{"paper_id":"dcc1cf78-1a01-4b64-b03e-ef967354ea29","body_text":"WWW.KJOG.ORG 683\nA CASE OF MESENTERIC CYST CONFUSED WITH \nOVARIAN ENDOMETRIOMA\nSe Ik Kim, MD\n1\n, Young Dae Kim, MD\n1\n, Hye Seung Lee, MD, PhD\n2\n, Byung Chul Jee, MD, PhD\n3,4\n1\nDepartment of Obstetrics and Gynecology, Seoul National University Hospital, Seoul; \n2\nDepartment of Pathology, Seoul National University Bundang Hospital, \nSeongnam; \n3\nDepartment of Obstetrics and Gynecology, Seoul National University Bundang Hospital, Seongnam; \n4\nDepartment of Obstetrics and Gynecology, Seoul \nNational University College of Medicine, Seoul, Korea\nMesenteric cysts are usually not considered in the differential diagnosis of pelvic cystic masses. The more common considerations \nfor pelvic cystic masses include ovarian cysts such as, endometrioma, dermoid cyst, and other neoplasm. Here we report a case \nof 15-year-old girl with pelvic cystic mass; it was initially thought to be ovarian endometrioma, but the operative and histologic \nfindings revealed a mesenteric cyst. \nKeywords: Mesenteric cyst; Ovarian cyst; Pelvic; Endometrioma\nReceived: 2012.5.25.   Revised: 2012.7.10.   Accepted: 2012.7.10.\nCorresponding author: Byung Chul Jee, MD, PhD\nDepartment of Obstetrics and Gynecology, Seoul National \nUniversity Bundang Hospital, Seoul National University College of \nMedicine, 300 Gumi-ro, Bundang-gu, Seongnam 463-707, Korea\nTel: +82-31-787-7254  Fax: +82-31-787-4054\nE-mail: blasto@snubh.org\nThis is an Open Access article distributed under the terms of the Creative Commons \nAttribution Non-Commercial License (http://creativecommons.org/licenses/\nby-nc/3.0/) which permits unrestricted non-commercial use, distribution, and \nreproduction in any medium, provided the original work is properly cited.\nCopyright © 2012. Korean Society of Obstetrics and Gynecology \nMesenteric cysts are rare disease and usually not considered in \nthe differential diagnosis of pelvic cystic masses. Since most mes -\nenteric cysts are usually asymptomatic, they tend to be diagnosed \nincidentally during imaging tests or surgery [1]. In order to exclude \nmalignant transformation and prevent further complications, large \nmesenteric cysts are recommended to be removed. Complete sur -\ngical resection is the treatment of choice with the excellent long‐\nterm prognosis [2].\nHere we report a case of incidental mesenteric cyst, which was \nconfused with ovarian endometrioma in preoperative assessment.\nCase Report\nA 15-year-old girl presented with history of irregular menstruation \nand an incidental pelvic cystic mass. The patient did not complain \nof dysmenorrhea, and denied sexual activity. The past medical his-\ntory was unremarkable.\nLaboratory tests including complete blood cell count and renal \nand liver function tests were all normal, except slightly increased \nalanine aminotransferase (ALT) (68 IU/L). The level of CA-125, CA-\n19-9, and carcinoembryonic antigen were 20.6 IU/mL, 0.6 IU/mL, \nand 1.9 ng/mL, respectively (all were within normal range). \nIn computed tomographic scan (CT), the cystic mass was \n10.5 × 7.9 × 7.6 cm sized, unilocular shaped, and had relatively \nthick and prominent wall. It was supposed that the cyst doesn’t \ncontain fat component or calcified materials. The origin of cystic \nmass was supposed to be her right ovary (Fig. 1). In addition, con-\nsidering its homogeneously hypoechoic cyst fluid and thick wall \nin ultrasonogram (Fig. 2), the cystic mass was thought to be right \novarian endometrioma.\nBased on the clinical impression of an ovarian endometrioma, \nlaparoscopic approach was planned to perform right ovarian cys -\ntectomy. During the operation, it was confirmed that the origin of \nthe cystic mass was not ovary, but mesentery (Fig. 3A). Both ova -\nries were intact (Fig. 3B).\nTo define and make delicate resection, surgical approach was \nCASE REPORT\nKorean J Obstet Gynecol 2012;55(9):683-686\nhttp://dx.doi.org/10.5468/KJOG.2012.55.9.683\npISSN 2233-5188 · eISSN 2233-5196\n\nWWW.KJOG.ORG684\nKJOG  Vol. 55, No. 9, 2012\nchanged into laparotomy. Examining bowel and mesentery, it was \nconfirmed that the cystic mass was originated from mesentery \nwhich was 50 cm above ileocecal valve. It was surgically removed, \nclearly. Exploration of jejunum, ileum, cecum, and appendix was \nfollowed, and intactness was confirmed. The postoperative recov -\nery was uneventful.\n1. Histopathology\nExamination of the specimen showed a cyst filled with mucoid \nfluid. The cyst was lined by respiratory epithelium and focal squa -\nmous epithelium with glandular structure. Disoriented smooth \nmuscle wall was also observed (Fig. 4). Combining these features, \nthe cyst was consistent with enterogenous cyst, and the diagnosis \nof mesenteric cyst was made.\nDiscussion\nMesenteric cysts are rare intra-abdominal disease, identified in \nabout 1 out of 100,000 admissions in adults and 1 out of 20,000 \nin children [1]. Mesenteric cysts are known to occur in every part \nof mesentery, and the most common site is small bowel mesentery \n(ileum in 60%) and next is mesocolon (ascending colon in 40%). \nAlthough etiology and classifications are still controversial, mes -\nenteric cysts are clinically divided into 6 groups based on histo -\npathological features: lymphatic origin; mesothelial origin; enteric \norigin; urogenital origin; mature cystic teratoma; nonpancreatic \npseudocysts with traumatic or infectious origin [2].\nMost mesenteric cysts are asymptomatic; therefore correct diagno-\nsis is difficult and incidentally diagnosed during imaging tests or \nsurgery in many cases. Disease-related symptoms include abdomi -\nnal distension, pain, and/or palpable abdominal lumps [3]. Some \npatients can develop acute abdomen in case of complicated cysts, \nsuch as infection, hemorrhage, torsion, rupture, or bowel obstruc -\nFig. 1. Computed tomography images showed a unilocular shaped cystic mass without fat and/or calcification. Its origin was supposed to be right \novary.\nFig. 2.  Trans-abdominal ultrasonogram showed homogeneously hy -\npoechoic feature of cystic mass.\n\nWWW.KJOG.ORG 685\nSe Ik Kim, et al. A case of mesenteric cyst\nFig. 4. Microphotographs. (A) Cyst wall on low grade magnification. (B-D) Lined by respiratory epithelium (black arrow and C) and focal squamous epi-\nthelium (gray arrow) with glandular structure (white arrow and D). Disoriented smooth muscle wall was also observed (star). (A, ×10; B-D, ×200, H&E \nstain). \nA  B\nC  D\nFig. 3. Intra-operative findings. (A) The origin of cystic mass was mesentery. (B) Both ovaries were intact. \nA  B\n\nWWW.KJOG.ORG686\nKJOG  Vol. 55, No. 9, 2012\ntion [4-6],\nIn diagnosis of mesenteric cysts, ultrasonography is the first-line \ndiagnostic method [7]. Other image modalities including plain \nabdominal radiographs, gastrointestinal study using barium, CT, \nand magnetic resonance imaging (MRI) could be used in selected \npatients. Especially, CT and MRI could be more informative in \nmeasuring the exact extension and association with bowels [8]. \nHowever, if a mesenteric cyst locates within the pelvic cavity, as \nlike our case, it may be misdiagnosed as an ovarian cyst [9]. \nIt has been recommended that large mesenteric cysts are removed \nin order to exclude malignant transformation and prevent further \ncomplications [2]. The treatment of choice is complete surgical \nresection, and sometimes it may need bowel resection. A relation \nof the mesenteric cyst with the major abdominal vessels should be \nconsidered, and if needed, careful and accurate dissection should \nbe performed. Furthermore, there is one case report documenting \nsuccessful excision of the mesenteric cyst by laparoscopic opera -\ntions. Laparoscopy is regarded as a feasible method in selected \npatients [10].\nHere we report a case of mesenteric cyst confused with ovarian \nendometrioma. The patient showed irregular menstruations only, \nand no other specific symptoms were noted. By the images, a \npelvic cystic mass was founded incidentally. In practice, mesenteric \ncysts are usually not considered in the differential diagnosis of \npelvic cystic masses. The more common considerations for pelvic \ncystic masses include ovarian cysts such as, endometrioma, der -\nmoid cyst, and neoplasm. Thus we suggest that mesenteric cysts \nshould also be considered in the differential diagnosis of pelvic \ncystic masses.\nReferences\n  1. Vanek VW, Phillips AK. Retroperitoneal, mesenteric, and \nomental cysts. Arch Surg 1984;119:838-42.\n  2. de Perrot M, Bründler M, Tötsch M, Mentha G, Morel P . Mes-\nenteric cysts. Toward less confusion? Dig Surg 2000;17:323-8.\n  3. Egozi EI, Ricketts RR. Mesenteric and omental cysts in chil -\ndren. Am Surg 1997;63:287-90.\n  4. Fitoz S, Atasoy C, Ekim M, Yildiz S, Erden A, Aktug T. Torsion \nof a giant omental cyst mimicking ascites. J Clin Ultrasound \n2007;35:85-7.\n  5. Ozdoğan  M. Acute abdomen caused by a ruptured spon -\ntaneously infected mesenteric cyst. Turk J Gastroenterol \n2004;15:120-1.\n  6. Kim EJ, Lee SH, Ahn BK, Baek SU. Acute abdomen caused by \nan infected mesenteric cyst in the ascending colon: a case re -\nport. J Korean Soc Coloproctol 2011;27:153-6.\n  7. Mihmanli I, Erdogan N, Kurugoglu S, Aksoy SH, Korman U. Ra-\ndiological workup in mesenteric cysts: insight of a case report. \nClin Imaging 2001;25:47-9.\n  8. Okur H, Küçükaydin M, Ozokutan BH, Durak AC, Kazez A, Köse \nO. Mesenteric, omental, and retroperitoneal cysts in children. \nEur J Surg 1997;163:673-7.\n  9. Long CY , Wang CL, Tsai EM. Incidental diagnosis of a mes -\nenteric cyst mimicking an ovarian cyst during laparoscopy. \nTaiwan J Obstet Gynecol 2011;50:388-9.\n10. Tebala GD, Camperchioli I, Tognoni V, Noia M, Gaspari AL. \nLaparoscopic treatment of a huge mesenteric chylous cyst. \nJSLS 2010;14:436-8.\n자궁내막종으로 오인한 장간막낭 1예\n1서울대학교병원 산부인과, 2분당서울대학교병원 병리과, 3분당서울대학교병원 산부인과, 4서울대학교 의과대학 산부인과학교실\n김세익1, 김영대1, 이혜승2, 지병철3,4\n  장간막낭은 드물고, 통상적으로 여성 골반강 낭성 종괴의 감별진단에 있어 고려되지 않고 있다. 본 저자들은 15세 여환의 골반강 낭성 \n종괴를 난소의 자궁내막종으로 오인한 장간막낭 1예를 경험하였기에 간단한 문헌고찰과 함께 보고하는 바이다.\n중심단어: 장간막낭, 난소낭, 골반강, 자궁내막종","source_license":"CC0","license_restricted":false}