Gastrointestinal sistem kaynaklı konjenital nadir görülen kistik lezyonların histopatolojik değerlendirmesi

Öz

Amaç: Gastrointestinal sistem kaynaklı konjenital kistler oldukça nadir görülmektedir. Bu grupta mezenterik- omental kistler, enterik duplikasyon kistleri, meckel divertikülü/ omfalomezenterik duktus kistinden oluşmaktadır. Etyopatogenez, histopatoloji ve klinik özellikleri önemli ölçüde farklılık göstermektedir. Neoplastik kitleler ile ayırt etmede tanı zorluğuna neden olmaktadırlar. Bu çalışmada intrabdominal gastrointestinal sistem kaynaklı konjenital benign kistik lezyonların klinik, histopatolojik özellikleri ve ayırıcı tanıları birlikte incelenmiştir.

Gereç ve Yöntem: Tıbbi Patoloji  Anabilim Dalı arşivi taranarak mide, ince-kalın barsak, mezenterik-omentumdan köken alan intrabdominal konjenital kistik kitleler çalışmaya alınmıştır.

Bulgular:  Nonneoplastik kistik 55 olgu retrospektif olarak incelendi.  Yaş, cinsiyet, klinik semptom, yerleşim yeri, histopatolojik bulgularına göre olgular değerlendirildi. En sık meckel divertikülü/ omfalomezenterik duktus kisti (n:34) mevcuttu. Daha sonra olguların görülme sıklığı sırasıyla; mezenterik-omental kistleri (n:15) ve duplikasyon kistlerine (n:6) rastlandı. En sık görülen bulgu abdominal kitle ve ağrıydı.

Sonuç: Kistlerin kökeni ne olursa olsun spesifik tiplendirme, lezyonların histopatolojik olarak değerlendirmesiyle ( epitele sahip olup olmayışı, epitelin tipi) konmaktadır. Gastrointestinal sistem yerleşimli kistler ile ilgili en önemli sorun, bazen bu kistlerin neoplastik nitelik taşıyan kitlelerden veya parazite bağlı kistlerden ayırt edilememesidir. Fizik muayenede düzgün sınırlı kitle palpe edilen ve görüntüleme yöntemleriyle intraabdominal kistik kitle saptanan, karın ağrısı ile başvuran hastalarda ayırıcı tanıda farklı gelişimsel nitelikler taşıyan kistik kitleler göz önünde bulundurulmalıdır.

Anahtar Kelimeler

• Mezenterik kist,enterik duplikasyon kistleri,meckel divertikülü

Histopathological evaluation of congenital rare cystic lesions of gastrointestinal tract.

Abstract

Purpose: Congenital cysts originating from the gastrointestinal tract are very rare. In this group, mesenteric-omental cysts, enteric duplication cysts, meckel diverticulum / omphalomesenteric duct cyst. The etiopathogenesis, histopathology and clinical features differ significantly. They cause diagnostic difficulties in differentiating with neoplastic masses. In this study, the clinical, histopathological and differential diagnoses of the congenital benign cystic lesions of the intrabdominal gastrointestinal tract were investigated.

Materials and Methods: The archives of the Department of Medical Pathology were reviewed and intrabdominal congenital cystic masses originating from the stomach, small-large intestine and mesenteric-omentum were included in the study.

Result: Nonneoplastic cystic cases were retrospectively evaluated. Patients were evaluated according to age, gender, clinical symptoms, location and histopathological findings. The most common meckel diverticulum / omphalomesenteric duct cyst (n:34) was present. Then, the incidence of the cases were as follows; mesenteric-omental cysts (n:15) and duplication cysts (n:6). The most common finding was abdominal mass and pain.

Conclusion: Specifically, regardless of the origin of cysts, specific typing is indicated by histopathological evaluation of lesions (epithelium, type of epithelium). The most important problem with cysts located in the gastrointestinal tract is that these cysts cannot be differentiated from neoplastic masses or parasites. In physical examination, cystic masses with different developmental characteristics should be considered in the differential diagnosis of patients with abdominal pain and intraabdominal cystic mass with palpated mass.

 

Keywords

• Mesenteric cysts,duplication cysts,meckel diverticulum

References

1. 1. Tiwari C, Shah H, Waghmare M, Makhija D, Khedkar K. Cysts of gastrointestinal origin in children: varied presentation. Pediatr Gastroenterol Hepatol Nutr 2017; 20:94-99.
2. 2. Ferrero L, Guanà R, Carbonaro G, Cortese M, Lonati L, Teruzzi E, Schleef J. Cystic intra-abdominal masses in children. Pediatr Rep 2017;6:7284.
3. 3. De Perrota M, Bründler M,Tötsch M, Morela P. Mesenteric cysts, toward less confusion? Dig Surg 2000;17:323-328.
4. 4. Aguirre SV, Mercedes Almagro M, Romero C.A, Romero S.S, Molina G.A, Buenaño R.A. Giant mesenteric cyst from the small bowel mesentery in a young adult patient. J Surg Case Rep 2019;1,1-4.
5. 5. Tan J, Tan K, Chew S. Mesenteric cysts: an institution experience over 14 years and review of literature. World J Surg 2009;33:1961-1965.
6. 6. Chen J, Du L, Wang DR. Experience in the diagnosis and treatment of mesenteric lymphangioma in adults:a case report and review of literature. World J Gastrointest Oncol 2018;10:522-527. doi:10.4251/wjgo.v10.i12.522.
7. 7. Navarro F, Schmieler E, Beversdorf W. Infarcted mesothelial cyst:a case report. Int J Surg Case Rep 2017;30:155-158.
8. 8. Stoupis C, Ros PR, Abbitt PL, Burton SS, Gauger J. Bubbles in the belly: imaging of cystic mesenteric or omental masses, Radiographics 1994;14:729-737.

9. 9. Ousadden A, Elbouhaddouti H, Ibnmajdoub KH, Harmouch T, Mazaz K, Aittaleb K. A giant peritoneal simple mesothelial cyst: a case report, J Med Case Rep 2011;5:361.doi: 10.1186/1752-1947-5-361
10. 10. Gündeş E, Çakır M, Tekin A, Taşcı H.İ, Vatansev C. Mezenterik kist;17 olgunun analizi. Selçuk Tıp Derg 2013;29:105-107.
11. 11. Yoon JW, Choi DY, Oh YK, Lee SH, Gang DB, Yu ST. A case of mesenteric cyst in a 4-year-old child with acute abdominal pain. Pediatr Gastroenterol Hepatol Nutr 2017;20:268-272.
12. 12. Liaqat N, Latif T, Khan FA, Iqbal A, Nayyar SI, Dar SH. Enteric duplication in children: a case series. Afr J Paediatr Surg 2014;11:211-214.
13. 13. Lopez-Fernandez S, Hernandez-Martin S, Ramírez M, Ortiz R, Martinez L, Tovar JA. Pyloroduodenal duplication cysts: Treatment of 11 cases. Eur J Pediatr Surg 2013;23:312-6.
14. 14. Coran A.G, Caldamone A, Adzick N.S, Krummel T.M, Laberge J.M, Lund, Shamberger R. Almentary tract duplications. Pediatric surgery. 7th ed. Philadelphia:Elsevier; 2012. p. 1155.
15. 15. Ildstad ST, Tollerud DJ, Weiss RG, Ryan DP, McGowan MA, Martin LW. Duplications of the alimentary tract. Clinical characteristics, preferred treatment, and associated malformations. Ann Surg 1988;208:184-189.
16. 16. Rasool N, Safdar CA, Ahmad A, Kanwal S.. Enteric duplication in children: clinical presentation and outcome. Singapore Med J 2013;54:343-346.
17. 17. Blank G, Königsrainer A, Sipos B, Ladurner R. Adenocarcinoma arising in a cystic duplication of the small bowel: case report and review of literature. World J Surg Oncol 2012;10:55.
18. 18. Sheikh MA, Latif T, Shah MA, Hashim I, Jameel A. Ileal duplication cyst causing recurrent abdominal pain and melena. APSP J Case Rep 2010;1:4.
19. 19. Khan YA, Qureshi MA, Akhtar J. Omphalomesenteric duct cyst in an omphalocele:a rare association. Pak J Med Sci 2013;29:866-868.
20. 20. Abizeid GA, Aref H. Case report: preoperatively diagnosed perforated Meckel's diverticulum containing gastric and pancreatic-type mucosa. BMC Surg 2017;11:36.
21. 21. Stone PA, Hofeldt MJ, Lohan JA, Kessel JW, Flaherty SK. A rare case of massive gastrointestinal hemorrhage caused by Meckel’s diverticulum in a 53-year-old man. W V Med J 2005;101:64-66.
22. 22. Yorganci K, Ozdemir A, Hamaloglu E, Sokmener C. Perforation of acute calculous Meckel’s diverticulitis:a rare cause of acute abdomen in elderly. Acta Chir Belg 2000;100:226-227.