Table 2 Published reports on the cases with idiopathic or primary retroperitoneal pseudocyst
From: An asymptomatic huge primary retroperitoneal pseudocyst: a case report and review of the literature
Year and Country | Sex/ Age | Chief Complaints | Physical Examination | Ultrasound, magnetic resonance (MR) imaging, and other radiological findings | CT scan findings | Surgery | Pathology | |
|---|---|---|---|---|---|---|---|---|
1 | Japan, 1978 [7] | F/54 | The patient was hospitalized for the management of diabetes mellitus | A solid mass was felt in the left upper quadrant at an abdominal examination | An abdominal scout film and excretory urography showed a grape-fruit sized mass unrelated to the urinary tract | Not mentioned | The tumor removed was 7 × 6 × 8.5 cm in size, and 240 g in weight | The content of the tumor was gray necrotic material. The histology revealed a fibrous capsule and degenerative material containing cholesterin crystals |
2 | India, 1995 [8] | F/3 | A mass in the left side of the abdomen noticed by the parents 10 days prior to the admission | A well-defined, non-tender, irregular mass in the left lumbar region with restricted mobility | Ultrasound: Multi-cystic retro-peritoneal mass anterior to left kidney that displaced the left kidney upward | Not mentioned | Exploration, completely excision of the cyst | The absence of an epithelial lining, the wall was composed of collagen and fibrin with inflammatory-cell infiltration, a retroperitoneal pseudocyst |
3 | Spain, 1996 [9] | M/48 | Dysuria and urinary frequency | On digital rectal examination, a right-side mass was detected | 1. Endo-rectal ultrasound showed a 13-cm well-defined retro-rectal mass with posterior acoustic enhancement, 2. A barium enema showed the compression of the rectum, without mucosal changes or communication between the cyst and the rectum lumen | A pre-sacral cystic mass with thin walls and peripheric calcifications. The rectum was displaced anteriorly | A cystic pelvic mass surrounded by fat was resected | Brownish fibrous tissue without epithelium in the wall |
4 | India, 2007 [4] | F/80 | Vague ‘dragging’ pain in the left upper quadrant | A large mass in the left hypochondrium, mobile and non-tender | Ultrasound: A large retroperitoneal, cystic mass, 19 × 17 cm with a calcified wall | CT scan of the abdomen confirmed the ultrasound findings | Laparoscopic excision, four ports | No lining epithelium, extensive calcification and chronic inflammatory cells, primary retroperitoneal pseudocysts |
5 | UK, 2008 [10] | M/51 | Right-sided abdominal pain for three days, jaundice, fever | jaundice, fever | Fluid collection/mass measuring 14 cm in the right hepato-renal space, separated from the liver, pancreas and the right kidney, lack of definition of the right suprarenal gland | As the same finding as sonography | 1.150 ml brown-colored fluid was aspirated from the mass under CT guidance, 2. laparotomy for excision of the mass and right adrenalectomy | Normal adrenal gland was adherent by fibrous tissues to the external wall of the cyst, but the cyst was not arising from the adrenal. The cyst wall consisted of a thick layer of fibrous tissues which showed focal calcifications and areas of acute and chronic inflammation, no epithelial lining, granulation tissue as a part of the lining of the cyst, idiopathic benign retroperitoneal cyst |
6 | USA, 2009 [11] | M/59 | Sudden onset of left upper quadrant abdominal pain, nausea, and vomiting | Involuntary guarding, rebound, and tenderness over the epigastrium and left upper quadrant | 1. Ultrasound was not mentioned, 2. MR imaging showed dynamic fat-suppressed T1-weighted image following intravenous gadolinium injection and enhancement of the wall of the cystic mass | A 5.0 × 3.8 cm, well marginated, rounded mass in the left upper quadrant, within the small bowel mesentery | Elective exploratory laparotomy | The cyst wall was lined by fibrous tissue, with no evidence of an endothelial lining, and showed chronic inflammation with lipid clefts and calcification, which are indicative of prior rupture (a non-pancreatic pseudocyst of the mesentery that had undergone focal rupture) |
7 | Poland, 2011 [6] | F/27 | Abdominal discomfort | A vague right side abdominal, non-tender mass | Not mentioned | A huge, unilocular, right-sided retroperitoneal cystic mass, unknown origin, well-demarcated margins, extending from the liver to the pelvis, dislocations of the right kidney and adrenal gland | Laparotomy, exploration, and totally excision of the cyst | Absence of an epithelial lining, dense connective tissue with focal inflammatory cell infiltration primary retroperitoneal pseudocyst |
8 | Taiwan, 2012 [5] | M/43 | Progressive lower abdominal pain, abdominal distension and frequent urination | A large mass in the lower abdomen, soft, fixed, and non-tender | Not mentioned | A large thick-walled retroperitoneal cyst compressing the bladder | Laparotomy, vertical midline incision, peritoneal approach | Dense fibrous tissue with no epithelial lining, non-pancreatic pseudocyst |
9 | India, 2013 [12] | M/76 | Abdominal pain over the right upper quadrant and constipation | A mass effect protruding out of the right mid-abdomen, measuring 15 × 15 cm, non-tender, non-mobile and not moving with respiration | Not mentioned | A large well defined thin-walled cystic lesion measuring 10.3 × 13.9 × 14.3 cm in the right lumbar and iliac region without calcification or hemorrhage | The cyst was excised in toto after separating it from the duodenum, transverse colon, and the ureter | Absence of epithelia and was reported as pseudocyst |
10 | China, 2016 [13] | F/27 | Presented with the discovery of a cyst in the left upper quadrant of six years duration and abdominal distention of ten days | On visual inspection of the abdomen, there was a mass effect protruding out of the left upper abdomen. Abdominal physical examination revealed a large mass was non-mobile and non-tender | 1. Ultrasound: A large retroperitoneal, cystic mass measuring 11 cm × 14 cm with a thick wall, 2. MRI of the abdomen confirmed the ultrasound findings | A contrast-enhanced CT scan of the abdomen confirmed the ultrasound findings | Four ports laparoscopy, with puncture and aspiration of the cyst, then a complete excision of the cyst using a combination of blunt and sharp dissection | The cyst wall was devoid of lining epithelium with extensive inflammatory cells and multinucleate giant cells, confirming the diagnosis of a pseudocyst |
11 | The UK, 2016 [14] | M/70 | Bilateral reducible groin swellings | Incidental finding of a large right-sided cystic mass below the liver edge. This was noted clinically when the patient was on the table and was confirmed laparoscopically | Not mentioned | A unilocular, cystic lesion, 22 × 20 × 19 cm arising from within the right side of the abdomen | Laparotomy and excision of the cyst using both blunt and sharp dissection | The cyst wall was lined by foamy macrophages and fibrin, with some chronic inflammation in the wall. An epithelial or mesothelial lining was absent, a benign non-pancreatic pseudocyst |
12 | India, 2019 [15] | M/53 | Abdominal distension, pain, reduced appetite, and intermittent fever | Tachycardia, mild tachypnea, and had tenderness in the epigastric region with a palpable lump in the epigastrium, right hypochondrium and extended into the right iliac fossa | Ultrasound: A large cystic lesion in the epigastrium | A large cystic lesion in close vicinity of the pancreatic head and neck, extending into sub-hepatic space, pushing the transverse colon down and reaching up to the right iliac fossa | 1. EUS guided cystogastrostomy with the placement of SEMS, 2. Laparotomy due to failure of symptomatic resolution after endoscopic management, a right subcostal incision (A Cattell-Braasch maneuver) | Cyst lined by a fibrino-purulent exudate, and no epithelial lining, wall contained proliferating granulation tissue and fibroblasts, chronic inflammation |
13 | Australia, 2019 [16] | M/55 | An incidental finding on CT of a’large adrenal mass’ | Not mentioned | Not mentioned | An incidental 40 × 32 mm mass positioned adjacent to the medial border of the spleen, and the left adrenal gland | An elective laparoscopy | A non- pancreatic fibrous pseudocyst, a thick calcified wall, the absence of epithelial lining, and widespread inflammatory change |
14 | Qatar, 2020 (3) | M/49 | Right iliac fossa pain, constipation | The abdomen was non-tender, non-distended, and soft to touch, no definite mass palpated | Not mentioned | A 7 × 6 cm cystic lesion, incomplete peripheral calcification in the pelvis | Laparoscopic cyst excision | No epithelial or endothelial lining, idiopathic retroperitoneal non-pancreatic pseudocyst |
15 | Iran, 2020 (current study) | M/67 | Mild abdominal discomfort for 3 months | The abdomen was non-tender, non-distended, and soft to touch, no definite mass palpated | Ultrasound: A large retroperitoneal, cystic structure measuring 135 × 88 mm in mid-line position in the level of bifurcation of the aorta | A well-defined huge (140 × 120 mm), unilocular, thickened wall cystic structure within the left hemi-pelvic cavity with pressure effect over recto-sigmoid, lower rectus muscle, and urinary bladder | Laparotomy, total excision | Benign cystic lesion with no epithelial lining, a primary non-neoplastic retroperitoneal pseudocyst |