Mucinous cystic neoplasms of the mesentery: a case report and review of the literature

Abstract

Background: Mucinous cystic neoplasms arise in the ovary and various extra-ovarian sites. While their pathogenesis remains conjectural, their similarities suggest a common pathway of development. There have been rare reports involving the mesentery as a primary tumour site.

Case presentation: A cystic mass of uncertain origin was demonstrated radiologically in a 22 year old female with chronic abdominal pain. At laparotomy, the mass was fixed within the colonic mesentery. Histology demonstrated a benign mucinous cystadenoma.

Methods and results: We review the literature on mucinous cystic neoplasms of the mesentery and report on the pathogenesis, biologic behavior, diagnosis and treatment of similar extra-ovarian tumors. We propose an updated classification of mesenteric cysts and cystic tumors.

Conclusion: Mucinous cystic neoplasms of the mesentery present almost exclusively in women and must be considered in the differential diagnosis of mesenteric tumors. Only full histological examination of a mucinous cystic neoplasm can exclude a borderline or malignant component. An updated classification of mesenteric cysts and cystic tumors is proposed.

Figure 1

(a, b): MR scan appearance of the cystic tumour (arrow).

Figure 2

Intra-operative appearance, medial view of the mesentery, inferion mesenteric vessels lying on the cyst surface.

Figure 3

Lateral view of mesentery, cyst enucleation in an avascular plane.

Figure 4

Microscopic appearance of the cyst wall, ovarian like stroma, epithelial lining.

Figure 5

Benign columnar mucinous epithelium lining of the cyst wall. Immunohistochemistry reveals stromal positivity for actin.

Figure 6

Immunohistochemistry, epithelial positivity for CK 7.

Figure 7

Immunohistochemistry, epithelial positivity for CA-125.