Chylous Mesenteric Cyst Research Articles

Not Your Typical Cyst: A Periduodenal Chylous Cyst Diagnosed via Endoscopic Ultrasound

Chylous mesenteric cysts represent a subgroup of uncommon, mostly benign intra-abdominal masses often identified incidentally on radiographs. Diagnosis is often challenging because these lesions cannot be reliably distinguished from hematomas or other cystic lesions without direct tissue sampling. In addition, data remains scarce regarding nonsurgical diagnostic and therapeutic options for these cysts. This case describes an endoscopic option for a uniquely located chylous cyst.

Laparoscopic Management of Acutely Symptomatic Chylous Mesenteric Cyst

Laparoscopic Management of Acutely Symptomatic Chylous Mesenteric Cyst

Amyand\u2019s hernia associated with mesenteric chylous cyst in infant: a rare case report

BackgroundAmyand’s hernia is a rare condition approximately 0.4–0.6% of all inguinal hernias. Although rare, the Amyand’s hernia is worthy of discussion since the variable presentation that make clinical challenge to diagnose especially in infant. A mesenteric chylous cyst is rare disease and has not been reported in Amyand’s hernia.Case presentationWe report an unusual case of Type II Amyand’s hernia with an enlarging chylous mesenteric cyst on the retrocaecal in the anulus into canalis inguinalis. A-2-months old infant presented with enlarging mass in the right scrotal. During laparotomy exploration, we found inguinal sac with intestinal and appendix content in the sac. In the edge site of the sac we found enlarging of mesenteric cyst on the retrocaecal in the anulus into canalis inguinalis. Based on the histopathology examination, the morphological feature is suitable for mesenteric chylous cyst appearance.ConclusionPresentation of mesenteric chylous cyst is rare, and there was no report about it in Amyand’s hernia. This unusual presentation should be considered by the surgeon, especially pediatric surgeon, in Amyand’s hernia cases.

Mesenteric and retroperitoneal chylus cyst in a neonate: unusual case report

We are reporting an unusual case of diffuse chylous mesenteric cyst extending to the retroperitoneum in a neonate. The lump was unresectable as it was diffuse and mesenteric vessels traversed through it. The child was followed till one year of age and is asymptomatic. Repeat imaging shows persistence of the cysts.

Ideal treatment strategy for chylous mesenteric cyst: a case report

BackgroundA mesenteric chylous cyst is defined as a cyst occurring in the mesentery of the gastrointestinal tract anywhere from the duodenum to the rectum and is diagnosed most often during the fifth decade of life.Case presentationIn our case report, we describe a case of 38-year-old Greek woman who presented at our Emergency Department complaining of abdominal pain without any other symptoms. Her medical and family histories were clear and she had never had any abdominal interventions. During an imaging examination with ultrasound of her abdomen, an anechoic lesion in her upper left abdomen was revealed. In a further investigation with computed tomography, a well-defined hypodense cystic 7.08 × 6.05 cm mass with mild enhancement was noted. The mass was excised by open laparotomy within healthy borders and the specimen was sent for pathological examination. The histopathological findings were found to be most consistent with a simple lymphatic (chylous) cyst of the mesentery. A review of the literature considering this rare entity was also performed to evaluate our treatment strategy and the result was analyzed.ConclusionsChylous cysts represent a diagnostic challenge and they should be considered when a physician encounters an intraabdominal mass. Physical examination and imaging do not always provide a diagnosis and surgical management should be advised due to the potential complications that may develop.

A Chylous Mesenteric Cyst Masquerading as a Pancreatic Mass

A 51 year-old male was referred for further evaluation of an incidental finding of a large cystic mass inferior to the uncinate process of the pancreas and anterior to the 3rd portion of the duodenum. The cystic mass was initially noted on a CT pyelogram ordered to evaluate microscopic hematuria. His past medical history was remarkable only for morbid obesity; he had no history of abdominal surgery or alcohol abuse. He reported feeling well and specifically denied fevers, chills, night sweats, weight loss, nausea, vomiting, abdominal pain, and diarrhea. A comprehensive metabolic panel and complete blood count were unremarkable. Further imaging with MRCP/MRI of the pancreas showed a T2 hyperintense, microlobulated, multiseptated, and multi-cystic mass measuring 6.0 x 5.1 x 3.6 cm overall with the largest cystic component measuring about 3 cm in size. The mass was centered at the third portion of the duodenum but also in close proximity to the tip of the uncinate process with lack of a fat plane between the uncinate process and the mass. It appeared to partially surround and cause mild narrowing of the third portion of the duodenum. There was no demonstrated communication between the mass and the pancreatic duct. The patient subsequently underwent endoscopic ultrasound (EUS) with fine-needle aspiration, during which 18 mL of milky-white fluid was aspirated from the largest cyst. Analysis revealed fluid CEA 27.3 ng/mL, amylase 47 U/L, and triglycerides 6162 mg/dL. Cytology showed scant lymphocytes and macrophages in a background of acellular debris with no malignant cells identified. This case exemplifies the rare but fascinating diagnosis of a chylous mesenteric cyst. A recent review found only 19 cases reported in the literature since 1980. This review noted an average age of 46, a slight male predominance (1.4:1), and many cases were discovered incidentally in asymptomatic patients. Surgical resection has been the mainstay of treatment, but there is no clear evidence of malignant potential and overall prognosis appears to be good. This case also demonstrates the utility of EUS as a minimally invasive diagnostic tool in the initial evaluation of intra-abdominal cystic lesions. Our patient remained asymptomatic following his diagnosis and we plan periodic surveillance with MRI given the limited information regarding the natural history of these lesions.

A Case of a 4-Year-Old Boy with a Mesenteric Chylous Cyst Infected with Histoplasma capsulatum.

Mesenteric cysts are uncommon entities and chyle- (lymph-) containing cysts are the rarest of this group. This is a case report of a 4-year-old boy with a mesenteric chylous cyst who was later found to have Histoplasma capsulatum infection.

Chylous mesenteric cyst: A diagnostic dilemma

A mesenteric cyst is defined as a cyst that is located in the mesentery of the gastrointestinal tract and may extend from the base of the mesentery into the retroperitoneum. A case report of a patient with mesenteric cyst is presented. In addition, a systematic review was performed of English language literature on chylous mesenteric cysts in adult humans. Of the 18 articles included in the review, there were 19 cases of chylous mesenteric cysts reported. Male to female ratio was 1.4:1 with a median age of 46 years. Apreoperative diagnosis of mesenteric cyst was made in four patients based on computed tomography. All patients underwent surgery and there were no reports of recurrence on follow up. Chylous mesenteric cyst is a rare entity that needs to be recognized whenever a preliminary diagnosis of intra-abdominal cystic mass is made.

A case of chylous mesenteric cyst: unusual presentation

Background: Chylous mesenteric cyst is a rare entity with variable clinical presentations and possible surgical implications in pediatric age group. Constipation and thick fibrous wall with thin endothelial lining are rarely reported as first clinical presentation and commonest histologic appearance in pediatric patients, respectively. Case presentation: We herein report the case of a 9-year-old male patient presented with an abdominal mass and constipation. Abdominal ultrasonography and computed tomography revealed a well-defined large cystic mass extending to the right abdominal cavity. Laparotomy and histopathology of the excised mass confirmed the diagnosis of chylous mesenteric cyst. Conclusion: To our knowledge, this is the first reported case worldwide as well as in Lebanon with such unusual presentation in pediatric patient. Ultrasonography and CT scan suggest the diagnosis; however, histopathology is often required for confirmation. Complete excision of the cyst yields excellent results.

Mesenteric Chylous Cyst Diagnosed in an Adult with Endoscopic Ultrasound and Fine Needle Aspiration

Mesenteric Chylous Cyst Diagnosed in an Adult with Endoscopic Ultrasound and Fine Needle Aspiration

Chylous mesenteric cysts in children

To evaluate the clinical features, diagnosis, and treatment of chylous mesenteric cysts (CMCs) in children. We analyzed retrospectively the clinical records of 10 children with a CMC, treated in the Department of Pediatric Surgery, West China Hospital of Sichuan University, between 1987 and 2008. This series comprised five girls and five boys. The CMC manifested as abdominal distention (n = 9), acute abdomen (n = 8), or an asymptomatic abdominal mass (n = 1), and included five mesojejunal cysts and five mesoileal cysts. Intestinal volvulus occurred in four patients with mesoileal cysts and acute chylous effusion occurred in two patients with mesojejunal cysts. All ten children were treated surgically. The cystic content was positive for Sudan III staining and the chylous test. Chylous mesenteric cysts manifest as an abdominal mass, abdominal distention, and/or acute abdomen more often in children than in adults. The clinical presentation suggests some association with the localization of the cysts. A good prognosis can be expected with removal of the cyst and the affected intestinal segment.

Mesenteric Chylous Cyst

Mesenteric cysts are uncommon and mesenteric chylous cysts are extremely rare. The most common presenting symptoms are abdominal pain and abdominal distention. We report two cases of mesenteric chylous cyst in a young man and a young woman. Pre-operative, intra-operative and histological findings are discussed.

Laparoscopic Treatment of a Huge Mesenteric Chylous Cyst

Mesenteric chylous cysts are rare pathologic entities that often present with unspecific symptoms. The preoperative diagnosis requires all the common abdominal imaging techniques, but usually the correct diagnosis may be made only at the operation stage or during the histological examination. The treatment of choice is the complete surgical excision that may be safely performed by laparoscopy. A 58-year-old man underwent laparoscopic excision of a huge mesenteric chylous cyst. The technique entails the perfect control of the major abdominal vessels running near the tumor and the complete sealing of the chylous and blood vessels to and from the cyst.

Chylous Mesenteric Cyst in Asymptomatic 60 Year-Old Woman

Purpose: 60-year-old female presented for further evaluation of a large mesenteric cyst noted incidentally on routine abdominal CT scanning performed during a preoperative evaluation for elective kidney donation. Clinically, she denied gastrointestinal symptoms. Past medical history was significant for recurrent episodes of diverticulitis, and hyperlipidemia. No prior history of pancreatitis. No significant family history of malignancy. Past surgeries included a transabdominal hysterectomy and three caesarean sections, all greater than twenty years prior to the current presentation. She reported two motor vehicle accidents in the remote past associated with unspecified abdominal trauma, managed conservatively. Labs showed normal hemoglobin, electrolytes, TSH, and liver function tests. Abdominal CT scan showed a 6.7 × 2.6 multilobulated, septated cystic lesion at the mesenteric root, inferior to the third portion of the duodenum, interpreted as a mesenteric cyst or potentially enteric cyst. The patient underwent endoscopic ultrasound guided biopsy of the mesenteric cyst. Cytology from multiple fine-needle aspirates was negative for malignancy, but showed abundant histiocytes and chronic inflammation. No epithelial cells were present. Approximately 10 cc of milky yellow fluid was aspirated from the cyst. CEA and CA 19-9 levels from the cyst fluid were unremarkable, but revealed elevated cholesterol and triglycerides, 256 mg/dL and 1131 mg/dL, respectively, consistent with a mesenteric chylous cyst. Discussion Mesenteric cysts are rare and frequently cause abdominal pain, distension, or intestinal obstruction due to the mass effect. Chylous mesenteric cysts, notably, are exceedingly rare with few case reports in the literature. Constitutional symptoms of malaise, fatigue, fever, and weight loss may develop though are infrequent. Mesenteric cysts are often large in size, cause acute or chronic symptoms, though have a very low malignant potential and associated morbidity. Underlying etiologies include congenital malformations and scarring of the mesenteric lymphatics due to chronic inflammatory states e.g. mesenteric panniculitis. Cysts are generally unilocular though may present with multiple loculations and, most importantly, lack solid components. Surgical excision is the recommended therapy in clinically symptomatic patients. Cyst drainage alone is not recommended, due to the high frequency of recurrence. Given the absence of clinical symptoms in this case, a conservative approach with observation was recommended.

Chylous cysts of the mesentery

Mesenteric cysts are uncommon lesions with a variable clinical presentation. A provisional diagnosis is possible on clinical and radiological grounds, while confirmation is subject to histopathological examination. We present two cases of mesenteric cysts, both occurring in children. Following clinical examination and histopathological analysis, both were diagnosed as cases of chylous mesenteric cysts.

Gorlin syndrome presenting as prenatal chylothorax in a girl

Gorlin syndrome (GS), also known as nevoid basal cell carcinoma syndrome, is a rare autosomal dominant condition with an estimated prevalence of 1:57 000. GS is associated with congenital malformations and predisposition to neoplasms. The main features observed in patients with GS are basal cell carcinomas, odontogenic keratocysts, skeletal anomalies including scoliosis and bifid ribs, palmar and plantar epidermal cysts, facial dysmorphism, and cerebral falx calcification. More than 100 other clinical manifestations have also been described in the literature including ovarian fibroma, enlarged cerebral ventricles, and lymphatic as well as chylous mesenteric cysts. The Patched (PTCH) gene is responsible for GS when mutated. Here, we report on a prenatal diagnosis of GS in a girl with a chylothorax, a previously unreported feature in GS. We discuss the clinical features observed in this family and we comment on the molecular studies that allowed us to describe a previously unreported Patched gene mutation.

A CASE OF ADULT MESENTERIC CHYLOUS CYST

A 38-year-old woman was seen at the hospital because of abdominal pain and fever. Abdominal ultrasonography and CT revealed an abdominal cyst. Exploratory laparotomy was performed. During the surgery the cyst was diagnosed as mesenteric cyst and extripated. Pathologically a single cystic tumor with cystic lymphatic dilatation, lymphatic proliferation and focal lymphatic infiltration were observed. The cyst was filled with milky whitish mucinous liquid. The definitive diagnosis of mesenteric chylous cyst was made. Adult mesenteric cysts, especially mesenteric chylous cysts are relatively rare. This paper describes such a case with a review of literature.

A CASE OF LARGE MESENTERIC CHYLOUS CYST

A mesenteric chylous cyst is a rare disorder, and it is difficult to diagnose preoperatively because of lack of unique symptoms and definitive diagnostic test. In Japan 39 cases of mesenteric chylous cysts have been reported in the past. This paper presents a case of large mesenteric chylous cyst. An 18-year-old man visited his home doctor because of an abdominal fullness which gradually enlarged for several month. This patient was pointed out abdominal tumor and referred to the hospital. Abdominal ultrasonography, abdominal CT, magnetic resonance image, and abdominal angiography were conducted, and the tumor was diagnosed as mesenteric chylous cyst arising in an area from the ventral mesogastrium to parietal peritoneum. Laparotomy was performed. The cyst occupied entire the abdomen and strongly opressed the other organs, but there was no communication with the small intestine or lymph channel. It was able to be excised completely. There has been no sign of recurrence, as of about one year after the operation.

Mesenteric cyst with atypical computed tomography appearance

A case of mesenteric chylous cyst containing an unusual fluid-fluid level demonstrated on computed tomography but not on ultrasonography is presented.

Chylous cysts of the mesentery in infants

Summary Isolated mesenteric cysts form an interesting and rare group of abdominal tumors. They are presumed to arise from congenital bits of lymphatic tissue misplaced in the mesentery. A relatively small proportion of the total number of the mesenteric cysts contain chyle. These cysts may be found at any age and are relatively unusual in infancy. They present with abdominal swelling, occasional bouts of pain and nausea, and may rarely cause intestinal obstruction. Two cases of chylous mesenteric cysts in infancy are reported here. In one the cyst was an incidental finding in a case of malrotation and volvulus; in the second the cyst caused acute intestinal obstruction. Both cases were successfully managed by excision of the mesenteric cyst without intestinal resection.