Laparoscopic Removal of a Mesothelial Cyst of the Greater Omentum: Clinical Case

Introduction. Abdominal mesothelial cyst (AMC) is a type of mesenteric cysts of mesothelial origin. In patients with AMC and a history of diverticular disease, differential diagnosis is extremely difficult and requires the use of a correct diagnostic algorithm.

Materials and methods. A case of a 39-year-old patient with a cystic mass of the greater omentum is presented. The preliminary diagnosis was made on the basis of an ultrasound examination and an abdominal CT scan with intravenous contrast.

Results. The patient underwent a laparoscopic removal of the cystic mass of the greater omentum. The intraoperative findings confirmed the presence of a clearly defined cystic tumor originating from the greater omentum. The histologic study yielded the following macroscopic description: a thin-walled mass of gelatinous consistency, round in shape, and 8.5 cm in diameter. The outer surface was shiny and translucent, with a vascular pattern, a small amount of fatty tissue, and reddish-brown hemorrhages. The contents of the cyst were yellowish in color. The inner surface was translucent with white strands and a vascular pattern. The wall thickness varied from 0.1 to 0.3 cm. The microscopic description was as follows: fragments of adipose tissue with layers of fibrous tissue, that are lined with mesothelium in some areas. The morphology does not contradict the diagnosis of a cyst of the greater omentum.

Discussion. The described clinical case demonstrated that in patients with AMC and a history of diverticular disease, differential diagnosis is extremely difficult and requires the use of a correct diagnostic algorithm. A thorough preoperative preparation and surgical risk assessment allowed a laparoscopic surgical procedure to be performed.

Conclusion. The clinical case demonstrates that for such neoplasms, surgeons should give preference to laparoscopic access. It is also necessary to conduct a thorough differential diagnosis prior to surgery.

1. de Perrot M., Bründler M., Tötsch M., Mentha G., Morel P. Mesenteric cysts. Toward less confusion? Dig Surg. 2000;17(4):323–8. DOI: 10.1159/000018872

2. Kochukov V.P., Lojkevich A.A., Ostroverhova E.G., Popova I.E., Losovator A.L., Bunin I.B. Cyst of the greater omentum. Difficult Patient. 2012;10(1):34–5 (In Russ.).

3. Prior-Rosas J.E., Mejía-Ruíz B., Magdaleno-Becerra B.A., Nava-Tenorio C.G., Alonso-Domínguez S.M., Botello-Ortiz G.E. Giant benign mesenteric cysts (mesothelioma and lymphangioma): A report of two cases. Int J Surg Case Rep. 2024;125:110587. DOI: 10.1016/j.ijscr.2024.110587

4. Stoupis C., Ros P.R., Abbitt P.L., Burton S.S., Gauger J. Bubbles in the belly: imaging of cystic mesenteric or omental masses. Radiographics. 1994;14(4):729–37. DOI: 10.1148/radiographics.14.4.7938764

5. Tsopozidi M., Kepertis C., Godosis D., Mouravas V., Demiri C., Spyridakis I. Laparoscopic-assisted excision of a huge polycystic omental lymphangioma in a 3 year old patient presenting with acute abdomen: case report and review. Pan Afr Med J. 2021;38:228. DOI: 10.11604/pamj.2021.38.228.26607

6. Abebe D.M., Nureta T.H., Gima T. A rare case of huge intra-abdominal cystic lymphangioma arising from rectovesical pouch; a case report. Int J Surg Case Rep. 2023;106:108275. DOI: 10.1016/j.ijscr.2023.108275

7. Alqurashi H.E., Alaryni A.A., Alsairafi R.A., Alharbi A.M., Alaqla A.A. Mesenteric cyst: a case report. Cureus. 2023;15(1):e34325. DOI: 10.7759/cureus.34325

8. Azimi B., Bagherian Lemraski S., Kouchak Hosseini S.P., Khoshnoudi H., Aghaei M., Haghbin Toutounchi A. Small bowel volvulus and mesenteric ischemia induced by mesenteric cystic lymphangioma in an adult and literature review; a case report. Int J Surg Case Rep. 2023;105:108083. DOI: 10.1016/j.ijscr.2023.108083

9. Shayesteh S., Salimian K.J., Fouladi D.F., Blanco A., Fishman E.K., Kawamoto S. Intra-abdominal lymphangioma: A case report. Radiol Case Rep. 2020;16(1):123–7. DOI: 10.1016/j.radcr.2020.10.052

10. Gagliardi F., Lauro A., Tripodi D., Amabile M.I., Palumbo P., Di Matteo F.M., et al. Mesenteric cyst with GI symptoms: a fluid approach to treatment—case report and literature review. Dig. Dis. Sci. 2022;67(3):786–98. DOI: 10.1007/s10620-021-07352-0

11. Mahfoud H., Flissate F., Tligui S., Benammi S., Etber A., Baidada A. Mesenteric cystic lymphangioma misdiagnosed as ovarian cyst in a 63-year-old female: a case report and review of literature. Int. J. Surg. Case Rep. 2024;120:109846. DOI: 10.1016/j.ijscr.2024.109846

12. Kogo H., Matsumoto S., Uchida E. Single-port laparoscopic-assisted resection for a large abdominal cystic lymphangioma: a case report. Surg Case Rep. 2018;4(1):92. DOI: 10.1186/s40792-018-0501-9

13. Hamaguchi Y., Arita S., Sugimoto N., Inamoto O., Takagi H., Kogire M., et al. Laparoscopic resection of abdominal cystic lymphangioma derived from lesser omentum: Case report. Medicine (Baltimore). 2020;99(1):e18641. DOI: 10.1097/MD.0000000000018641

14. Chew B.J.W., Khare M.M. Intra-abdominal cystic lymphangioma. J Pediatr. 2019;205:288. DOI: 10.1016/j.jpeds.2018.09.034

15. Yacoub J.H., Clark J.A., Paal E.E., Manning M.A. Approach to cystic lesions in the abdomen and pelvis, with radiologic-pathologic correlation. Radiographics. 2021;41(5):1368–86. DOI: 10.1148/RG.2021200207

16. Hoang V.T., Nguyen M.D., Van H.A.T., Hoang D.T. Review of diagnosis, differential diagnosis, and management of retroperitoneal lymphangioma. Jpn J Radiol. 2023;41(3):283–301. DOI: 10.1007/s11604-022-01356-0

17. Maranna H., Bains L., Lal P., Bhatia R., Beg M.Y., Kumar P., et al. Cystic lymphangioma of the greater omentum: a case of partial spontaneous regression and review of the literature. Case Rep Surg. 2020;2020:8932017. DOI: 10.1155/2020/8932017

18. Namikawa T., Shimizu S., Yokota K., Tanioka N., Munekage M., Uemura S., et al. Cystic lymphangioma of the greater omentum treated by laparoscopic resection. Clin J Gastroenterol. 2021;14(4):1004–7. DOI: 10.1007/s12328-021-01404-8

19. Li Y.-Y., Wang Q., Zhu J. Mesenteric cystic lymphatic malformation: a rare case report and review of the literature. AME Case Rep. 2024;8:23. DOI: 10.21037/acr-23-143

20. Chand M.T., Edens J., Lin T., Anderson I., Berri R. Benign multicystic peritoneal mesothelioma: literature review and update. Autops Case Rep. 2020;10(3):e2020159. DOI: 10.4322/acr.2020.159

21. Li Y.-Y., Wang Q., Zhu J. Mesenteric cystic lymphatic malformation: a rare case report and review of the literature. AME Case Rep. 2024;8:23. DOI: 10.21037/acr-23-143

22. Takeda A., Ito H., Nakamura H. Large omental cystic lymphangioma masquerading as mucinous ovarian neoplasia in an 8-year-old premenarchal girl: the findings from diagnostic imaging and laparoscopic-assisted excision. J Pediatr Adolesc Gynecol. 2017;30(6):659–62. DOI: 10.1016/j.jpag.2017.06.003

23. Ellis C.L., Banerjee P., Carney E., Sharma R., Netto G.J. Adrenal lymphangioma: clinicopathologic and immunohistochemical characteristics of a rare lesion. Hum Pathol. 2011;42(7):1013–8. DOI: 10.1016/j.humpath.2010.10.023

24. Chin C.C., Shiau J., Luo C.W., Hou M.F. Lymphangioma of small bowel in adults: A rare cause of abdominal symptoms. Asian J Surg. 2023;46(2):863–7. DOI: 10.1016/j.asjsur.2022.09.013