Navarro Fernando, Schmieler Eric, Beversdorf Walter
University Specialty Clinics, Dept. of Surgery 2 Medical Park, Suite 306,Columbia, SC 2920, United States.
University of South Carolina School of Medicine, United States.
Int J Surg Case Rep. 2017;30:155-158. doi: 10.1016/j.ijscr.2016.11.013. Epub 2016 Nov 15.
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].
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 4×2cm 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.
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.
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.
肠系膜和网膜间皮囊肿较为罕见，在因腹痛入院的患者中仅占十万分之一（Tan Jane等人，2009年）[1]。它们通常仅在CT成像时被发现，由于其影像学特征与其他肿块重叠，在确定确切的组织来源方面往往不明确（Stoupis等人，1994年）[2]。此类肿块表现出的症状也不具有特异性，在鉴别诊断中，相较于囊性肿块，更倾向于考虑普通外科中更常见的问题。本例间皮囊肿的确诊是通过对手术切除标本进行组织病理学检查得出的。本病例报告符合SCARE标准（Dragoslav等人，2007年）[6]。
一名41岁男性患者因数天的腹痛伴恶心、呕吐就诊于一家学术教学医院。初步检查无异常，腹部CT显示肠系膜中央有炎症病灶。血清奥曲肽、5-羟吲哚乙酸和嗜铬粒蛋白A正常排除了神经内分泌肿瘤。通过腹腔镜检查发现并切除了一个4×2cm的肿块。标本的组织病理学诊断为梗死性间皮囊肿。患者报告症状缓解，最近一次随访时情况良好。
腹腔内囊性肿块因其罕见性、非特异性症状以及此类肿块之间重叠的影像学特征，难以快速诊断（Stoupis等人，1994年）[2]。症状的病因可能是囊肿对周围组织产生的局部肿块效应。切除此类囊肿后症状持续缓解支持了这一结论。
对该患者腹痛进行全面的体格检查和实验室检查后进行的影像学检查，指导了我们对腹腔内囊性肿块进行手术切除的进一步检查和管理工作。囊肿的组织病理学检查最终诊断为梗死性间皮囊肿。
