PMC5573788_01
Computed tomography scan shows a right sided intrabdominal rim-enhancing cystic mass.
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A computed tomography (CT) scan revealed a rim-enhancing cystic mass (Fig. 1), thought more likely to be abscess or superinfected duplication cyst, and less likely malignancy.
Laparoscopic view of the right colon and mass/cystic structure, with tense, thin wall.
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Diagnostic laparoscopy revealed a large, firm mass emanating from the mesentery of the right colon (Fig. 2); given its size and relative immobility, an open laparotomy was then pursued through a limited periumbilical midline incision.
Right colon and mass/cystic structure mobilized from right retroperitoneum and exteriorized.
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The mass and the right colon were densely adherent to the retroperitoneum (Fig. 3, video), but no adjacent organs were involved.
Histologic features. A: Purulent material with a surrounding inflamed fibrous wall, consistent with an abscess (frozen section; hematoxylin and eosin; original magnification, 200x). B and C: Dilated lymphatic channels of varying size, often lined by lymphoid aggregates (hematoxylin and eosin; original magnification, 12.5 and 40x). D: D2-40 immunostain, highlighting lymphatic endothelium (original magnification, 40x).
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A representative section was frozen at the time of surgery for intraoperative consultation; this fragment showed a neutrophilic abscess (Fig. 4A). Excess numbers of small lymphatic channels were also present, along with diffuse fibrosis (Fig. 4B and C). The lymphatic endothelium was highlighted by a D2-40 (podoplanin) immunostain (Fig. 4D).