A case of mesenteric cyst confused with ovarian endometrioma

Abstract

Mesenteric cysts are usually not considered in the differential diagnosis of pelvic cystic masses. The more common considerations for pelvic cystic masses include ovarian cysts such as, endometrioma, dermoid cyst, and other neoplasm. Here we report a case of 15-year-old girl with pelvic cystic mass; it was initially thought to be ovarian endometrioma, but the operative and histologic findings revealed a mesenteric cyst.Keywords: Mesenteric cyst; Ovarian cyst; Pelvic; Endometrioma Received: 2012.5.25. Revised: 2012.7.10. Accepted: 2012.10. Corresponding author: Byung Chul Jee, MD, PhD Department of Obstetrics and Gynecology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, 300 Gumi-ro, This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/ by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. Copyright © 2012. Korean Society of Obstetrics and GynecologyMesenteric cysts are rare disease and usually not considered in the differential diagnosis of pelvic cystic masses. Since most mesenteric cysts are usually asymptomatic, they tend to be diagnosed incidentally during imaging tests or surgery [1]. In order to exclude malignant transformation and prevent further complications, large mesenteric cysts are recommended to be removed. Complete surgical resection is the treatment of choice with the excellent longterm prognosis [2]. Here we report a case of incidental mesenteric cyst, which was confused with ovarian endometrioma in preoperative assessment. Case ReportA 15-year-old girl presented with history of irregular menstruation and an incidental pelvic cystic mass. The patient did not complain of dysmenorrhea, and denied sexual activity. The past medical history was unremarkable. Laboratory tests including complete blood cell count and renal and liver function tests were all normal, except slightly increased alanine aminotransferase (ALT) (68 IU/L). The level of CA-125, CA-19-9, and carcinoembryonic antigen were 20.6 IU/mL, 0.6 IU/mL, and 1.9 ng/mL, respectively (all were within normal range). In computed tomographic scan (CT), the cystic mass was 10.5 × 7.9 × 7.6 cm sized, unilocular shaped, and had relatively thick and prominent wall. It was supposed that the cyst doesn't contain fat component or calcified materials. The origin of cystic mass was supposed to be her right ovary (Fig. 1). In addition, considering its homogeneously hypoechoic cyst fluid and thick wall in ultrasonogram (Fig. 2), the cystic mass was thought to be right ovarian endometrioma. Based on the clinical impression of an ovarian endometrioma, laparoscopic approach was planned to perform right ovarian cystectomy. During the operation, it was confirmed that the origin of the cystic mass was not ovary, but mesentery (Fig. 3A). Both ovaries were intact (Fig. 3B). To define and make delicate resection, surgical appr...

A huge mesenteric teratoma in reproductive age woman: a case report

“…Mesenteric cysts are one of the very rare entities with incidence of 1 in 1,00,000 to 1 in 2,50,000 admissions. 1,2 Mesenteric dermoid cyst are even rarer. 3 Dermoid cysts, which are also known as mature cystic teratoma's are the most common primary ovarian neoplasm accounting for 15-20% of total ovarian malignancy.…”