A peritoneal inclusion cyst is a cyst-like structure that appears in the pelvis due to non neoplastic reactive mesothelial proliferation, often as a consequence of prior episodes of pelvic inflammation, as can occur in pelvic inflammatory disease. It has the potential to mimic ovarian cysts, hydrosalpinx or even malignancy, due to its nonspecific anechoic appearance.[1]
| Peritoneal inclusion cyst | |
|---|---|
| Other names | Benign multicystic peritoneal mesothelioma |
 | |
| Peritoneal inclusion cyst | |
| Specialty | Dermatology |
Signs and symptoms
editThe most common symptoms of a peritoneal inclusion cyst are persistent abdominal or pelvic pain and a subjectively palpable abdominal mass.[2] Often, a physical examination reveals no palpable mass in the abdomen or pelvis.[3] The symptoms can last for days or months at a time.[4] Acute or chronic pelvic pain, back pain, dyspareunia, hernia, constipation, tenesmus, urinary frequency, urinary incontinence, anorexia, dysfunctional uterine bleeding, infertility, postmenopausal bleeding, and pulmonary embolism due to compression and venous stasis are some other reported presentations.[2]
Causes
editPeritoneal inclusion cysts are almost exclusively seen in premenopausal women who have had endometriosis, trauma, pelvic inflammatory illness, or previous abdominal or pelvic surgery.[5][6]
Diagnosis
editPeritoneal inclusion cysts are commonly visualized on ultrasonography as a spider-web-like pattern. A normal-looking ovary is encircled by a big, irregular or oval, echolucent cyst with fine internal septations. The ovary is frequently located in the middle of the inclusion cyst or on its lateral aspect, appearing to be dangling inside the cyst.[2] Peritoneal inclusion cysts appear as a cystic mass with regular or irregular boundaries on CT scans, including material that has fluid or hemorrhagic attenuation properties. Cystic lesions with low T1 signal and high T2 signal, consistent with serous fluid, are shown on MR imaging.[7]
Differential diagnoses for peritoneal inclusion cysts include mesothelial hyperplasia, non-granulomatous histiocytic lesions, granulomatous lesions, and Müllerian lesions, among other tumour-like peritoneal lesions.[8]
Treatment
editClinical symptoms determine the best course of treatment for peritoneal inclusion cysts.[9] When a patient is asymptomatic, ultrasonographic surveillance is recommended.[10] For chronic cysts, aspiration or drainage is a safe, less invasive treatment option.[9] When there is any suspicion of malignancy, surgical therapy in the form of a laparoscopy or laparotomy with full excision of the cyst is usually needed.[10][8]
References
edit- ^ Singh, A; Sehgal, A; Mohan, H (2015). "Multilocular peritoneal inclusion cyst mimicking an ovarian tumor: A case report". Journal of Mid-Life Health. 6 (1): 39–40. doi:10.4103/0976-7800.153648. PMC 4389384. PMID 25861208.
- ^ a b c Vallerie, Amy M.; Lerner, Jodi P.; Wright, Jason D.; Baxi, Laxmi V. (2009). "Peritoneal Inclusion Cysts: A Review". Obstetrical & Gynecological Survey. 64 (5): 321–334. doi:10.1097/OGX.0b013e31819f93d4. ISSN 0029-7828. PMID 19386139.
- ^ Amesse, Lawrence S.; Gibbs, Paul; Hardy, John; Jones, Kimberly R.; Pfaff-Amesse, Teresa (2009). "Peritoneal Inclusion Cysts in Adolescent Females: A Clinicopathological Characterization of Four Cases". Journal of Pediatric and Adolescent Gynecology. 22 (1). Elsevier BV: 41–48. doi:10.1016/j.jpag.2008.02.003. ISSN 1083-3188. PMID 19232301.
- ^ Weiss, S. W.; Tavassoli, F. A. (1988). "Multicystic mesothelioma. An analysis of pathologic findings and biologic behavior in 37 cases". The American Journal of Surgical Pathology. 12 (10): 737–746. doi:10.1097/00000478-198810000-00001. ISSN 0147-5185. PMID 3421410.
- ^ Sohaey, R; Gardner, T L; Woodward, P J; Peterson, C M (1995). "Sonographic diagnosis of peritoneal inclusion cysts". Journal of Ultrasound in Medicine. 14 (12). Wiley: 913–917. doi:10.7863/jum.1995.14.12.913. ISSN 0278-4297. PMID 8583527.
- ^ Koninckx, P. R.; Renaer, M.; Brosens, I. A. (1980). "Origin of Peritoneal Fluid in Women: An Ovarian Exudation Product". BJOG: An International Journal of Obstetrics & Gynaecology. 87 (3). Wiley: 177–183. doi:10.1111/j.1471-0528.1980.tb04514.x. ISSN 1470-0328. PMID 7387917.
- ^ Goldfisher, Rachelle; Awal, Divya; Amodio, John (2014). "Peritoneal Inclusion Cysts in Female Children: Pathogenesis, Treatment, and Multimodality Imaging Review". Case Reports in Radiology. 2014. Hindawi Limited: 1–5. doi:10.1155/2014/427427. ISSN 2090-6862. PMC 4131098. PMID 25143853.
- ^ a b Baker, Patricia M.; Clement, Philip B.; Young, Robert H. (2014). "Selected Topics in Peritoneal Pathology". International Journal of Gynecological Pathology. 33 (4): 393–401. doi:10.1097/PGP.0000000000000146. ISSN 0277-1691. PMID 24901399.
- ^ a b Pereira, Nigel (2019). "Postsurgical peritoneal inclusion cyst masquerading as a large pelvic mass". BMJ Case Reports. 12 (4). BMJ: e230066. doi:10.1136/bcr-2019-230066. ISSN 1757-790X. PMC 6506023. PMID 30996072.
- ^ a b Rapisarda, Agnese Maria Chiara; Cianci, Antonio; Caruso, Salvatore; Vitale, Salvatore Giovanni; Valenti, Gaetano; Piombino, Eliana; Cianci, Stefano (2018). "Benign multicystic mesothelioma and peritoneal inclusion cysts: are they the same clinical and histopathological entities? A systematic review to find an evidence-based management". Archives of Gynecology and Obstetrics. 297 (6): 1353–1375. doi:10.1007/s00404-018-4728-2. ISSN 0932-0067. PMID 29511797.
Further reading
edit- Veldhuis, Wouter B.; Akin, Oguz; Goldman, Debra; Mironov, S.; Mironov, O.; Soslow, Robert A.; Barakat, Richard R.; Hricak, Hedvig (2013). "Peritoneal inclusion cysts: clinical characteristics and imaging features". European Radiology. 23 (4): 1167–1174. doi:10.1007/s00330-012-2695-8. ISSN 0938-7994. PMID 23263602.
- Jain, Kiran A. (2000). "Imaging of Peritoneal Inclusion Cysts". American Journal of Roentgenology. 174 (6): 1559–1563. doi:10.2214/ajr.174.6.1741559. ISSN 0361-803X. PMID 10845480.