Large retroperitoneal isolated fibrous cyst in absence of preceding trauma or acute pancreatitis

Our plain-English summary of Large retroperitoneal isolated fibrous cyst in absence of preceding trauma or acute pancreatitis, by J. Ahn, M.D. Chandrasegaram, K. Alsaleh, et al (BMC Surgery, 2015).

The study

• Authors: J. Ahn, M.D. Chandrasegaram, K. Alsaleh, B.L. Woodham, A. Teo, A. Das, N.D. Merrett, C. Apostolou
• Journal: BMC Surgery
• Published: 2015;15:25
• Type of article: Case report
• Cited by: 6 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

Background: Isolated retroperitoneal cystic masses are uncommon with an estimated incidence of 1/5750 to 1/250,000. The majority present with size related symptoms, complications, or a mass. Approximately a third of patients are asymptomatic and are diagnosed incidentally. Aetiologies of retroperitoneal cystic masses (RPC) include mesenteric, omental, splenic and enteric duplication cysts. Neoplastic RPCs can be divided into epithelial (mucinous or serous cystadenoma), mesothelial (mesothelioma), germ cell (cystic teratoma) and cystic changes in a solid neoplasm (paraganglioma, neurilemmoma, sarcoma).

Case Presentation: A 53 year-old man presented to us with abdominal pain related to a large mass in his left upper quadrant with associated anorexia and weight loss. He gave no history of previous trauma and denied having symptoms or a history of pancreatitis. He said he had felt this mass increasing in size over the course of several years. Clinical examination of his abdomen revealed a large firm left sided mass extending to his left upper quadrant. Imaging with computed tomography (CT) and magnetic resonance imaging cholangio-pancreatogram (MRCP) revealed a 13.7 cm × 12.2 cm × 10.9 cm cystic lesion in the retroperitoneum which was separate from the kidney, pancreas, spleen and bowel. At laparotomy, this mass was easily dissected from the surrounding viscera and was excised completely intact. Histopathological assessment found the mass to be a large fibrous pseudocyst with no epithelial lining.

Conclusion: We present a rare case of an isolated large retroperitoneal fibrous pseudocyst unrelated to previous pancreatitis which was successfully managed with surgery.

In plain English

This was a case report from Bankstown Hospital in Sydney, Australia. It described a 53-year-old man with a large cyst at the back of the abdomen (the retroperitoneum). He had four weeks of worsening abdominal pain, loss of appetite and weight loss. The cyst had been found on imaging nine months earlier while he lived overseas. He reported no previous trauma and no history of pancreatitis. CT and MRI scans showed a cystic lesion measuring 13.7 by 12.2 by 10.9 cm. It sat separate from the pancreas, stomach, spleen and left kidney. Surgeons removed the cyst intact, and his recovery was uneventful. His pain after eating and his vomiting resolved. Under the microscope the cyst had no epithelial lining and was a large fibrous pseudocyst. Because the cyst was removed whole, its fluid was not tested for amylase or lipase. The authors concluded that this was a rare case of a large isolated retroperitoneal fibrous pseudocyst unrelated to pancreatitis, managed successfully with surgery. The article does not discuss asbestos. Mesothelioma appears only in a background list of possible causes of such cysts.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: case report (one patient)
• Who was studied: One 53-year-old man treated at Bankstown Hospital, Sydney, Australia. He had a history of hepatitis C and diverticulosis, drank about 20 standard drinks a week, had a 30 pack-year smoking history and smoked marijuana daily.
• Main results:
  • CT and MRCP imaging showed a large retroperitoneal cystic lesion in the left flank, with no septations or enhancement, measuring 13.7 cm by 12.2 cm by 10.9 cm. It appeared separate from the pancreas, stomach, spleen and left kidney.
  • Blood tests in this patient showed an elevated CEA of 9.5 μg/L (reference range under 2.5 μg/L). CA 19.9 and AFP were normal.
  • At operation the cyst was separated from surrounding structures and did not communicate with them. After surgery the patient's pain after eating and his vomiting resolved.
  • Histopathology found no epithelial lining; the cyst was a large fibrous pseudocyst.
• The authors' conclusion: The authors concluded that this was a rare case of an isolated large retroperitoneal fibrous pseudocyst unrelated to previous pancreatitis, successfully managed with surgery.
• Limitations the authors state:
  • The cyst fluid was not tested for amylase or lipase because the cyst was removed intact for pathological assessment.

Topics

Medical terms in this study, explained in our Lexicon: Mesothelioma, Neoplasm, Sarcoma, Retroperitoneum, Laparotomy.

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