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| LETTER TO THE EDITOR |
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| Year : 2014 | Volume
: 7
| Issue : 3 | Page : 407-408 |
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Mesenteric cyst of Müllerian origin: A rare case with review of literature
Shailja Puri Wahal, Kavita Mardi
Department of Pathology, Indira Gandhi Medical College, Shimla, Himachal Pradesh, India
| Date of Web Publication | 18-Mar-2014 |
Correspondence Address:
Shailja Puri Wahal
Department of Pathology, Indira Gandhi Medical College, Shimla - 171 001, Himachal Pradesh
India
 Source of Support: None, Conflict of Interest: None  | Check |
DOI: 10.4103/0975-2870.129016
How to cite this article:
Wahal SP, Mardi K. Mesenteric cyst of Müllerian origin: A rare case with review of literature. Med J DY Patil Univ 2014;7:407-8 |
Sir,
Mesenteric cyst of Mόllerian origin is a rare entity and thought to be a subtype of urogenital cyst. Mullerian cysts arise from the fused embryonic ducts, which typically regress in the uterus
We report a case of a 42-year-old female who presented in emergency with acute abdominal pain in right iliac fossa. A provisional diagnosis of acute appendicitis was made and exploratory laparotomy was done. On laparotomy, the appendix was normal. A small lesion measuring less than 1 cm was detected in the mesentery of the ileum. The lesion was excised and sent for histopathologic examination. Grossly, 5 × 4 mm soft tissue mass was received. The cut surface was gray-white and showed small cystic spaces. Microscopic examination showed fibro-fatty soft tissue mass containing two cysts lined by ciliated cuboidal to low columnar epithelium [Figure 1]. Wall of the cyst showed smooth muscle bundles, fibrous tissue, blood vessels, lymphatics, and acute inflammatory cells. A diagnosis of mesenteric cyst of Müllerian origin was given. | Figure 1: Single layer ciliated cuboidal to low columnar epithelium lining the cyst wall. (H and E ×40)
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Mesenteric cysts are one of the rarest intra-abdominal tumors. [1] The reported incidence is 1 in 20,000 with equal sex distribution. [1] Their rarity makes them difficult to diagnose both clinically and pathologically. Cysts that are present in the mesentery, omentum and retroperitoneum are comparable embryologically and pathologically. These anatomical structures are all lined by peritoneum and composed of connective tissue containing fat, lymphatic channels, blood vessels, scant muscle fibers, and neural tissue. It has been suggested that mesenteric cysts develop when the mesenteric leaves fail to fuse during development. [2] Mesenteric cysts have now been categorized into four etiologic groups: embryonic and developmental, traumatic and acquired, infective and degenerative and neoplastic cysts. [2] The differential diagnosis for cystic lesions in the mesentery includes lymphangioma, hemangioma, enterogenous cysts, cystic mesothelioma, hydatid cyst, cystic teratoma, and urogenital cysts. [2] Simple mesenteric cysts have a fibrous wall devoid of a muscular layer, and are lined by an attenuated layer of epithelium. Traumatic cysts lack an epithelial lining and the wall may show calcification and reactive, chronic inflammatory cells. The lining epithelium of cystic lymphangiomas and hemangiomas are flat and/or immunoreactive for endothelial markers. Enterogenous cysts are lined by intestinal epithelium and may communicate with the gastrointestinal tract. They contain a better defined muscular layer with myenteric plexus. The wall of hydatid cyst comprises of external, anucleate laminated layer lined by a germinal layer surrounded by a thin outer layer of fibrous tissue produced by the host. The fertile hydatid cysts contain pathognomonic brood capsules. Mesothelial cysts may be arranged in grape-like clusters or as isolated lesions studding the surface of the peritoneum. They are filled with mucinous or gelatinous fluid. Microscopically, they are lined by a single layer of cuboidal or flattened mesothelium. Surgery is the mainstay of treatment for any kind of mesenteric cyst. [2]
The cyst described here is distinguished by the close histological similarity of the epithelium to that of normal Fallopian tube More Details. Epithelial structures that occur in women, on and beneath the visceral or parietal peritoneum, in the retroperitoneal lymph nodes, or in the soft tissue of the pelvis and lower abdomen, with differentiation typical of the lining of the female genital tract, have been generally termed Mόllerianosis. [3] The case reported here is a type of urogenital cyst derived from vestiges of the embryonic urogenital apparatus. They may be sub classified into pronephric, mesonephric, metanephric, and Mόllerian types. [4] A similar case of mesenteric cyst of Mόllerian origin was reported by Lee et al in 1998. [5]
We are reporting this case due to its rarity and unusual location.
| References | |  |
| 1. | Kurtz MD, Heimann TM, Beck AR, Holt J. Mesenteric and retroperitoneal cysts. Ann Surg 1986;203:109-12. 
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| 2. | Pantanowitz L, Botero M. Giant Mesenteric Cyst: A case report and review of the literature. Internet J Pathol 2001;1:2.
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| 3. | Russel P, Frasworth A. Müllerianosis and reactive mesothelial lesions. Surgical pathology of ovaries. New York: Churchill Livingstone; 1997. p.195-207.
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| 4. | Handfield-Jones RM. Retroperitoneal cysts: Their pathology, diagnosis and treatment. Br J Surg 1924;12:119-34.
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| 5. | Lee J, Song SY, Park CS, Kim B. Müllerian cysts of the mesentery and retroperitoneum: A case report and literature review. Pathol Int 1998;48:902-6.
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[Figure 1]
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