PMC3163403_01
Prominent mass lower abdomen.
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A 4-year-old girl was referred with an 18-month history of a lower abdominal swelling (Figure 1).
T2 coronal section of fat-suppressed abdominal magnetic resonance scan showing different signal intensities in solid component (A) and high signal in cystic component (B).
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Magnetic resonance imaging demonstrated a 16 x 15 x 12 cm mass with cystic and solid components (Figure 2). T2-weighted images (Figure 2).
T1 transverse section of abdominal magnetic resonance scan showing intermediate signal in solid component (A) with low signal areas representing calcification and low signal in cystic component (B).
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The solid component (b) was posterolateral showing intermediate signal on T1-weighted images with low signal areas representing calcification (Figure 3). These findings resulted in a decision to remove the lesion.
Cystic component of mass. (a) Macroscopic appearance of fresh unfixed specimen. (b) Macroscopic appearance of fixed specimen with cyst opened. (c) Microscopy of haematoxalin and eosin-stained specimen at x2.5 magnification. Layers of enteric lined mucosa comprising of columnar epithelia (E), submucosa (S), and muscularis (M).
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Extraperitoneal and anterior to the bladder was a cystic bowel-like structure which was not continuous with true bowel (Figure 4(a)). Histological examination of the cystic bowel-like component (Figure 4(b)) demonstrated gastrointestinal structure throughout with mucosa, submucosa, muscularis propria, and serosa.
Solid component of mass stained with haematoxalin and eosin. (a) Macroscopic appearance of fresh unfixed specimen. (b) Microscopy x10 magnification. Osteoblast layer on the surface of bone (B) adjacent to cartilage (C). (c) Microscopy x20 magnification. Skeletal muscle fibres (M), nerve (N), and fat (F). (d) Microscopy x10 magnification. Nerve cells (N), ganglion (G), fat (F) and, epithelia lined cyst (E). (e) Microscopy x20 magnification. Pilosebaceous unit comprising of sebaceous gland (SG), hair follicle (HF), hair (H). (f) Plain X-ray of solid component showing skeletal structure.
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Separate from this and also extraperitoneal was a large calcified mass (Figure 5(a)) to the left of the midline abutting the iliac vessels at the level of the pelvic brim. X-rays showed irregular areas of well-formed bone in a circular formation but no true skeletal formation (Figure 5(f)).