Cole P Rodman, MS, Sophia Roberts, Michael P Meara, MD, MBA, FACS. The Ohio State University Wexner Medical Center
Introduction: This is the case of a 24-year-old woman who presented with a large retroperitoneal mass which was found to be a primary retroperitoneal mucinous neoplasm. Such tumors are rare and less then 20 cases have been reported in the literature. Consequently, their histopathology is not well understood and preoperative diagnosis can often prove challenging. In this case the mass was initially diagnosed as a benign enteric duplication cyst. To our knowledge this is the only documented robotic removal of a retroperitoneal mucinous neoplasm.
Case Presentation: This is a twenty-four-year-old woman with an uncomplicated medical history complaining of right upper quadrant fullness and discomfort. After delivery of her second child in 2017, she subsequently noted a palpable mass in the right abdomen which became progressively more bothersome. Abdominal and pelvic CT scan obtained in January, 2018 showed a cystic mass in the right colic gutter suspicious for enteric duplication cyst. After four months of worsening symptoms, she decided to undergo resection in April, 2018.
The abdomen was accessed laparoscopically via the left upper quadrant and the cystic mass was identified. Electrocautery and blunt dissection were used to define the margins of the cyst and to free it from the surrounding retroperitoneum. The cyst was drained of all fluid with a laparoscopic aspiration needle prior to removal of the sac with an occlusive bag. After removal of the mass, all ports were removed and port sites were closed. The patient’s postoperative course was uneventful and she was discharged on the day of surgery in stable condition.
The pathology report indicated that the sample from the mass was consistent with a mucinous cystic neoplasm (MCN) with ovarian-type stroma. At follow-up one month after her surgery, the patient was well and only complained of occasional constipation.
Discussion: In addition to the rarity of extra-ovarian or extra-pancreatic, ovarian-type MCNs, as of this writing we are unaware of any case presentations of such tumors being managed robotically. The primary challenge of the case presented here was the radiologic and clinicopathologic similarity of this MCN and an enteric duplication cyst. In this case, the mass appeared as smooth and thin-walled with a single loculation. Ultimately, the diagnosis of MCN is postoperative, however we hope that the presentation of this case will serve as a reminder that care should be taken in the surgical approach to seemingly benign intrabdominal masses.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 96038
Program Number: P656
Presentation Session: Poster Session (Non CME)
Presentation Type: Poster