2021, Number 3
Mesothelial cyst of the greater omentum
Full text
10.35366/108575
Language: English/Spanish [Versi?n en espa?ol]
References: 10
Page: 202-204
PDF size: 199.19 Kb.
ABSTRACT
We present the case of a 49-year-old female patient with a history of intraabdominal volume increase of slow and progressive growth. In epigastrium and mesogastrium a mass of approximately 16 cm was palpated, not painful, movable in all directions. The abdominal ultrasound showed a cystic mass. Abdominal computed tomography more accurately determined its origin and location. A programmed midline laparotomy was performed, identifying a multiloculated cyst of 15 × 8 cm located in the greater omentum. We perform complete surgical exeresis. The anatomopathological study reported a multiloculated cyst covered with a simple columnar epithelium of mesothelial type without cellular atypia that rests on a thin layer of fibro-connective tissue, compatible with a simple mesothelial cyst. Postoperative evolution was favorable. Cysts of the greater omentum are infrequent surgical conditions. They should be taken into account as a differential diagnosis in all female patients during the fourth decade of life that presents an increase in intraabdominal volume located in mesogastrium, mobile, slow and progressive growth. The treatment of choice is surgical resection, either conventionally or laparoscopically.INTRODUCTION
Lomentum cysts are rare benign tumors; Garnier published the first case of omentum cysts, and their frequency varies from one in 27,000 to one in 250,000. The highest frequency occurs in the fourth decade of life, although a quarter of the cases are found in children.1
There are many theories to consider regarding the formation of omental cysts; among these is the benign proliferation of ectopic lymphatic tissue and lymphatic obstruction leading to large intraperitoneal cysts. Other causes also include failure of peritoneal sheet fusion, occult trauma, neoplasia, and lymph node degeneration.2,3
Histologically, cysts of mesothelial origin have a lining of flat, cuboidal, or columnar epithelial cells; the wall is fibrous and lacks muscle fibers or lymphoid tissue, which allows differentiation from simple lymphatic cysts.4
PRESENTATION OF THE CASE
We present the case of a 49-year-old woman with a history of intra-abdominal volume increase with slow and progressive growth. Physical examination revealed a mass of approximately 16 cm, smooth surface, defined borders, stiff consistency, did not protrude with the Valsalva maneuver, does not pulsate or expand, is not painful, and is mobile in all directions in the epigastrium and mesogastrium. An abdominal ultrasound showed an intra-abdominal cystic mass with partitions inside, measuring approximately 155 mm, located in the epigastrium and mesogastrium, which was corroborated by contrasted abdominal tomography.
Laparotomy was performed, and a 15 × 8 cm multiloculated cyst located in the greater omentum was found (Figure 1), which was wholly resected without complications (Figures 2 and 3).
The anatomopathological study reported a multiloculated cyst covered by the simple columnar epithelium of mesothelial type without cellular atypia resting on a thin layer of fibroconnective tissue, compatible with a simple mesothelial cyst.
The patient evolved satisfactorily and was discharged five days after surgery with uncomplicated external follow-up at 12 months.
DISCUSSION
According to Bannura G et al.,4 most mesothelial cysts occur in young or middle-aged women who remain stable over time; however, their location is usually within the mesentery and not in the greater omentum. Few cases of omental cysts have been reported in the Japanese literature. In a study by Uramatsu M5 and colleagues, this surgical condition occurs more than 68% of children under ten years of age and more frequently in male patients.
Small cysts are almost always asymptomatic and are detected during a laparotomy performed for another problem, and a palpable abdominal mass sometimes manifests larger cysts. Uncomplicated cysts are usually located in the lower mesogastrium and move freely, have a smooth contour, and are painless.6
Imaging studies, consistent with Kumar S and colleagues, establish the diagnosis.7 The imaging modality of choice is abdominal ultrasonography. Ultrasonography shows a cystic structure, commonly with thin internal septa and sometimes with internal echoes of hemorrhage and infection; these can be confused with large ovarian cysts in women. Abdominal computed tomography adds little information, although it may reveal that the cyst does not arise from another organ such as the kidney, pancreas, or ovary.
The spectrum of presentation depends primarily on the location and size of the cyst. Any complications, including accelerated growth, intracystic hemorrhage, torsion, infection, or rupture, are common indications for surgical excision.8
We agree with other authors that complete resection represents the only correct therapeutic approach.9,10 In 1993, Mackenzie described the first laparoscopic complete resection. The advantages of laparoscopic surgery are well known: respect for the abdominal wall, less postoperative pain, and shorter hospital stay, which results in a significant reduction in costs. In all cases, complete cyst resection is mandatory; conversion to "open surgery" is only necessary when laparoscopic resection is challenging to perform due to the risk of cellular leakage or inadequate treatment, which leads to a higher incidence of relapse.
CONCLUSION
Cysts of the greater omentum are rare surgical conditions. They should be considered a differential diagnosis in any patient during their fourth decade of life who presents an intra-abdominal enlargement in the mobile mesogastrium of slow and progressive growth. The treatment of choice is surgical resection, either conventionally or laparoscopically.
REFERENCES
AFFILIATIONS
1 Assistant Professor. First-degree specialist in General Surgery. General Surgery Service of the "Celia Sánchez Manduley" Teaching Clinical-Surgical Provincial Hospital. Manzanillo, Granma, Cuba.
2 Assistant Professor. Second-degree specialist in General Surgery. General Surgery Service of the "Celia Sánchez Manduley" Teaching Clinical-Surgical Provincial Hospital. Manzanillo, Granma, Cuba.
Ethical considerations and responsibility: the authors declare that they followed the protocols of their work center on the publication of patient data, safeguarding their right to privacy through the confidentiality of their data.
Funding: no financial support was received for this work.
Disclosure: the authors declare no conflict of interest in carrying out the work.
CORRESPONDENCE
Fernando Karel Fonseca-Sosa. E-mail: ffonsecasosa@gmail.comReceived: 08/14/2020. Accepted: 08/03/2021