Multilocular peritoneal inclusion cyst with extensive xanthogranulomatous stromal changes: a differential diagnosis of cystic pelvic tumors in women

This report presents an unusual case of multilocular peritoneal inclusion cyst with extensive xanthogranulomatous changes in the cyst stroma occurring in a 21-year-old woman. The multicystic tumor was found attached to the mesentery of the terminal ileum. Microscopically, the cystic spaces were lined by flattened to cuboidal cells, which displayed immunoreactivity for cytokeratin but not for factor VIII-related antigen. Large stromal areas contained cholesterol clefts, multinucleated foreign body giant cells, and accumulations of foam cells. The pathogenesis of this multilocular peritoneal inclusion cyst remains obscure. The patient is disease-free 10 years after surgery. The most important differential diagnosis to this case is mature cystic teratoma of the ovary with xanthogranulomatous changes.     

Multilocular peritoneal inclusion cyst--a case report

Multilocular Peritoneal Inclusion Cyst (MPIC) is a rare mesothelial lesion. It is most commonly found in women of reproductive age group involving the abdominal and pelvic peritoneum. Previously, this lesion was often confused with cystic lymphangioma, but now its mesothelial origin has been confirmed. We report a case of a 26-year old female who underwent Caesarean section during which cysts which were multiloculated, thin-walled and filled with serous fluid, were incidentally discovered. Its histopathologic examination established the diagnosis     

Peritoneal benign cystic mesothelioma

A case of a benign cystic peritoneal mesothelioma is reported. A 25-year-old woman presented a 8-year history of recurrent tumor and five operations because of that. On the basis of this case and of 18 cases proved by electron microscopy reported by others, the clinicopathological features and the problems of differential diagnosis are discussed. The ultrastructural examination is essential for the diagnosis of cystic mesothelioma.     

Benign cystic peritoneal mesothelioma.

The well defined but rare entity of benign cystic mesothelioma is reported. The aetiology of this neoplasm remains obscure. The presenting features make a precise preoperative diagnosis difficult; information provided by computed tomography and cytology may help. A firm diagnosis can only come from electron microscopic or immunohistochemical examination of the tumour. Diagnostic accuracy and diligent follow up are essential because, although the tumour is considered benign, it does tend towards local recurrence.     

Multilocular renal cyst

Summary Multilocular renal cyst is an uncommon focal, unilateral, cystic, epithelial lesion of uncertain pathogenesis. Because nephroblastomatous foci have been found on microscopic examination of several of the reported cases, some authors have proposed that multilocular cysts are differentiated and cystic forms of Wilms' tumour. This proposition is analysed and it is concluded that three possibly interrelated lesions may be defined: (1) Wilms' tumours showing cystic differentiation. (2) Lesions macroscopically indistinguishable from multilocular cyst containing variably differentiated nephroblastomatous foci. All such cases have been described in infants. (3) Typical multilocular renal cysts, which have described in children and adults. Review of the literature shows that several cases have been included in the second category solely because of the presence of small intraseptal tubules. Consequent anomalies of interpretation are highlighted and a further case of multilocular cyst in an adult female is reported in which ultrastructural examination, recorded for the first time, confirms the epithelial nature of the cyst lining cells which resemble simplified renal tubular epithelium.     

Multilocular cystic nephroma

The nephroma occurred in a 38-year-old woman, and its sole clinical manifestation was an aching pain in the lumbar region. Angiographic, macroscopic, and light- and electron-microscopic findings are presented. A special feature of the tumor was the presence of secretory granules in its epithelial cells. The possibility of prostaglandin synthesis by the tumor is discussed.     

Multilocular cystic renal cell carcinoma

Multilocular cystic renal cell carcinoma (MCRCC) appears to be a distinct subtype of renal cell carcinoma with characteristic gross and microscopic features. The authors' ten-year experience (1977-1987) included six cases of MCRCC that were followed for a minimum of two years, with neither recurrence nor metastasis observed in any of the cases. During this period, there were 855 urologic procedures for the upper urinary tract, with 256 neoplasms or cysts identified. These included 32 simple cysts, 41 transitional cell carcinomas, 133 renal cell carcinomas, 17 papillary renal cell carcinomas, and 33 miscellaneous tumors. Histologically, the MCRCCs were well-demarcated multicystic lesions containing variably sized aggregates of neoplastic clear cells showing grade 1 nuclear features and little or no mitotic activity. The cyst walls were densely fibrotic, and the lining was often devoid of epithelium. Flow-cytometric analysis performed in five of the six cases with the use of paraffin-embedded tissue showed the tumors to be diploid in all instances, with low proliferative activity. The authors believe that this tumor is a low-grade variant of renal cell carcinoma and should be studied further to determine appropriate therapy.     

多房囊性肾细胞癌一例

患者男,62岁。因体检发现右肾占位于2005年12月9日入院。患者无发热、腰痛、血尿等异常症状。B 超检查发现右肾体积增大,上极实质内见一囊实性包块,向外突起,大小约6.5cm×5.5cm,边界尚清,内可见多条分隔。CT 显示右肾上极有一6.5cm×5.8cm 的类圆形低密度影,CT 值17Hu,加强 CT 值71Hu,内见明显网状分隔。体检:腹部未扪及包块,双肾区无叩痛,双侧输尿管区无压痛。临床诊断为肾肿瘤,行右肾癌根治术,完整切除右肾送病理科检查。病理检查:切除肾脏组织一件,12.5cm×7.0cm×4.0cm,切面肾上极见一5.5cm×4.5cm 肿物,多囊性,内含淡     

多囊性肾透明细胞癌的病理学诊断

目的：探讨多囊性肾透明细胞癌的临床病理特点。方法：对1例多囊性肾透明细胞癌进行了免疫组化染色,并进行文献复习。结果：本例右肾肿物18年。大体见肿物由多发不等的囊腔组成。镜下囊内壁主要由单层立方或柱状上皮被覆,部分为多层并有乳头形成。瘤细胞胞质透亮,无明显异型性。癌细胞免疫表型cytokeratin、CEA和vimentin呈阳性表达。本例诊断为多囊性肾透明细胞癌。结论：多囊性肾透明细胞癌是一种罕见的肾癌病理类型。临床上主要采用根治切除术。本瘤的生物学行为属于低度恶性肿瘤。     

Multicystic peritoneal mesothelioma

A multicystic peritoneal mesothelioma in a 55-year-old man is reported. The large multicystic tumor was only partially removed. 36 months after the first presentation he is still working and his only complaint is abdominal swelling. The light microscopical, immunocytochemical and ultrastructural features are described and differential diagnoses discussed.     

Comparison of laparoscopic and laparotomic surgery for the treatment of peritoneal inclusion cyst

Objectives: Peritoneal inclusion cyst (PIC) is defined as a fluid-filled mesothelial-lined cysts of the pelvis and it is most frequently encountered in women of reproductive age. The treatment options are observation, hormonal management, imaging-guided aspiration, image-guided sclerotherapy and surgical excision. The objective of this study is to compare between the laparoscopic and laparotomic surgery for the treatment of PIC.Methods: Thirty-five patients with laparoscopy and forty-eight patients with laparotomy were included in the study. We compared the perioperative and postoperative data, the complications and the recurrence between the two groups.Results: There was a significantly reduced mean length of the hospital stay, estimated blood loss and complication rate in the laparoscopic group as compared to that of the laparotomic group (P=0.037, P=0.047 and P=0.037 respectively). There was also no statistical difference of recurrence rate between thelaparoscopic and laparotomic groups on the Cox proportional hazards model (p=0.209).Conclusion: Our study showed that laparoscopy was superior to the laparotomy for the mean estimated blood loss, the mean length of the hospital stay and the complication rate except for the recurrence rate.     

Multilocular thymic cyst (MTC) and other tumors with MTC features: Pitfalls in diagnosis

Cystic lesions of the anterior mediastinum represent a well-known group of benign lesions that are relatively common in the general practice, namely in the pediatric age group. In the adult population, multilocular thymic cyst (MTC) plays an important role in occurrence as it presents as a cystic anterior mediastinal mass that clinically may mimic another anterior mediastinal tumor. In general, MTC is of rather unusual occurrence and its histopathological features have been well described in the literature. However, similar histopathological features may also be associated with a gamut of other tumoral conditions that although unrelated may be encountered growing along the walls of these cystic structures. Herein a presentation of the classical MTC and the classical histopathological features of such entity in association with other tumoral conditions will be discussed. It is highly important to underscore that the final interpretation of some of these tumors is based on a thorough evaluation of the cystic lesion and a reasonable sampling for histological evaluation so that the proper interpretation can be reached. Needless to say, the radiological and clinical information of the patients with cystic anterior mediastinal lesions is very important in the final analysis of these cases.