PMC6344927_01
(A) Echography revealing a 15 x 15 cm2 septate thin-walled giant cystic mass. (B) Giant cyst was near the root of the small bowel mesentery. (C) Pathology, cyst wall, without areas of malignancy. (Hematoxylin and eosin staining 10x).
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The cyst occupied most of the hepatorenal space and it was in intimate contact with the liver, right kidney and pancreas (Fig. 1A). At laparotomy, a 19 x 15 x 10 cm3 mesenteric cyst was discovered (Fig. 1B), the cyst was near the root of the small bowel mesentery but did not compromise its main vessels, it had a yellowish appearance (Fig. 2B), and clear fluid was found within the cyst. Pathology reported a giant primary mesenteric cyst, it was lined with a single layer of cuboidal epithelial cells and partially covered by adipose tissue and prominent vasculature, it had a yellowish wall and its thickness varied between 0.1 and 0.3 cm (Fig. 1C).
(A) CT revealing a well-defined 19.7 x 15 x 10 cm3 giant cyst. (B) Giant cyst surrounded by the bowel. (C) Pathology, cyst wall covered by adipose tissue. (Hematoxylin and eosin staining 40x.)
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Due to the size of the mass, CT was requested, it revealed well-defined 19.7 x 15 x 10 cm3 giant cyst, the cyst was located within the small bowel mesentery and it was in intimate contact with the liver, gallbladder, pancreas and right kidney (Fig. 2A). Its interior had a white trabecular internal surface with brown patches it did not have any communication with other organs, and no areas of malignancy were found (Fig. 2C).
(A) MRI, showing a giant cyst without communication with the bile duct or pancreas. (B) Mesenteric cyst adhesions to the gallbladder and liver.
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This is why a magnetic resonance cholangiopancreatography found that the cyst was attached but had no communication with the bile duct or the pancreas (Fig. 3A). With these findings surgery was straightforward, complete resection of the cystic mass was performed, however, the cyst wall was completely attached to the body of the gallbladder and could not be resected without compromising it (Fig. 3B), so a cholecystectomy was performed as well.