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Surgical images: soft tissue. Müllerian cyst of the upper abdomen: a lesion mimicking pancreatic cystadenoma.

2004; National Institutes of Health; Volume: 47; Issue: 5 Linguagem: Inglês

Hossein Shayan, David Owen, Garth L. Warnock,

Muscle and Compartmental Disorders

Mullerian cysts are rare retroperitoneal lesions, the majority of which occur in women. Most develop in the pelvis but a few involve the upper abdomen, manifesting as a mass at the tail of the pancreas. The cysts are large and often displace adjacent organs. Precise preoperative diagnosis is seldom possible. Surgical excision is curative, but many cysts are multilocular and may recur if removal is incomplete. Histologically the lining is epithelium, ordinarily ciliated but occasionally mucinous. The cyst wall usually includes some smooth muscle. Although uncommon, cystic lesions in the retroperitoneum are of 2 predominant types: epithelial cysts arising from large retroperitoneal organs, and cystic lesions originating from soft tissues of the retroperitoneum. Epithelial cysts arising from the pancreas and kidneys are relatively common. In rare cases such cysts may become detached from the organ, making the site of origin difficult to determine. Cystic upper-abdominal retroperitoneal lesions are difficult to diagnose; other cysts arising primarily from retroperitoneal connective tissues include lymphangiomas,1 mesothelial cysts (so-called cystic mesotheliomas),2 enterogenous cysts,3 urogenital cysts and cystic neoplasms such as teratomas or schwannomas. The overall incidence of retroperitoneal cysts is reported as anywhere from 1 in 5750 individuals to 1 in 250 000 (average, 1 in 105 000).4 Urogenital cysts are very uncommon. Upon histologic differentiation, such cysts may be subclassified as pro-, meso- or metanephric (mullerian) in type.5 In women, mullerian cysts may occur within the pelvis (where they clinically mimic ovarian lesions) or in the upper abdomen. They also occur in the pelvis in men, where they arise in association with embryologic remnants of the regressed mullerian (paramesonephric) duct system. Typical locations include the prostatic utricle6 and the appendix testis.7