Giant Mesenteric Cyst: A Case Report And Review Of The Literature

摘要

We present a case of a giant mesenteric cyst successfully removed surgically. The rarity of such mesenteric cysts makes them difficult to diagnose clinically and pathologically. Simple mesenteric cysts need to be distinguished from lymphangiomas, hemangiomas, pancreatic pseudocysts, endometriomas, loculated ascites, peritoneal inclusion cysts (cystic mesothelioma), cystic mesenteric panniculitis, hydatid cysts, cystic teratomas and urogenital cysts of the mesentery. Complete enucleation of these cysts is considered the procedure of choice, to prevent complications, recurrence and possible malignant transformation. CASE REPORT A 39-year-old otherwise healthy man presented to hospital because of an increasing abdominal girth, which he attributed to merely getting fat. He experienced abdominal discomfort only late in his presentation. On examination, his abdomen was significantly distended, non-tender to palpation and dull to percussion. A fluid thrill could be elicited through his abdomen. A computerized tomographic (CT) scan revealed a large intra-abdominal cyst, with thin intracystic septations (figure 1). The cyst had displaced his bowel throughout the entire abdomen and extended inferiorly into his pelvis. Intraoperatively, it was found to be intimately associated with his mesentery. Grossly, the multicystic mass was tan in color, measured 23 x 15 x 3 cm and contained approximately five liters of serous fluid. There were no papillary excrescences or areas of hemorrhage and necrosis identified. Microscopically, the fibrous wall contained sparse, scattered reactive lymphocytes and was lined focally by cuboidal to attenuated epithelium. The epithelial cells were immunoreactive with low- and high-molecular weight cytokeratins, but failed to stain with factor VIII (figure 2).