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1.  Pediatric chylolymphatic mesenteric cyst - a separate entity from cystic lymphangioma: a case series 
Introduction
Chylolymphatic mesenteric cysts are rare entities with variable presentations and this has surgical implications in the pediatric age group.
Case presentation
We carried out a retrospective analysis of the clinical and histopathological records of pediatric patients diagnosed and treated for chylolymphatic mesenteric cysts at our institute from 1998 to 2008. Eight patients met the histopathological criteria of chylolymphatic mesenteric cyst. These patients were in the age range 18 months to 10 years with a mean age of 4.5 years. Of these eight patients, four presented with an abdominal lump, and two each with abdominal pain and acute intestinal obstruction. On clinical examination, five out of the eight patients had a palpable abdominal mass. Laparotomy and complete excision of the cyst along with the involved gut was performed in all patients. There were no postoperative complications or any recurrence during the follow-up period which ranged from 4 months to 8 years.
Conclusion
Although very rare, chylolymphatic mesenteric cyst should be kept in mind as one of the differential diagnoses of cystic masses of the abdomen including cystic lymphangioma. Ultrasonography and computed tomography suggest the diagnosis but histopathological examination is required for confirmation. Complete excision of the cyst yields excellent results.
doi:10.1186/1752-1947-3-111
PMCID: PMC2783052  PMID: 19946589
2.  Omental Lymphangioma in Adults—Rare Presentation Report of a Case 
Case Reports in Surgery  2012;2012:629482.
Lymphangioma is an uncommon benign lesion that usually occurs during childhood. Its occurrence in adults is rare. Its presentation in the abdomen is even rare. This case report describes a case of omental lymphangioma presented as retroperitoneal lump. Subsequent imaging, operative, and histological findings revealed omental lymphangioma. Laparotomy done under general anesthesia, a 10 × 12 cm cystic swelling arising from omentum, identified complete excision of the cyst done and send the specimen for histopathological examination. Biopsy report came as omental lymphangioma. Complete surgical excision is the treatment of choice. Prognosis is excellent and recurrence rate is very low if resection is complete. During two years of followup no recurrence was detected. Omental lymphangioma is very rare presentation among abdominal lymphangiomas specifically in adults. Complete excision is the treatment of choice. Long-term followup is required to detect recurrence.
doi:10.1155/2012/629482
PMCID: PMC3502815  PMID: 23198248
3.  A giant peritoneal simple mesothelial cyst: a case report 
Introduction
A peritoneal simple mesothelial cyst is a very rare mesenteric cyst of mesothelial origin. The size of this lesion usually ranges between a few centimeters and 10 cm. It is usually asymptomatic, but occasionally presents with various, non-specific symptoms, which makes correct pre-operative diagnosis difficult. We present a case of a giant peritoneal simple mesothelial cyst that was successfully managed by complete surgical excision which is the treatment of choice.
Case presentation
A 21-year-old Caucasian Moroccan woman with vague abdominal discomfort and associated distention, during the previous 2 years, without other symptoms, presented to our hospital. Her past medical history was unremarkable. On physical examination, a mobile, painless and relatively hard abdominal mass was palpated. The laboratory examination and abdominal radiograph were unremarkable. Abdominal radiologic imaging showed a cystic mass of 35 × 20 × 10 cm that occupied the entire anterior and right abdominal cavity. Radical excision of the cyst was performed by midline laparotomy without any damage to the adjacent abdominal organs. The histopathological diagnosis was simple mesothelial cyst. The postoperative course was uneventful with no recurrence.
Conclusion
A peritoneal simple mesothelial cyst is a quite rare abdominal tumor, that must always be considered in differential diagnosis of pelvic cystic lesions and other mesenteric cysts. The treatment of choice is the complete surgical excision of the cyst.
doi:10.1186/1752-1947-5-361
PMCID: PMC3163219  PMID: 21831267
4.  Chylous mesenteric cysts: a rare surgical challenge 
Journal of Surgical Case Reports  2014;2014(3):rju012.
A mesenteric cyst is defined as a cyst that is located in the mesentery of the gastrointestinal tract and may extend from the base of the mesentery into the retroperitoneum. It is often asymptomatic and therefore it is usually found as an incidental finding. Preoperative diagnosis may be possible with computed tomography and magnetic resonance imaging. However, the correct diagnosis can only be made with histology. The first-choice therapy is the complete removal of the cyst, which must be accurately planned according to the anatomy of the lesion, its dimensions and its relationships with major abdominal structures. We present two clinical cases: the one of a 30-year-old man with a mesenteric cyst that was removed by laparoscopy and the other of a 61-year-old woman who underwent open excision of a huge retroperitoneal cyst.
doi:10.1093/jscr/rju012
PMCID: PMC4197922  PMID: 24876395
5.  Serous adenocarcinoma of the sigmoid mesentery arising in cystic endosalpingiosis 
Journal of Clinical Pathology  2005;58(11):1221-1223.
This case report describes a Mullerian serous adenocarcinoma arising within a multoloculated cyst lined by ciliated serous-type epithelium located in the sigmoid mesentery. Twenty years previously the patient underwent a hysterectomy, bilateral salpingo-oophorectomy, and omentectomy. The ovaries contained bilateral serous cystadenofibromas, and multiple cysts lined by ciliated serous-type epithelium were present in the omentum. The resection specimen 20 years later contained a 14 cm multiloculated cyst located in the sigmoid mesentery. This was lined largely by benign ciliated serous-type epithelium but a focus of well differentiated serous adenocarcinoma projected into the lumen. Two further peritoneal cysts were present, both of which were lined by ciliated serous-type epithelium. There was a coincidental renal cell carcinoma. This is a unique case of multiple omental, peritoneal, and retroperitoneal cysts (classified as cystic endosalpingiosis), one of which developed a focus of serous adenocarcinoma. Although rarely serous adenocarcinomas, similar to those occurring within the ovary, arise in the retroperitoneum, this is the first reported occurrence in association with a pre-existing benign lesion.
doi:10.1136/jcp.2005.027946
PMCID: PMC1770769  PMID: 16254118
ovary; mesentery; endosapingiosis; serous adenocarcinoma; secondary Mullerian system
6.  A pathologic study of abdominal lymphangiomas. 
Journal of Korean Medical Science  1999;14(3):257-262.
Abdominal lymphangiomas are uncommon angiomatous tumor occurring mainly in childhood. This is a retrospective clinicopathologic study of 17 cases of abdominal lymphangioma. The patients included are five children and 12 adults, with a mean age at initial presentation of 30.7 years (age ranges 3-63). The locations of the tumors were mesentery (5), retroperitoneum (4), colon (3), omentum (3), mesocolon (1) and gallbladder (1). Infiltrative growth was more common pattern than entirely circumscribed pattern. Masses were mostly multilocular cysts and contained chyle or serous fluid. On immunohistochemical staining, 16 cases were reactive for either CD31 or factor VIII-related antigen. These fact would suggest that intra-abdominal lymphangiomas simulate the immunohistochemical features of collecting lymphatics. Follow up was possible in 12 cases for 3-50 months (mean 19 months) and only one patient showed local recurrence. Although abdominal lymphangiomas are rare in adulthood and correct preoperative diagnosis is difficult, awareness of such a possibility in adulthood will contribute to make a correct preoperative diagnosis.
PMCID: PMC3054378  PMID: 10402167
7.  Lymphangioma of the small bowel mesentery: A case report and review of the literature 
Lymphangioma is a rare benign condition characterized by proliferation of lymphatic spaces. It is usually found in the head and neck of affected children. Lymphangioma of the small-bowel mesentery is rare, having been reported for less than 1% of all lymphangiomas. Importantly, it can cause fatal complications such as volvulus or involvement of the main branch of the mesenteric arteries, requiring emergency surgery. Moreover, the gross and histopathologic findings may resemble benign multicystic mesothelioma and lymphangiomyoma. Immunohistochemical study for factor VIII-related antigen, D2-40, calretinin and human melanoma black-45 (HMB-45) are essential for diagnosis. Factor VIII-related antigen and D2-40 are positive in lymphangioma but negative in benign multicystic mesothelioma. HMB-45 shows positive study in the smooth-muscle cells around the lymphatic spaces of the lymphangiomyoma. We report a case of small-bowel volvulus induced by mesenteric lymphangioma in a 2-year-and-9-mo-old boy who presented with rapid abdominal distension and vomiting. The abdominal computed tomography scan showed a multiseptated mass at the right lower quadrant with a whirl-like small-bowel dilatation, suggestive of a mesenteric cyst with midgut volvulus. The intraoperative findings revealed a huge, lobulated, yellowish pink, cystic mass measuring 20 cm × 20 cm × 10 cm, that was originated from the small bowel mesentery with small-bowel volvulus and small-bowel dilatation. Cut surface of the mass revealed multicystic spaces containing a milky white fluid. The patient underwent tumor removal with small-bowel resection and end-to-end anastomosis. Microscopic examination revealed that the cystic walls were lined with flat endothelial cells and comprised of smooth muscle in the walls. The flat endothelial cells were positive for factor VIII-related antigen and D2-40 but negative for calretinin. HMB-45 showed negative study in the smooth-muscle cells around the lymphatic spaces. Thus, the diagnosis was lymphangioma of the small bowel mesentery with associated small bowel volvulus.
doi:10.3748/wjg.v18.i43.6328
PMCID: PMC3501784  PMID: 23180956
Lymphangioma; Mesentery; Small bowel; Volvulus; Factor VIII-related antigen; D2-40
8.  Diagnosis and treatment of retroperitoneal bronchogenic cysts: A case report 
Oncology Letters  2014;7(6):2157-2159.
Bronchogenic cysts are uncommon, predominantly benign, congenital malformations arising from the primitive foregut. The occurrence of such cysts in the retroperitoneum is extremely rare. The present study presents the case of a 30-year-old female who presented with a left adrenal mass. Imaging investigations revealed a cystic mass located medially to the left adrenal gland. Retroperitoneal laparoscopic excision and complete resection were performed, and the subsequent pathological examination confirmed the diagnosis of a bronchogenic cyst in the retroperitoneum. The patient was discharged on the fourth post-operative day and received no further treatment, however, regular follow-up was performed due to the lesion being benign. A rare case of bronchogenic cyst and literature review is presented, which may aid in improving the understanding of the etiology and pathogenesis of retroperitoneum bronchogenic cysts.
doi:10.3892/ol.2014.1974
PMCID: PMC4049691  PMID: 24932307
bronchogenic cysts; retroperitoneal
9.  Lymphoepithelial Cyst of the Pancreas 
Case Reports in Gastroenterology  2012;6(3):604-611.
Cystic lesions of the pancreas can be divided into true cysts, pseudocysts, and cystic neoplasms. Lymphoepithelial cysts (LECs) are a type of true cyst that can mimic pseudocysts and cystic neoplasms. LECs are rare lesions; fewer than 90 cases have been reported in the English language literature. The case of a 60-year-old man with an LEC of the pancreas is reported. He was admitted with upper abdominal discomfort. Computed tomography showed a 64 × 39 mm cystic mass in the retroperitoneum behind the duodenum and inferior caval vein. Magnetic resonance imaging revealed a right-sided mass on T1-weighted imaging, with a clear boundary between the mass and its surroundings, except for the pancreas. The mass had an inhomogeneous intensity on T2-weighted imaging. Within the mass, small floating nodules with low intensity were seen. Endoscopic ultrasound showed many high-echoic nodules and smaller grains scattered everywhere in the mass. Fine needle aspiration and cytologic examination were performed. Characteristic chylaceous fluid was obtained in which anucleate squamous cells were found. There were also a few atypical large cells with irregularly shaped marked nucleoli and degenerative cytoplasm. Cytologic diagnosis was suspicious for malignancy. The lesion was diagnosed as a retroperitoneal cyst, probably of pancreatic origin. Since a neoplastic lesion could not be ruled out, surgery was performed. The lesion was palpable on the dorsal side of the second portion of the duodenum. The mass was completely resected. Macroscopically, the lesion was a multilocular cyst with a thin septal wall. The cyst was filled with cottage cheese-like substance. Microscopically, the cyst wall was composed of stratified squamous epithelium and dense subepithelial lymphatic tissue with developed lymph follicles. The epithelial cells had no atypia. The histopathologic diagnosis was LEC of the pancreas. The patient's postoperative course was good.
doi:10.1159/000343421
PMCID: PMC3493017  PMID: 23139650
Lymphoepithelial cyst; Pancreas; Pancreatic tumor; Endoscopic ultrasound
10.  Giant neoplastic omental cyst masquerading as ascites: a case report 
Cases Journal  2009;2:6482.
Introduction
Cystic lesion of the omentum and mesentery are rare. The incidence of both cyst types has been variously reported to vary from 1/27,000-100,000 hospital admission. Omental cysts occur three to ten times less frequently than mesenteric cyst. Preoperative diagnosis is infrequently made because of lack of characteristic symptoms and signs.
Case presentation
We present our diagnostic and management challenges in a 43-year-old man with an unusually giant omental cyst confirmed as fibrosarcoma at histology. The cyst gave the abdomen an anteroposterior diameter of about 74 cm that could not be penetrated sufficiently by X-ray photons to produce diagnostic image even at maximum attainable output. Patient benefited from surgical excision. The removed cyst contained about 35 litres of fluid.
Conclusion
Neglected omental cysts as in this case may grow to enormous size, undergo malignant transformation and poses serious diagnostic and surgical challenges.
doi:10.4076/1757-1626-2-6482
PMCID: PMC2769296  PMID: 19918526
11.  Asymptomatic lymphangioma involving the spleen and retroperitoneum in adults 
Lymphangioma, a benign neoplasm of the lymphatic system, is common in children but rare in adults. Its clinical manifestations include abdominal pain, nausea, vomiting and a palpable mass. However, abdominal sonography or abdominal computed tomography (CT) scan can also incidentally reveal lymphangioma. A larger or symptomatic lymphangioma is treated with total resection to prevent recurrence, infection, torsion and enlargement. Although lymphangioma rarely becomes malignant, its prognosis is generally good. We report a cystic lymphangioma of the spleen and retroperitoneum, which was incidentally found in a 56-year-old man who was hospitalized due to a colon mass. Physical examination showed no specific findings. Abdominal CT revealed a 5.7 cm, non-enhanced multilobulated cystic mass with multiple septa in the spleen and a 10 cm lobulated cystic mass in the paraaortic area. Splenectomy and retroperitoneal resection of the cystic mass were conducted. The endothelium of splenic and retroperitoneal cyst was immunohistochemically stained with D2-40 antibody. The patient was finally diagnosed with splenic cystic and retroperitoneal cavernous lymphangioma.
doi:10.3748/wjg.15.5620
PMCID: PMC2785067  PMID: 19938204
Lymphangioma; Retroperitoneum; Spleen
12.  Choledochal cysts: lessons from a 20 year experience. 
Archives of Disease in Childhood  1995;73(6):528-531.
Cystic dilatation of the biliary tree is a rare congenital anomaly. To determine mode of presentation, diagnostic pitfalls, and long term outcome after surgery, 78 children (57 girls, 21 boys) with choledochal cyst treated between 1974 and 1994 were reviewed. Anatomical types were: Ic (n = 44), If (n = 28), IVa (n = 4), and V (n = 2); a common pancreaticobiliary channel was identified in 76% patients. Age at presentation ranged from 0-16 (median 2.2) years, six patients being diagnosed by prenatal ultrasonography. Of the 72 patients diagnosed postnatally, 50 (69%) presented with jaundice, associated with abdominal pain in 25 or a palpable mass in three, 13 (18%) presented with pain alone, and two (3%) with a palpable mass. The classic triad of jaundice, pain, and a right hypochondrial mass was present in only four (6%). Four children presented acutely after spontaneous perforation of a choledochal cyst, two presented with ascites and one cyst was discovered incidentally. Plasma and/or biliary amylase values were raised in 30 of 31 patients investigated for abdominal pain; seven had evidence of pancreatitis at operation. In 35 of 67 (52%) patients referred without previous surgery, symptoms had been present for more than one month, and in 14 of them for more than one year, before diagnosis. Delayed referral was due to misdiagnosis as hepatitis (n = 12), incomplete investigation of abdominal pain (n = 6), and failure to note the significance of ultrasonographic findings (n = 10). Two patients referred late died from liver failure. Of the 76 patients with type I or IV cysts, 59 underwent radical cyst excision and hepaticojejunostomy as a primary procedure and 10 as a secondary operation after previously unsuccessful surgery. Sixteen patients have been lost to follow up but most of the remainder are well after a mean period of 4.1 (0.1-13) years. Choledochal cysts are often misdiagnosed, but prognosis is excellent if radical excision is performed.
PMCID: PMC1511455  PMID: 8546511
13.  Transoral approach for direct and complete excision of vallecular cysts in children 
Objective
To review the presentation, evaluation, and treatment of children with vallecular cysts and introduce a new technique of transoral excision for this entity.
Methods
Retrospective case series of children diagnosed with vallecular cyst between 2001 and 2008 at a single tertiary care children’s hospital. Data collected, including age at diagnosis, presenting symptoms, additional diagnoses, diagnostic modality, prior and subsequent surgical therapy, length of hospital stay, length of follow-up, and recurrence were analyzed with descriptive statistics.
Results
Seven children (mean age 198 days, range 2 days to 2.9 years) were included in this series. Five children presented with respiratory distress and/or swallowing difficulties. Vallecular cyst was diagnosed by initial flexible fiberoptic laryngoscopy (5/7), MRI (1/7), and intubating laryngoscopy (1/7). All children underwent complete cyst excision via transoral surgical approach. Two children underwent additional supraglottoplasty for concomitant laryngomalacia, one of whom underwent tracheotomy for persistent respiratory distress and vocal cord immobility. The average length of hospital stay postoperatively was 9.5 days, and four patients stayed less than 2 days. No patients experienced recurrence of the vallecular cyst at last follow-up (range 4–755 days, mean 233 days).
Conclusions
Vallecular cysts are rare but should be considered in children with respiratory distress and dysphagia. Awake, flexible fiberoptic laryngoscopy with particular attention to the vallecular region should be performed on any child presenting with these symptoms. Direct, transoral approach for excision of the vallecular cyst is our preferred method of treatment with no recurrences to date.
doi:10.1016/j.ijporl.2011.06.007
PMCID: PMC4038648  PMID: 21752477
Vallecular cyst; Excision; Transoral; Endoscopic; Stridor; Dysphagia; Laryngomalacia
14.  Retroperitoneal cystic lymphangioma in an adult: A case report and review of the literature 
Lymphangiomas are rare benign cystic tumors of the lymphatic system. Retroperitoneal lymphangiomas account for 1% of all lymphangiomas, and approximately 186 cases have been reported. They may clinically present as a palpable abdominal mass and can cause diagnostic dilemmas with other retroperitoneal cystic tumors, including those arising from the liver, kidney and pancreas. This report describes the rare case of a cystic retroperitoneal lymphangioma in a 54-year-old male patient. The lymphangioma had progressed to the point of inducing clinical symptoms of abdominal distention, abdominal pain, anorexia, fever, nausea and diarrhea. Radiological imaging revealed a large multiloculated cystic abdominal mass with enhancing septations involving the upper retroperitoneum and extending into the pelvis. Surgical removal of the cyst was accomplished without incident. A benign cystic retroperitoneal lymphangioma was diagnosed on histology and confirmed with immunohistochemical stains.
doi:10.4291/wjgp.v1.i5.171
PMCID: PMC3097960  PMID: 21607159
Retroperitoneum; Cystic; Lymphangioma
15.  Laparoscopic Treatment of a Huge Mesenteric Chylous Cyst 
Mesenteric chylous cysts are rare. This study suggests that even large mesenteric chylous cysts may be managed with minimally invasive means.
Mesenteric chylous cysts are rare pathologic entities that often present with unspecific symptoms. The preoperative diagnosis requires all the common abdominal imaging techniques, but usually the correct diagnosis may be made only at the operation stage or during the histological examination. The treatment of choice is the complete surgical excision that may be safely performed by laparoscopy. A 58-year-old man underwent laparoscopic excision of a huge mesenteric chylous cyst. The technique entails the perfect control of the major abdominal vessels running near the tumor and the complete sealing of the chylous and blood vessels to and from the cyst.
doi:10.4293/108680810X12924466007205
PMCID: PMC3041047  PMID: 21333204
Chylous cyst; Mesenteric cyst; Laparoscopic enucleation
16.  Acute Abdomen Caused by an Infected Mesenteric Cyst in the Ascending Colon: A Case Report 
Mesenteric cysts are rare intra-abdominal tumors. Mesenteric cysts are usually asymptomatic and are incidentally detected during physical or radiological examination. Although uncommon, complications such as infection, bleeding, torsion, rupture and intestinal obstruction cause an acute abdomen. Spontaneous infection is a very rare complication. We present a case of infected mesenteric cysts in the ascending colon, which caused an acute abdomen. A 26-year-old woman was admitted to our hospital with acute abdominal pain. She had a painful mass in the right abdomen on physical examination. Abdominal computed tomography showed a hypodense cystic mass with septation at the mesenteric region of the ascending colon. A laparotomy revealed two cystic tumors at the mesenteric region of the ascending colon. She underwent a right hemicolectomy. The two cysts were filled with a yellowish turbid fluid. The walls of both two cysts were lined with a thin fibrotic membrane without any epithelial cell. They were diagnosed as psuedocysts with E. coli infection. Mesenferic cysts may cause life-threatening complications. Mesenteric cyst, even if it is asymptomatic and was diagnosed incidentally, should be removed completely.
doi:10.3393/jksc.2011.27.3.153
PMCID: PMC3145887  PMID: 21829771
Mesenteric cyst; Infection; Abdomen, acute
17.  “Juxtafacet cysts”, a misleading name for cystic formations of mobile spine (CYFMOS) 
European Spine Journal  2007;16(9):1499-1505.
To present 58 cystic space-occupying formations of the spinal canal in 53 cases; these formations are called “juxtafacet cysts”. Fifty-Three patients (33 women and 20 men, with an average age of 60.8 years) were evaluated retrospectively by neurosurgery. All of the patients had received simple X-P, computed tomography (CT) and magnetic resonance imaging (MRI) before surgery. The neurological findings were evaluated on admission and in a follow-up review. Surgical intervention was performed on all patients and they underwent gross-total cyst removal. During surgery, the origin of a cyst was well observed. Follow-up data ranged from 6 to 46 months. Patient outcome was graded on a scale of excellent, good, or poor. Histological findings were evaluated. In 53 patients 58 cysts were identified. Four of the patients had multiple cysts. All cysts were associated with mobile spine. Fifty-five cysts were found in the lumbo-sacral region, two cysts were found in the cervico-thoracic region and one cyst in the thoracic region. Forty-two patients presented back pain and 52 patients presented radicular pain. Four patients had a cauda equina syndrome. Sensory disturbance was observed in 24 cases and motor weakness was observed in 21 cases. Claudication was observed in 19 cases. All cases with cervico-thoracic or thoracic cysts presented myelopathy. The duration of these clinical symptoms ranged from 10 days to 10 years. After surgery there was no case of a recurrent cyst during the follow-up period. Thirty-four cases had an excellent outcome, 18 a good outcome, and one a poor outcome. Out of 58 cysts 32 were joint cysts (11 synovial cysts, 21 ganglion cysts). A further 19 were flavum cysts, one was a posterior longitudinal ligament (PLL) cyst and six others were unknown pseudo cysts. In 34 of the cysts we found hemosiderin deposits and in eight amyloid deposits. Present investigation and findings in literature show a clear comparison of these cystic formations and the mobile part of the spine. An anatomical relation to a vertebral joint (“facet”) is only found in some of the cases (32 of 58). Further to that, the name “cyst” is not correct either, because most of the cystic formations are presented without a cell lining on their internal wall and therefore they are pseudo-cystic. We think that these cystic formations should be called “cystic formations of mobile spine” (CYFMOS) rather than “juxtafacet cysts”. A surgical intervention is the best treatment for these cysts if they cause a compression of nerve roots or/and of the spinal cord.
doi:10.1007/s00586-006-0287-5
PMCID: PMC2200759  PMID: 17203271
Synovial cyst; Pseudo cyst; Ganglion cyst; Juxtafacet cyst; Mobile spine
18.  Liver Hydatid Cyst in Children (A 14-year Review) 
Iranian Journal of Pediatrics  2011;21(3):385-389.
Objective
Hydatid disease is still an important health hazard in the world. This disease is a parasitic infestation which is endemic in many sheep and cattle raising areas such as in Iran. The aim of this study was to evaluate the clinical appearance, diagnosis, and treatment of liver hydatid cyst in children.
Methods
This retrospective study evaluated 100 patients who were referred to Mofid Children's Hospital with liver hydatid cyst from March 1996 to March 2010. Medical records of 1 to 14 year old patients who had definitive liver hydatid cyst were included and analysis of variables such as age, gender, symptoms, diagnostic investigation, operative technique, hospital stay, mortality, morbidity and outcome of treatment were evaluated.
Findings
The patients consisted of 54 boys (54%) and 46 (46%) girls with an age range of 1-14 years (mean 11.8±4.6). The incidence rate increased by age. The patients had totally 110 cysts, right pulmonary lobe 81 (73%) cysts and left side had 29 (27%). Abdominal mass was the most common (50%) symptom. Abdominal sonography gave correct diagnosis in 94 (94%) patients. Conservative surgical treatment was carried out in 98 children. Two patients were treated medically as the cysts were small and calcified. The most common complication was wound infection in 3 cases. Mean length of hospitalization was 9 days. In 100% of our patients the type of parasite was Echinoccocus granulosus. The morbidity rate was 12% (prolonging external catheter drainage in 12 patients). There was only one (1%) mortality and 2 (2%) recurrences.
Conclusion
Due to the less invasive and high accuracy of liver sonography in diagnosis of hydatid cyst, we recommend it as the method of choice for the diagnosis in endemic regions. Surgery is the method of choice for treatment.
PMCID: PMC3446171  PMID: 23056818
Liver Hydatid Cyst; Abdominal Mass; Diagnosis; Treatment; Children
19.  Curative surgery for locally advanced retroperitoneal mature teratoma in an adult. Case report 
INTRODUCTION
Primary teratomas of retroperitoneum are not usual in the adult population. These tumors most commonly seen at the gonadal and sacrococcygeal regions. Herein we describe a case of an 18-year-old female who had a benign cystic teratoma at the retroperitoneum.
PRESENTATION OF CASE
The patient underwent an operation at another hospital following a misdiagnosis of hydatid cyst. The patient was referred to our hospital because of the detection of an unresectable tumor during her operation. A computerized tomography (CT)–angiography revealed a cystic mass, with a diameter of 14 cm which was invaded into the retrohepatic suprarenal inferior vena cava and also extended to the posterior aspect of the liver. Additionally the mass invaded the posterior wall of the inferior vena cava and the right renal vein. The tumor was completely resected with a vascular resection. The inferior vena cava was reconstructed with a 12 cm Dacron® graft and the renal vein was implanted. The patient's postoperative period was uneventful.
DISCUSSION
Germ cell tumors of retroperitoneum are usually seen in children, but there are also some reports of adult cases in the literature. Adult cases are especially seen in females. Imaging studies are paramount for diagnosis, preoperative strategy and safe surgical excision. CT scans and MRIs can identify various components of these tumors.
CONCLUSION
Even though primary retroperitoneal teratomas are quite rare in adults. Preoperative radiology imaging and strategy is critical for performing a safe surgery. The gold standard treatment strategy for this neoplasm is the surgical resection.
doi:10.1016/j.ijscr.2012.08.017
PMCID: PMC3537928  PMID: 23117007
Teratoma; Mature; Vascular invasion
20.  Laparoscopic excision of mesenteric cyst of sigmoid mesocolon 
Mesenteric cysts are rare abdominal tumours. They are found in the mesentery of small bowel (66%) and mesentery of large intestine (33%), usually in the right colon. Very few cases have been reported of tumours found in mesentery of descending colon, sigmoid or rectum. Mesenteric cysts do not show classical clinical findings and are detected incidentally during imaging due to absent or non-specific clinical presentation or during management of one of their complications. Ultrasonography (USG)/computed tomography (CT)/ magnetic resonance imaging (MRI) are used in diagnosing mesenteric cyst but they cannot determine the origin of cyst. Laparoscopy not only helps in diagnosing the site and origin of the mesenteric cyst but also has a therapeutic role. Laparoscopic treatment of mesenteric cyst is a safe, preferred method of treatment and is a less-invasive surgical technique. Here, we present an unusual case of mesenteric cyst arising from the sigmoid mesocolon treated by laparoscopic excision.
doi:10.4103/0972-9941.107138
PMCID: PMC3630717  PMID: 23626420
Benign; laparoscopy; mesenteric cyst; mesocolon; sigmoid
21.  A bronchogenic cyst, presenting as a retroperitoneal cystic mass 
Rare Tumors  2012;4(1):e13.
Bronchogenic cysts are mostly benign, congenital abnormalities originating from the remnants of the primitive foregut. A retroperitoneal location is rare. Due to the mostly asymptomatic behavior and the historical confusion regarding histology, an exact prevalence is not known. We present here a case report of a retroperitoneal bronchogenic cyst. A literature review was performed for cases of retroperitoneal bronchogenic cysts written in English. Anatomopathological criteria for inclusion were pseudo stratified, ciliated, columnar epithelium together with the presence of at least one of the following: cartilage, smooth muscle or seromucous glands. In addition, the embryology, pathogenesis, radiological, clinical and suggested treatment modalities are reviewed. We report the surgical excision of a retroperitoneal bronchogenic cyst that presented as a non-functioning left adrenal mass. Our review of literature revealed only 62 potential cases of retroperitoneal bronchogenic cysts. After applying the strict anatomopathological criteria, only 30 cases of true retroperitoneal bronchogenic cysts could be identified. Retroperitoneal location of a bronchogenic cyst is rare. Despite the rarity of this pathologic entity, bronchogenic cysts should be considered in the differential diagnosis of retroperitoneal cystic lesions. Only histology can confirm definitive diagnosis. Surgery remains the recommended treatment of choice.
doi:10.4081/rt.2012.e13
PMCID: PMC3325740  PMID: 22532911
bronchogenic cyst; retroperitoneal; embryogenesis; excision.
22.  Indocyanine Green Assisted Removal of Orbital Lacrimal Duct Cysts in Children 
Journal of Ophthalmology  2015;2015:130215.
Aim. To report on the use of indocyanine green (ICG) during surgical removal of pediatric orbital lacrimal duct cysts. Method. We conducted a retrospective review of our cases of surgical excision of orbital lacrimal duct cysts using intraoperative injection of indocyanine green (ICG), which was used following inadvertent cyst rupture and volume loss. The dye allowed complete cyst visualization and complete excision despite volume loss or cyst rupture. Results. The study included 6 children (3 boys, mean age of 4.2 ± 0.84 years, range 3–5 years). Mean follow-up period was 9.3 months. All cysts were located in the inferonasal quadrant of the orbit (4 in the right side). In all cases, ICG was injected into the cyst at the time of surgery following unintentional cyst rupture. After the dye injection, it was easy to identify the borders of the cyst, permitting complete cyst removal, without any intra- or postoperative complications. Pathological examination revealed that all cysts were of lacrimal duct origin. Conclusion. Intraoperative injection of ICG into orbital cysts in children can aid surgeons in identifying cyst borders following inadvertent rupture, allowing complete removal.
doi:10.1155/2015/130215
PMCID: PMC4302382  PMID: 25642343
23.  Evolution of the Surgical Management of Neonatal Ovarian Cysts: Laparoscopic-Assisted Transumbilical Extracorporeal Ovarian Cystectomy (LATEC)* 
Abstract
Purpose
Since its first detailed description in 1995, the laparoscopic management of neonatal ovarian cysts has typically required multiple incisions, specialized equipment, and advanced laparoscopic skills. After some initial frustration with neonatal laparoscopy, we developed a simplified single-incision laparoscopic-assisted transumbilical extracorporeal cystectomy (LATEC). This paper reviews our experience with this technique and compares outcomes to those of our other surgically managed neonatal ovarian cyst patients.
Materials and Methods
A retrospective record review of 20 patients treated surgically between 1992 and 2006. Student's t-tests were used for comparisons (P < 0.05 was significant).
Results
Means were: age, 11 days; weight, 3.7 kg; and cyst diameter, 5.0 cm. Nineteen patients were diagnosed prenatally, at the mean gestational age of 33 weeks. Twelve of 20 (60%) had torsed cysts (1 bilateral). Three of 13 torsed cysts (23%) were less than 4 cm diameter (range, 2.9–3.5). Laparotomies were transverse lower abdominal incisions. Laparoscopic operations used 2 (3 patients) or 3 incisions (2 patients). LATEC involved transumbilical laparoscopy, complete cyst aspiration, and then cyst evisceration through the umbilicus for either ovarian cystectomy (simple cysts) or salpingo-oophorectomy (torsed cysts). Laparoscopic patients had similar time to feeds, length of stay, and postoperative narcotic requirements, when compared to laparotomy patients (P = nonsignificant). LATEC patients had shorter surgical times, more rapid advancement to full enteral feedings, shorter length of hospital stay, and equal ovarian preservation, when compared to laparoscopy. Cosmetic results with LATEC were outstanding.
Conclusions
Both laparoscopic and “open” approaches have acceptable perioperative morbidity and rapid recovery. LATEC is a relatively simple procedure, which combines laparoscopy and traditional extracorporeal surgery, and may be successfully performed by experienced pediatric surgeons and with a single incision.
doi:10.1089/lap.2007.0193
PMCID: PMC3198621  PMID: 18721022
24.  Giant mesenteric lymphangioma: a rare cause of a life-threatening complication in an adult 
BMJ Case Reports  2010;2010:bcr0420102896.
Mesenteric cyst lymphangiomas (MCLs) are rare benign tumours of unknown aetiology seen mostly in children. Clinical presentation can be diverse ranging from incidental abdominal cysts to an acute abdomen. A 24-year-old previously fit and healthy young man presented with a 2-week history of cramping, central abdominal pain and vomiting requiring acute hospital admission. He was a diagnostic conundrum despite extensive preoperative investigations. Recurring symptoms required urgent surgical exploration, resection and histological confirmation with a successful outcome. We review the literature and present here this rare case in an adult of MCL that has the potential to grow, invade and develop major life-threatening complications.
doi:10.1136/bcr.04.2010.2896
PMCID: PMC3029268  PMID: 22778193
25.  Multiple Organ Involvement with Hydatid Cysts 
Hydatid disease is the most common infections worldwide, but it rarely involves multiple organs. Herein, a 12-year-old boy is presented, who was admitted to Children's Medical Center, Tehran University of Medical Sciences, Tehran, Iran with symptoms of irritability, sleepless, and weakness of the extremities. Patient's brain computed tomography (CT) scan with contrast media showed large multilocular cystic lesions in right temporal lobe associated with two other smaller similar cystic lesions in centrum semiovale bilaterally. Abdominal sonography revealed intestinal mesenteric and a cardiac cyst. Abdomino-pelvic CT scan showed a cyst medial to the cecum and a cortical cyst in the left kidney as well as a heart cyst. The echocardiography confirmed hydatid cysts at apical and interventricular septum. Serology test was positive for hydatid cyst. Albendazole and praziquantel were started for the patient immediately and right temporal lobe lesions were removed via neurosurgery intervention. After one month, cardiac and mesenteric cysts were operated during two separate surgeries. Pathologic findings of all cysts were compatible with hydatid cyst. Cystic hydatidosis should be suspected in any cystic mass, whilst prompt diagnosis and appropriate treatments are the keys in management of affected patients.
PMCID: PMC3279838  PMID: 22347246
Hydatid cyst; Echinococcus granulosus; Multiple organ hydatidosis; Disseminated echinococcosis; Iran

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