Dr Lorna Woodbridge lornawoodbridgenhsnet Dr Naheed Mir Dr Katie Planche Royal Free Hospital London Clinical Information 34 year old MALE Urinary frequency urgency and dribbling No significant PMH ID: 928623
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Slide1
Unusual case of a cystic pelvic mass in a male
Dr Lorna Woodbridge (lorna.woodbridge@nhs.net)
Dr Naheed Mir
Dr Katie Planche
Royal Free Hospital, London
Slide2Clinical Information
34 year old
MALE
Urinary frequency, urgency and dribbling
No significant PMH
Slide3Initial Ultrasound –
August 2008
Figure 1- US of the pelvis shows a loculated fluid collection in the left side of the pelvis
Normal appearances of the kidneys and bladder
Slide4CT abdomen and pelvis –
October 2008
Figure 2 – axial post contrast CT images showing fluid density lesion in the pelvis with thin septae within it
Slide5MRI Pelvis - March 2009
Figure 3a – axial T2 image confirming a multicystic, high T2 lesion in the pelvis with thin septae.
Figure 3b – the same lesion is low on T1
Slide6MRI Pelvis - March 2009
Figure 4 – Small FOV angled T2 shows layering of debris within a cyst.
Slide7MRI Pelvis - March 2009
Figure
5a
– Sagittal
T2 showing
large multicystic pelvic mass encasing the vas deferens
Figure
5b
– Coronal T2 showing encasement of structures within the multicystic lesion
Slide8Sagittal T2
MRI - Sagittal T2 video
Slide9Coronal T2
MRI – Coronal T2 video
Slide10Diagnosis
Patient underwent resection and omentectomy in June 2009 and histopathology confirmed…
…
Benign multicystic
mesothelioma
Subsequent follow-up shows local recurrence which has been stable on repeat MRIs.
Slide11Learning Points:
Benign Multicystic Mesothelioma
Benign primary peritoneal tumour of mesothelial origin
Usually arises from pelvic peritoneal reflections but can arise from any peritoneal, pleural or pericardial lining cells
Debate as to origin – true neoplasm vs. reactive mesothelial proliferation
Rare malignant transformation
Slide12Benign Multicystic Mesothelioma
Clinical features:
Usually in women (84%) of reproductive age
Symptoms
: chronic lower abdominal/pelvic pain, palpable mass, constipation, urinary symptoms
Slide13Benign Multicystic Mesothelioma
Imaging findings:
US:
Multiseptated, cystic lesions
Cysts may contain debris or haemorrhage
CT/MRIC
haracterise extent of the massMultiple cysts – intermediate T1/high T2Septae show minimal enhancement
Encase other structures such as ovaries, vas
Slide14Benign Multicystic Mesothelioma
Histology:
Thin walled, serous filled, cysts lined with cuboidal mesothelial cells
CR and MC positive
Treatment and prognosis:
Ideally en-bloc resectionRecurs in 50%
Slide15Discussion:
Differential diagnosis for a cystic lesion in a male pelvis:
Pseudomyxoma peritonei
US: non mobile internal echos
Presence of omental cake, peritoneal nodules, +/ calcifications, scalloping of the liver and spleen
Mucocele of the appendix
In continuation with the appendixUS: low-level echos
CT: +/- calcification, cyst wall of variable thickness
Slide16Differential cont..
Lymphangioma
Multiple thin walled cysts containing chylous fluid, no enhancement, +/- calcification, easily indentable
Lymphocele
Post operative complication, unilocular, follow course of pelvic LNs
Loculated ascitesSeroma
Slide17References
Wang TB,
Dia
, WG, Liu DW, Shi HP, Dong WG. Diagnosis and treatment of benign multicystic peritoneal mesothelioma. World J
Gastroenterol
2013; 19(39):6689-92.Szklaruk J, Tamm E, Choi H, Varavithya V. MR imaging of common and uncommon large pelvic masses.
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Levy A, Shaw J, Sobin L. Secondary
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2009. 29:347-73.
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Nonovarian
cystic lesions of the pelvis.
Radiographics
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Levy A,
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L. Primary peritoneal
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: Imaging features with pathologic correlation.
Radiographics
2008. 28:583-607.