence.
... It is generally reported that PMP peritoneal implants are cystic lesions (17,18). However, one case report showed that PMP could also manifest as a cystic-solid mass (19). ...
Background:
Because few studies have focused on the correlation between computed tomography (CT) signs and tumor grade in pseudomyxoma peritonei (PMP), we evaluated predictive value of abdominal enhanced CT in identifying high- vs. low-grade cases.
Methods:
In all, 75 patients diagnosed with PMP after surgery were consecutively recruited. The preoperative enhanced CT images were retrospectively analyzed for ascites, hepatic scalloping, omental and peritoneal lesion appearance, intralesional calcification and septa, and peripheral organ involvement. Logistic regression models were applied to analyze the relationship of CT signs with PMP grade. Receiver operating characteristic curves were generated to evaluate the potential utility of CT signs in detecting high-grade PMP.
Results:
Massive ascites (P=0.017) and peritoneal solid nodules (P<0.001) were more common in high-grade cases. Multivariate logistic regression identified massive ascites [odds ratio (OR) =4.389, 95% confidence interval (CI): 1.210-15.921; P=0.025] and peritoneal solid nodules (OR =19.932, 95% CI: 3.560-111.596; P<0.001) as independent predictors of high-grade PMP. For the 55 patients with hepatic scalloping, the maximum thickness of mucin deposition at the hepatic scalloping wave in high-grade PMP was thinner than that in low-grade PMP (P=0.021). Thickness of mucin deposition at the hepatic scalloping wave (OR =0.346, 95% CI: 0.148-0.809; P=0.014) was an independent predictor of high-grade PMP, with a cutoff value of 18.6 mm. Cancer antigen 125 (CA125) combined with CT signs was significantly better at diagnosing high-grade PMP than was CA125 alone in both the overall patients [area under the ROC curve (AUC): 0.812 vs. 0.656; P=0.020] and those with hepatic scalloping (AUC: 0.859 vs. 0.600; P=0.007).
Conclusions:
The CT signs of high-grade PMP significantly differ from those of low-grade PMP, and thus combining CT signs with CA125 may be highly valuable for classifying PMP.
... Although, the primary tumor appears heterogeneous, it can enhance homogenously. (Fig. 3) [2,13,[15][16][17]. Although both MRI and CT can estimate peritoneal carcinomatosis index accurately, MRI is superior in predicting tumor burden [18]. ...
... Mesothelial cysts have serous fluid within them and can also be found on mesentery and mesocolon as well as the small bowel (Fig. 15). Lymphangiomas are benign proliferations of lymphatic tissue occurring among all age groups, however, are commonly present in children [2,15,94,95]. ...
... Lymphangiomas are multilocular, thin-walled with septations and can reveal debris as a fluid-fluid level, but are more commonly anechoic. Similarly, enteric and mesothelial cysts are benign, thin-walled, smooth cysts without septations (Fig. 16), however, they can show focal wall calcifications [2,15,96,97]. ...
Mesenteries are extensions of the visceral and parietal peritoneum consisting of fat, vessels, nerves, and lymphatics. Mesenteric masses have a wide differential diagnosis with neoplastic, infectious, or inflammatory etiologies and can either be solid or cystic. Imaging features are critical for the diagnosis. We review the epidemiology, imaging spectrum, and differentiating features and treatment of mesenteric masses.
... 7A), nonpancreatic pseudocyst, and hydatid cyst need to be considered. 18,22 Nonpancreatic pseudocysts (►Fig. 7B, C) appear as thick walled septate lesions which may contain hemorrhage or pus. ...
The mesentery and its folds tether the small bowel loops to the posterior abdominal wall. It transmits nerves, vessels, and lymph ensconced in a fatty sponge layer wrapped in a thin glistening peritoneum, from and to the small bowel. Not only does this flexible dynamic fatty apron house various localized primary benign and malignant lesions, it is often involved in and gives an indication of generalized or systemic diseases in the body. An understanding of the anatomy, components, and function of the mesentery helps to classify mesenteric abnormalities. This further allows for characterizing radiological patterns and appearances specific to certain disease entities. Recent reviews of mesenteric anatomy have kindled new interest in its function and clinical applications, heralding the possibility of revision of its role in diseases of the abdomen.
