Intradiaphragmatic Mesothelial Cysts

Abstract

Primary tumours and cysts of the diaphragm are rare. In a review of the literature Clagett and Johnson (1949) were able to record 30 cases, to which they added four of their own. Of these cases, 18 were malignant and 16 were benign.Primary cysts constituted only a very small proportion of the cases, and in recording a case of mesothelial cyst of the diaphragm Aufses and Oseasohn (1949) stated that they were only able to find records of five other primary cysts in the literature.We have recently encountered a case of mesothelial diaphragmatic cyst; a second almost identical case which was under the care of Mr. Geoffrey Flavell, of the London Hospital, is also reported by his courtesy.CASE REPORTS Case 1.-W. B., a man aged 41, was radiographed when a mass radiography unit visited the factory in which he worked. He had no complaints. Radiographs (Figs. 1 and 2) revealed a small rounded opacity associated with the antero-medial part of the right diaphragm. A diagnostic pneumoperitoneum was carried out as it was thought that the most likely diagnosis was a small liver hernia, and this demonstrated clearly (Fig. 3) that the lesion was in or above the diaphragm, the former appearing more likely, as the outline of the diaphragm appeared to enfold the tumour. As no precise diagnosis could be established, thoracotomy was advised and accepted.On October 31, 1950, the right chest was opened through the bed of the seventh rib. The pleura was completely free of adhesions. In the anterior part of the diaphragm about two inches from the anterior chest wall and from the pericardium lay a tense, bluish cyst, the size of a hen's egg, covered by diaphragmatic pleura and having muscle fibres of diaphragm splayed out over it. The overlying pleura was incised and the cyst shelled out without difficulty, leaving a defect some 2 in. in diameter in the diaphragmatic musculature, in the floor of which intact peritoneum was visible. This defect was closed with interrupted silk sutures and the chest closed without drainage. The postoperative course was uneventful, the patient being discharged home on the tenth day.Dr. G. R. Osborn reported that the cyst from the diaphragm measured about 2 cm. in diameter. Microscopically it was of the simple chylous type; the lumen was lined with a single layer of endothelial cells which occasionally had rudimentary papillary projections. Outside this there was a little areolar connective tissue and then skeletal muscle fibres from the diaphragm.

Report of an incidental finding of a congenital intradiaphragmatic cyst in an adult and a critical review of the literature

“…An incidental cyst is much more likely, therefore, to be seen on the right. It is less easy to explain why the cysts are described in children as more commonly involving the posterolateral aspect of the hemidiaphragm as opposed to other sites particularly as this position does not appear to be more common in adults [1] , [2] , [10] .…”

“…Intrathoracic mesothelial cysts are recognized as being congenital defects thought to arise within the pleuro-peritoneal membrane during embryological development of the lung bud [1] , [2] and most commonly occur in the right or left anterior cardiophrenic angle although they may occur elsewhere [2] . An intradiaphragmatic location is exceptionally rare and there are only a few reports in the literature most of which are descriptions of 1 or 2 patients in whom surgical resection was performed because of concerns regarding the nature of the abnormality [1] , [3] , [4] , [5] , [6] . The majority of these reports conclude that imaging cannot safely exclude a malignant lesion and that resection is mandatory.…”

“…The fact that no left diaphragmatic mesothelial cysts were demonstrated in any of these articles was not discussed despite the fact that left-sided mesothelial cysts are described in adults. What is more, there is no embryologic reason why they should only occur on one side [1] , [2] . Perhaps the most likely explanation for the apparent exclusive right diaphragmatic involvement is that cysts occur with equal frequency on both sides but are more commonly visualized on the right because the hemidiaphragm on this side is easily seen during ultrasound due to its intimate relationship to the liver whilst that on the left is poorly visualized due to the adjacent stomach.…”

Mesothelial cyst derived from chest wall pleura growing after thoracic surgery: a case report

“…Pericardial cysts are thought to be formed by a failure of fusion during pericardial sac formation [3]. Most atypically located mesothelial cysts were explained embryologically, except for cysts arising from the chest wall [4]. Therefore, the mechanism for extramediastinal mesothelial cysts may differ from the mechanism for pericardial cysts.…”

Abolition, Economic Transition, Gender and Slavery: The Expansion of Women's Slaveholding in Ghana, 1807–18741

“….slaves were being annually imported' into the Gold Coast from Asante. 57 The result of the disequilibrium in demand and supply was the availability of large numbers of slaves at cheaper prices. Due to this market situation, Manning says, 'slaves came within the purchasing power' of many African buyers.…”