Müllerian cyst of the uterus treated with laparoscopy and diagnosed using immunohistology

Abstract

Among uterine cystic tumors, uterine cyst arising from secondary Müllerian epithelium is exceedingly rare. A 45-year-old woman presented with pelvic cystic mass, which was initially diagnosed as a paraovarian cyst by ultrasound and magnetic resonance imaging. At laparoscopy, the cyst proved to be a pedunculated uterine cyst, which was easily resected. Histologically, the cyst wall was lined by fallopian epithelium and positively stained for WT-1, estrogen receptor, and progesterone receptor. The final diagnosis was Müllerian cyst of the uterus. Preoperative diagnosis of uterine Müllerian cyst is usually impossible. Laparoscopy is useful as a minimally invasive treatment to diagnose and resect the cyst at the same time. Specific immunostaining is useful to make a definite diagnosis of Müllerian cyst of the uterus.

Mullerian cyst of the uterus misdiagnosed as ovarian cyst on pelvic sonography

“…The diagnosis often needs to be confirmed histologically. Mullerian cyst is typically lined by tubal epithelium, and immunohistochemical staining is usually positive to Wilms' tumor gene and estrogen receptors, and negative to CD10 as described in this case . Diagnosis of Mullerian cyst of the uterus can be challenging.…”

“…Careful identification of the normal ovaries and localization of the origin of the cyst during sonographic examination could help in making the correct diagnosis. Other imaging studies such as CT and MRI may also be helpful in selected cases . To the best of our knowledge, there are less than 15 cases of Mullerian cyst of the uterus reported in the literature and none was diagnosed preoperatively.…”

“…During surgery, Mullerian cyst of the uterus usually appears as a lobulated pedunculated cyst arising from the uterine serosa, contains viscous or clear fluid, and can be mistaken as cystic degeneration of leiomyoma . The diagnosis often needs to be confirmed histologically.…”

“…Mullerian cyst of the uterus, also known as endosalpingiosis, is rare and often can be misdiagnosed as adnexal cyst on pelvic sonography. 1 Ovarian and paraovarian cysts are a common condition in gynecology, and thus, Mullerian cyst of the uterus can easily be mistaken as ovarian, paraovarian, and even other intraabdominal tumors. Careful identification of the normal ovaries and localization of the origin of the cyst during sonographic examination could help in making the correct diagnosis.…”

Mullerian duct cyst misdiagnosed as ovarian cyst: a rare case report

“…In another case reported by Nakae et al, a 45-year-old woman presented with pelvic cystic mass, which was initially diagnosed as a paraovarian cyst by ultrasound and magnetic resonance imaging. 5 On laparoscopy, it proved to be a pedunculated uterine cyst which was resected and histology confirmed it to be a Müllerian cyst of the uterus. A similar case like ours has been reported by Datti et al where the patient was taken for exploratory laparotomy for a large ovarian cyst as the diagnosis, but the cyst was a paraovarian cyst; histopathology proved to be a mullerian duct cyst.…”