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Gazzetta Medica Italiana Archivio per le Scienze Mediche 2013 October;172(10):781-9

Copyright © 2013 EDIZIONI MINERVA MEDICA

language: Italian

Loose mesothelial cysts of the peritoneum and of the round ligament: laparoscopic treatment of two cases and review of literature

Gava G. ¹, Gava S. ²

¹ Divisione di Ostetricia e Ginecologia, Ospedale Villa Salus, Mestre, Venezia; ² Divisione di Ostetricia e Ginecologia, U.O.C. Clinica Ginecologica e Ostetrica Università degli Studi di Padova, Padova, Italia

Benign cystic mesothelioma is a rare, definite hystological disease generally occurring in women of reproductive age. It can affect the peritoneal structures covered by peritoneus, less commonly the pleural cavity or the pericardium, or extra-peritoneal areas that have been covered by peritoneus in the embryonal stage, like the inguinal canal. Two cases of peritoneal benign cystic mesothelioma are presented. The first case involved a 20-year-old woman; a pelvic ultrasound revealed the possible presence of ascites. The patient suffered from moderate non-specific abdominal pain. A diagnostic laparoscopy showed two loose pelvic cysts (450 ml) who appeared saccular, translucent, flaccid, smooth surfaced. Cysts were not attached to the pelvic or abdominal peritoneus, therefore they were just removed using a laparoscopic bag. Histologic study confirmed: benign cystic mesothelioma with squamouse metaplasia. The second case affected a 24-year-old asymptomatic patient. The ultrasound diagnosis was a possible left ovaric cyst. Laparoscopy revealed more than 8 free-floating cysts in the Douglas cavity (ca. 750 ml in total). One cyst with a diameter of 5 cm, together with smaller ones sized few millimeters, were attached to the right round ligament of the peritoneus, next to the inguinal canal, with a 2 cm-long and 1-2mm thick cord generating cysts. A small cyst was found at the beginning of the inguinal canal, lying on the round ligament. Laparoscopic treatment removed all cysts, both loosed and attached to the round ligament. Finally the peritoneus of the cord and cyst attachment area was diathermocoagulated. Histological analysis diagnosed benign cystic mesothelioma. This latter case may represent a connecting bridge between inguinal and peritoneal forms. Benign multicistic mesotelioma is a rare lesion of unknown pathogenesis and evolution, and no uniform treatment strategy. Literature on this topic is reviewed.