DOCSLIB.ORG

Primary Mucinous Cystic Neoplasm of the Retroperitoneum - a Report of Three Cases

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Primary Mucinous Cystic Neoplasm of the Retroperitoneum - a Report of Three Cases 대한병리학회지: 제 37 권제3 호 2003 The Korean Journal of Pathology. 2003; 37: 204-9 Primary Mucinous Cystic Neoplasm of the Retroperitoneum - A Report of Three Cases - Dong Eun Song∙Mi-Jung Kim Primary mucinous cystic neoplasms of the retroperitoneum in women are rare and show his- Shin Kwang Khang∙Eunsil Yu tologic features similar to their ovarian or pancreatic counterparts. We present three cases of Kyung-Ja Cho primary retroperitoneal mucinous neoplasms of variable malignant potentials including a cys- tadenocarcinoma in a 50-year-old woman, a cystic neoplasm of borderline malignancy in a 31- Department of Pathology, University of year-old woman, and a cystadenoma in a 67-year-old woman. All cases showed histologic Ulsan College of Medicine, Asan features similar to mucinous tumors of the ovary. Immunohistochemical study demonstrated Medical Center, Seoul, Korea positivity for calretinin in case 3. The histogenesis of these neoplasms can be assumed most likely to be mucinous metaplasia of the mesothelium or undetected heterotopic pancreatic tissue. Received : August 22, 2002 Accepted : April 22, 2003 Appropriate management is thought to be the same as for analogous ovarian neoplasms. Corresponding Author Kyung-Ja Cho, M.D. Department of Pathology, University of Ulsan College of Medicine, Asan Medical Center, 388-1 Pungnap-dong, Songpa-gu, Seoul 138-736, Korea Tel: 02-3010-4545 Fax: 02-472-7898 E-mail: [email protected] Key Words : Retroperitoneum, Primary Mucinous Cystic Naeoplasm The primary mucinous cystic neoplasm of the retroperitoneum was discovered in the retroperitoneum below the left kidney. On is rare. Only 29 cases have been reported in literature to date, in- abdominal and pelvic computed tomography (CT) with contrast, cluding 2 cases in domestic literature.1-20 They encompass benign, this tumor was found to be located around the pancreatic tail por- borderline and malignant varieties and show a histologic simi- tion and had lobulating contour (Fig. 1). The laboratory data sh- larity to the ovarian mucinous tumors. Although several theories owed a slight elevation of CA-125 (41 UI/mL) and marked ele- have been proposed, the histogenesis of this neoplasm is still uncer- vation of CA 19-9 (1,510 UI/mL). The levels of CEA (4.7 ng/mL) tain. Mucinous or coelomic metaplasia of the retroperitoneal me- and -fetoprotein (1.4 ng/mL) were within normal limits. The sothelium, proposed by Lauchlan,5,7 has gained wide acceptance. cystic mass was located in the mesentery, and no anatomical con- We report three cases of primary retroperitoneal mucinous cys- nections with the pancreas including the tail portion, ovaries, or tic neoplasm ranging the spectrum from benign to malignant small bowel were found. It was initially intact and was removed histologic features, and discuss the histogenesis and appropriate by laparoscopic procedure after the aspiration of the cyst content treatment for these rare neoplasms. to reduce the tumor volume. Grossly, the tumor was a lobulated multiseptate cystic mass (10×9×5 cm and 238 gm), filled with white to yellow thick CASE 1 mucoid material (Fig. 2). The outer surface was grayish tan and glistening, and showed a fibrous adhesion site. The inner surface A 50-year-old woman was admitted to our hospital. She com- was pinkish tan, glistening, and irregular with frond-like areas plained of a palpable abdominal mass in the left upper quadrant and a few solid mural nodules. that she’d had for one month. The previous routine gynecologi- Microscopically, the tumor was composed of irregular multi- cal examination had revealed no abnormalities. On ultrasonog- locular cysts lined by columnar cells with mucinous or eosinophilic raphy, a huge multiseptate cystic mass with a few mural nodules cytoplasm, which were flat or piled up with micropapillary pro- 204 Primary Mucinous Cystic Neoplasm of the Retroperitoneum 205 Fig. 1. Abdominal computed tomography of Case 1 shows a lob- Fig. 2. Gross photograph of Case 1 shows a multiseptate cystic ulated cystic tumor in the left side of the retroperitoneum. mass (10×9×5 cm) with pinkish tan, glistening, and irregular inner surface. trusions showing benign to borderline appearances (Fig. 3A). The the previous operation site, and the remaining solid organs showed adenocarcinoma components were well differentiated with a crib- no metastasis. The patient received chemotherapy using Taxol, riform pattern (Fig. 3B). The stroma consisted of hypocellular but expired ten months after the operation. fibrous or cellular ovarian stroma-like tissue. There were a few anaplastic mural nodules consisting of spindle or multinucleated cells with malignant features, including marked cellular pleomor- CASE 2 phism and high mitotic activity, mixed with mucinous glandu- lar components (Fig. 3C). Some tumor cells lining the cyst showed A 31-year-old woman was admitted to our hospital. She com- strong positivity for Alcian-blue and periodic acid schiff (PAS) plained of abdominal distension in the right lower quadrant that stainings, but negativity for calretinin by immunohistochemi- she’d had for one year. On abdominal and pelvic computed tomog- cal staining. The only mucinous glandular components in the raphy with contrast, a multiseptate cystic mass with calcifications anaplastic mural nodules showed strong positivity for cytoker- was detected in the right retroperitoneum. The laboratory data atin by immunohistochemical staining (Fig. 3D). This tumor was for CA 72-4 in serum was within the normal limit (1.9 /mL). diagnosed to be a primary retroperitoneal mucinous cystadeno- At excision, using a mid-line incision, a well-encapsulated, soft carcinoma. and glistening cystic mass was found in the right retroperitoneal After the laparoscopic operation, the level of CA 19-9 decreased space behind the ascending colon. The mass was easily separat- to 26.5 IU/mL at the two months follow-up, but re-increased to ed from the ascending colon without adhesion. Other solid organs 41.9 IU/mL at the four months follow-up. It increased up to 549 including both ovaries were intact. Incidental appendectomy was IU/mL at the ten months follow-up. The follow-up CT at post- also performed. operative six and eight months revealed neither local recurrence Grossly, the tumor was a smooth-surfaced, multilocular cyst nor distant metastasis despite increased levels of CA 19-9. But, (21×16×10 cm and 210 gm), filled with grayish green tur- it revealed thickening of the walls of the cecum and ascending bid fluid. The inner surface was grayish tan and glistening, and colon with pericolic fat infiltration: both paracolic gutters had showed calcified septa without any solid nodules. thickened and there was a presence of multiple mesenteric lym- Microscopically, the cyst was mostly lined by single layered phadenopathy at the ten months follow-up, which were sugges- low cuboidal or tall columnar cells with mucinous or eosinophilic tive of peritoneal seeding. No recurred mass was identified around cytoplasm (Fig. 4A). In addition, small papillae or glands com- 206 Dong Eun Song∙Mi-Jung Kim∙Shin Kwang Khang, et al. A B Fig. 3. (A) The multilocular cystic wall is lined by mucinous colum- nar cells, which are flat or piled up with micropapillary protrusions. (B) Well differentiated adenocarcinoma components are present in the cystic wall. (C) The mural nodule consists of anaplastic spin- dle or multinucleated cells and is mixed with mucinous glandular components. (D) The mucinous glandular components in the mural C D nodule show positive immunoreactivity for cytokeratin. posed of stratified hyperchromatic nuclei were occasionally ob- CASE 3 served (Fig. 4B). The stroma consisted of cellular ovarian stroma- like tissue or collagenous tissue with multifocal calcifications. A 67-year-old woman was admitted to our hospital. She com- Obvious malignant features or stromal invasion were not present. plained of abdominal discomfort in the right upper quadrant that Immunohistochemistry showed a negative reaction for calretinin she’s had for several months. On abdominal and pelvic comput- in the nucleus and cytoplasm of low cuboidal cells. This tumor ed tomography with contrast, a 5.1 cm sized cystic mass with was diagnosed to be a primary retroperitoneal mucinous cystic homogeneous low attenuation was detected in the posterior lat- neoplasm of borderline malignancy. The appendix was normal. eral side of the ascending colon. There was no lymphadenopa- The post-operative gynecological examination revealed no abnor- thy and the liver showed a tiny nodule in segment VIII, which malities. was too small to characterize. The laboratory data for CEA in serum was within the normal limit (1.9 ng/mL). At laparotomy, Primary Mucinous Cystic Neoplasm of the Retroperitoneum 207 A B Fig. 4. (A) The cystic wall is lined by low cuboidal or tall columnar cells. (B) Borderline malignancy foci show moderate nuclear atypia, strat- ification, and ovarian-like stroma. low cuboidal or tall columnar cells with mucinous cytoplasm (Fig. 5A). The tumor cells showed no evidence of stratification, pleomorphism, or papillary arrangement. The stroma consisted of hypocellular collagenous tissue with multifocal calcifications. PAS and alcian-blue stainings showed a strong positive reaction in the cytoplasm of tall columnar cells. Immunohistochemistry showed positive reaction for calretinin in the nucleus and cyto- A plasm of some low cuboidal cells (Fig. 5B). This tumor was diag- nosed to be a primary retroperitoneal mucinous cystadenoma. The patient was lost to follow-up 3 months after the operation. DISCUSSION Primary retroperitoneal mucinous cystic neoplasms in women are rare. There have been 29 cases reported to date.1-20 This neo- B plasm covers the spectrum from benign to malignant, and a case Fig. 5. (A) The cystic wall is lined by low cuboidal or tall columnar with distant metastasis was reported by Banerjee and Gough.1 cells and hypocellular collagenous stroma. (B) The lining low cu- The origin of this rare neoplasm has been a matter of debate boidal cells show positive immunoreactivity for calretinin.
Load more

Recommended publications
  • The Mesocolon a Histological and Electron Microscopic Characterization of the Mesenteric Attachment of the Colon Prior to and After Surgical Mobilization
    ORIGINAL ARTICLE The Mesocolon A Histological and Electron Microscopic Characterization of the Mesenteric Attachment of the Colon Prior to and After Surgical Mobilization Kevin Culligan, MRCS,∗ Stewart Walsh, FRCSEd,∗ Colum Dunne, PhD,∗ Michael Walsh, PhD,† Siobhan Ryan, MB,‡ Fabio Quondamatteo, MD,‡ Peter Dockery, PhD,§ and J. Calvin Coffey, FRCSI∗¶ uring fetal development, the dorsal mesentery suspends the en- Background: Colonic mobilization requires separation of mesocolon from tire gastrointestinal tract from the posterior abdominal wall. The underlying fascia. Despite the surgical importance of planes formed by these D mesocolon is the adult remnant of that part of the dorsal mesentery structures, no study has formally characterized their microscopic features. associated with the colon.1 In the adult human, the transverse and The aim of this study was to determine the histological and electron micro- lateral sigmoid portions of the mesocolon are mobile whereas the as- scopic appearance of mesocolon, fascia, and retroperitoneum, prior to and cending, descending, and medial sigmoid portions are nonmobile and after colonic mobilization. attached to underlying retroperitoneum.2–4 Classic anatomic teaching Methods: In 24 cadavers, samples were taken from right, transverse, de- maintains that the ascending and descending mesocolon “disappear” scending, and sigmoid mesocolon. In 12 cadavers, specimens were stained during embryogenesis.5,6 In keeping with this, the identification of a with hematoxylin and eosin (3 sections) or Masson trichrome (3 sections). In right or left mesocolon in the adult is frequently depicted as anoma- the second 12 cadavers, lymphatic channels were identified by staining im- lous rather than accepted as an anatomic norm.7 Accordingly, the munohistochemically for podoplanin.
    [Show full text]
  • Nomina Histologica Veterinaria, First Edition
    NOMINA HISTOLOGICA VETERINARIA Submitted by the International Committee on Veterinary Histological Nomenclature (ICVHN) to the World Association of Veterinary Anatomists Published on the website of the World Association of Veterinary Anatomists www.wava-amav.org 2017 CONTENTS Introduction i Principles of term construction in N.H.V. iii Cytologia – Cytology 1 Textus epithelialis – Epithelial tissue 10 Textus connectivus – Connective tissue 13 Sanguis et Lympha – Blood and Lymph 17 Textus muscularis – Muscle tissue 19 Textus nervosus – Nerve tissue 20 Splanchnologia – Viscera 23 Systema digestorium – Digestive system 24 Systema respiratorium – Respiratory system 32 Systema urinarium – Urinary system 35 Organa genitalia masculina – Male genital system 38 Organa genitalia feminina – Female genital system 42 Systema endocrinum – Endocrine system 45 Systema cardiovasculare et lymphaticum [Angiologia] – Cardiovascular and lymphatic system 47 Systema nervosum – Nervous system 52 Receptores sensorii et Organa sensuum – Sensory receptors and Sense organs 58 Integumentum – Integument 64 INTRODUCTION The preparations leading to the publication of the present first edition of the Nomina Histologica Veterinaria has a long history spanning more than 50 years. Under the auspices of the World Association of Veterinary Anatomists (W.A.V.A.), the International Committee on Veterinary Anatomical Nomenclature (I.C.V.A.N.) appointed in Giessen, 1965, a Subcommittee on Histology and Embryology which started a working relation with the Subcommittee on Histology of the former International Anatomical Nomenclature Committee. In Mexico City, 1971, this Subcommittee presented a document entitled Nomina Histologica Veterinaria: A Working Draft as a basis for the continued work of the newly-appointed Subcommittee on Histological Nomenclature. This resulted in the editing of the Nomina Histologica Veterinaria: A Working Draft II (Toulouse, 1974), followed by preparations for publication of a Nomina Histologica Veterinaria.
    [Show full text]
  • ABDOMINOPELVIC CAVITY and PERITONEUM Dr
    ABDOMINOPELVIC CAVITY AND PERITONEUM Dr. Milton M. Sholley SUGGESTED READING: Essential Clinical Anatomy 3 rd ed. (ECA): pp. 118 and 135­141 Grant's Atlas Figures listed at the end of this syllabus. OBJECTIVES:Today's lectures are designed to explain the orientation of the abdominopelvic viscera, the peritoneal cavity, and the mesenteries. LECTURE OUTLINE ­ PART 1 I. The abdominopelvic cavity contains the organs of the digestive system, except for the oral cavity, salivary glands, pharynx, and thoracic portion of the esophagus. It also contains major systemic blood vessels (aorta and inferior vena cava), parts of the urinary system, and parts of the reproductive system. A. The space within the abdominopelvic cavity is divided into two contiguous portions: 1. Abdominal portion ­ that portion between the thoracic diaphragm and the pelvic brim a. The lower part of the abdominal portion is also known as the false pelvis, which is the part of the pelvis between the two iliac wings and above the pelvic brim. Sagittal section drawing Frontal section drawing 2. Pelvic portion ­ that portion between the pelvic brim and the pelvic diaphragm a. The pelvic portion of the abdominopelvic cavity is also known as the true pelvis. B. Walls of the abdominopelvic cavity include: 1. The thoracic diaphragm (or just “diaphragm”) ­ located superiorly and posterosuperiorly (recall the dome­shape of the diaphragm) 2. The lower ribs ­ located anterolaterally and posterolaterally 3. The posterior abdominal wall ­ located posteriorly below the ribs and above the false pelvis and formed by the lumbar vertebrae along the posterior midline and by the quadratus lumborum and psoas major muscles on either side 4.
    [Show full text]
  • Primary Retroperitoneal Mucinous Cystadenoma
    Case Reports Primary retroperitoneal mucinous cystadenoma Malak S. Abedalthagafi, MD, Patrick G. Jackson, MD, Metin Ozdemirli, MD, PhD. rimary mucinous cystadenomas of the ABSTRACT Pretroperitoneum are extremely rare tumors. Although very rare cases were reported in men and children, these tumors are found exclusively in تتضمن أورام خلف الصفاق اﻷولي: السرطان الكيسي املخاطي، women.1-3 Like most retroperitoneal tumors, they can اﻷورام املخاطية ذات احلد الفاصل، اﻷورام النادرة واملتواجدة في cause symptoms through exertion of pressure or by النساء واملتضمنة احلزام املخاطي. وحيث أن خلف الصفاق اﻷولي .obstructing adjacent organs if they are large enough ﻻ يحتوي على ظاهرة مخاطية، تبقى نظرية حدوث هذه اﻷورام .They have potential for malignant transformation غير معروفة. نستنتج أن حدوث هذه اﻷورام قد يأتي من اﻷورام There is no unanimous opinion on the genesis of املسخية، أو من املبايض الزائدة، أو من التحول املخاطي للطبقة these tumors and due to their extreme rarity, their املتوسطة خللف الصفاق. نستعرض في هذا التقرير حالة للخدام histogenesis, biological behavior, and their optimal املخاطي خلف الصفاق اﻷولي ملريضة تبلغ من العمر 44 ًعاما، والتي ,management remains at a speculative level. In this paper حضرت بسبب ورم بطني. بعد استئصال الورم بجراحة املنظار we present a case of primary retroperitoneal mucinous لم يكن هناك أية أثر لعودة الورم بعد 16 شهرا.ً الشكل املجهري cystadenoma and review the clinicopathological features, therapeutic options, and outcome in respect والتحليل للصبغات النسيجية يدعم فرضية التحول املخاطي لطبقة to the cases reported in the literature. The morphologic خلف الصفاق املتوسطة واملسبوقة بتكوين كيسي اشتمالي والتي and immunohistochemical analysis observed in this تؤدي إلى حدوث أورام خلف الصفاق املخاطية.
    [Show full text]
  • Coordination of Endothelial Cell Positioning and Fate Specification By
    ARTICLE https://doi.org/10.1038/s41467-021-24414-z OPEN Coordination of endothelial cell positioning and fate specification by the epicardium Pearl Quijada 1,8, Michael A. Trembley1, Adwiteeya Misra1,2, Jacquelyn A. Myers 3,4, Cameron D. Baker 3,4, Marta Pérez-Hernández 5, Jason R. Myers3,4, Ronald A. Dirkx Jr.1, ✉ Ethan David Cohen6, Mario Delmar5, John M. Ashton 3,4 & Eric M. Small 1,2,7 The organization of an integrated coronary vasculature requires the specification of immature 1234567890():,; endothelial cells (ECs) into arterial and venous fates based on their localization within the heart. It remains unclear how spatial information controls EC identity and behavior. Here we use single-cell RNA sequencing at key developmental timepoints to interrogate cellular contributions to coronary vessel patterning and maturation. We perform transcriptional profiling to define a heterogenous population of epicardium-derived cells (EPDCs) that express unique chemokine signatures. We identify a population of Slit2+ EPDCs that emerge following epithelial-to- mesenchymal transition (EMT), which we term vascular guidepost cells. We show that the expression of guidepost-derived chemokines such as Slit2 are induced in epicardial cells undergoing EMT, while mesothelium-derived chemokines are silenced. We demonstrate that epicardium-specific deletion of myocardin-related transcription factors in mouse embryos disrupts the expression of key guidance cues and alters EPDC-EC signaling, leading to the persistence of an immature angiogenic EC identity and inappropriate accumulation of ECs on the epicardial surface. Our study suggests that EC pathfinding and fate specification is controlled by a common mechanism and guided by paracrine signaling from EPDCs linking epicardial EMT to EC localization and fate specification in the developing heart.
    [Show full text]
  • Development of the Serosal Mesothelium
    J. Dev. Biol. 2013, 1, 64-81; doi:10.3390/jdb1020064 OPEN ACCESS Journal of Developmental Biology ISSN 2221-3759 www.mdpi.com/journal/jdb Review Development of the Serosal Mesothelium Nichelle I. Winters and David M. Bader * Department of Medicine, Vanderbilt University, 2220 Pierce Ave Nashville, TN 37232, USA; E-Mail: [email protected] * Author to whom correspondence should be addressed; E-Mail: [email protected]; Tel.: +1-615-936-1976; Fax: +1-615-936-3527. Received: 3 May 2013; in revised form: 13 June 2013 / Accepted: 19 June 2013 / Published: 26 June 2013 Abstract: Mesothelia in the adult vertebrate are the simple squamous epithelia covering all coelomic organs and body cavities. Until recently, analysis of the generation and differentiative potential of mesothelia in organogenesis has largely focused on development of visceral mesothelium of the heart; the epicardium and its progenitor, the proepicardium. Here, we review emerging data on the development and differentiation of serosal mesothelium, the covering of the gastrointestinal tract. This literature demonstrates that serosal mesothelium is generated through a completely different mechanism than that seen in the heart suggesting that commitment of progenitors to this cell lineage does not follow a common pathway. The differentiative potential of serosal mesothelium is also discussed in comparison to that observed for progeny of the proepicardium/epicardium. In our review of the literature, we point out gaps in our understanding of serosal mesothelial development and that of mesothelial development as a whole. Keywords: mesothelium; proepicardium; epicardium; intestine; heart 1. Mesothelia: Broad Definition Mesothelia are simple squamous epithelia that line coelomic cavities and organs and form the mesenteries.
    [Show full text]
  • Chapter 16 (10E).Pdf
    Chapter 16 Student: ___________________________________________________________________________ 1. Choose the following statement that is NOT accurate concerning the female reproductive system. A.Fimbriae are fingerlike projections over the ovaries. B.The uterus is shaped like an inverted pear C.The lining of the uterus is called the mesometrium. D.The fertilized ovum is called a zygote. E.All of the choices are correct. 2. The tightly coiled tube in which maturation of sperm occurs is the: A.testis B.epididymis C.prostate 3. Some hepatitis viruses can be acquired through drinking contaminated water. A.True B.False 4. Progesterone is produced by the: A.follicle B.corpus luteum C.anterior pituitary D.posterior pituitary 5. Which of the following is also called the "morning after pill" because it is used to prevent pregnancy after intercourse has occurred? A.RU-486 B.Depo-provera C.mifepristone D.both RU-486 and mifepristone are correct 1 6. Which of the following surrounds the urethra and contributes to seminal fluid? A.acrosome B.scrotum C.prostate D.epididymis 7. Which of the following methods of contraception involves placing a device in the uterus to prevent implantation? A.IUD B.diaphragm C.contraceptive sponge 8. Congenital syphilis is caused by bacteria: A.in the birth canal B.crossing the placenta C.in the oviducts D.in the uterus 9. Blindness in newborn infants is most often associated with which disorder of the mother? A.diabetes B.gonorrhea or syphilis C.yeast infection D.chlamydia 10. Which type of hepatitis is most associated with sexual transmission? A.hepatitis A B.hepatitis B C.hepatitis C D.hepatitis D E.hepatitis E 2 11.
    [Show full text]
  • Mesothelium and Malignant Mesothelioma
    Journal of Developmental Biology Review Mesothelium and Malignant Mesothelioma Emilye Hiriart, Raymond Deepe and Andy Wessels * Department of Regenerative Medicine and Cell Biology, Medical University of South Carolina, 173 Ashley Avenue, Charleston, SC 29425, USA; [email protected] (E.H.); [email protected] (R.D.) * Correspondence: [email protected]; Tel.: +1-843-792-8183 Received: 4 March 2019; Accepted: 5 April 2019; Published: 8 April 2019 Abstract: The mesothelium is an epithelial structure derived from the embryonic mesoderm. It plays an important role in the development of a number of different organs, including the heart, lungs, and intestines. In this publication, we discuss aspects of the development of the mesothelium, where mesothelial structures can be found, and review molecular and cellular characteristics associated with the mesothelium. Furthermore, we discuss the involvement of the mesothelium in a number of disease conditions, in particular in the pathogenesis of mesotheliomas with an emphasis on malignant pleural mesothelioma (MPM)—a primary cancer developing in the pleural cavity. Keywords: mesothelium; development; malignant; mesothelioma; cancer 1. Introduction Malignant mesothelioma is a neoplasm that originates from mesothelial cells lining the body cavities, including the pleura, peritoneum, pericardium, and tunica vaginalis. The majority of malignant mesothelioma cases are mesotheliomas that develop in the pleural cavity. They are known as malignant pleural mesothelioma (MPM) and comprise 70–90% of all reported cases of malignant mesothelioma [1,2]. The other cases typically arise in the peritoneum [3], while the pericardium is rarely affected [4]. In this review we will briefly discuss the origin of the mesothelial structures, provide a succinct overview of molecular mechanisms involved in their development, and address aspects of the etiology and pathogenesis of mesotheliomas.
    [Show full text]
  • Peritoneal and Retro Peritoneal Anatomy and Its Relevance For
    Note: This copy is for your personal non-commercial use only. To order presentation-ready copies for distribution to your colleagues or clients, contact us at www.rsna.org/rsnarights. GASTROINTESTINAL IMAGING 437 Peritoneal and Retro­ peritoneal Anatomy and Its Relevance for Cross- Sectional Imaging1 Temel Tirkes, MD • Kumaresan Sandrasegaran, MD • Aashish A. Patel, ONLINE-ONLY CME MD • Margaret A. Hollar, DO • Juan G. Tejada, MD • Mark Tann, MD See www.rsna Fatih M. Akisik, MD • John C. Lappas, MD .org/education /rg_cme.html It is difficult to identify normal peritoneal folds and ligaments at imag- ing. However, infectious, inflammatory, neoplastic, and traumatic pro- LEARNING cesses frequently involve the peritoneal cavity and its reflections; thus, OBJECTIVES it is important to identify the affected peritoneal ligaments and spaces. After completing this Knowledge of these structures is important for accurate reporting and journal-based CME activity, participants helps elucidate the sites of involvement to the surgeon. The potential will be able to: peritoneal spaces; the peritoneal reflections that form the peritoneal ■■Discuss the impor- ligaments, mesenteries, and omenta; and the natural flow of peritoneal tance of identifying peritoneal anatomy fluid determine the route of spread of intraperitoneal fluid and disease in assessing extent processes within the abdominal cavity. The peritoneal ligaments, mes- of disease. ■■Describe the path- enteries, and omenta also serve as boundaries for disease processes way for the spread and as conduits for the spread of disease. of disease across the peritoneal spaces to ©RSNA, 2012 • radiographics.rsna.org several contiguous organs. ■■Explain inter- fascial spread of disease across the midline in the ret- roperitoneum and from the abdomen to the pelvis.
    [Show full text]
  • 2. Abdominal Wall and Hernias
    BWH 2015 GENERAL SURGERY RESIDENCY PROCEDURAL ANATOMY COURSE 2. ABDOMINAL WALL AND HERNIAS Contents LAB OBJECTIVES ............................................................................................................................................... 2 Knowledge objectives .................................................................................................................................. 2 Skills objectives ............................................................................................................................................ 2 Preparation for lab .......................................................................................................................................... 2 1.1 ORGANIZATION OF THE ABDOMINAL WALL ............................................................................................ 4 Organization of the trunk wall .................................................................................................................... 4 Superficial layers of the trunk wall ............................................................................................................. 5 Musculoskeletal layer of the anterolateral abdominal wall ...................................................................... 7 T3/Deep fascia surrounding the musculoskeletal layer of the abdominal wall ..................................... 11 Deeper layers of the trunk wall ...............................................................................................................
    [Show full text]
  • MESOTHELIAL TURIORS the Mesoderm of the Embryo Separates
    MESOTHELIAL TURIORS CHARLES F. GESCHTCKTER, M.D. (From the Siirgicd Piithologictil LaDorat ory, Deportmelit of Surjityv, Johns fZopkins Elo~pitaland Univerhity) The mesoderm of the embryo separates early into two major divisions. A paraxial or somatic portion forms the sclerotome. A coelomic or visceral por- tion forms the splanchnocoele and the tissue for the genito-urinary organs. Both the somatic and the visceral mesoderm give rise to epithelial and mesen- chymal elements. In the somatic mesoderm the primitive myo-epithelium is replaced by voluntary muscle; the mesenchyme forms the various types of con- nective tissue, including cartilage, bone, fibrous tissue, and fat. In the coelomic or visceral mesoderm the epithelial derivatives include the meso- thelium in the serous cavities and the epithelium of the genito-urinary organs; the mesenchymal elements form smooth muscle and angioblastic tissue from which are derived the vessels, lymphoid and myeloid elements. The major divisions and derivatives of the mesoderm are indicated in the outline below: SOMATICMESODERM Myo-epithelium ......................... Voluntary muscle Mesenchyme ............................ .Connective tissues (cartilage, bone, etc.) VISCERALMESODERM Mesenchyme ........................... Angioblastic tissue, smooth muscle Coelomic epithelium .................Mesothelium, genito-urinary epithelium The splanchnocoele, the major derivative of the coelomic cavity, gives rise to the special serous cavities of the body, including the peritoneal, pericardial and pleural cavities, which are lined by persisting coelomic epithelium-the mesothelium. Persisting portions of mesodermal partitions which once di- vided the coelomic chamber form the mesentery. A tendency for the coelomic epithelium to persist as such and for the underlying mesoderm to form vascu- lar connective tissue rather than muscle is characteristic of the derivatives of the splanchnocoele.
    [Show full text]
  • Effusion Cytology
    Last Updated: 4/1/2020 Effusion Cytology Prepared by Kurt Schaberg Normal Components Fluid sources: Peritoneum, Pleura, and Pericardium (Mesothelium-lined cavities) Mesothelial Cells “Mesos” Diff Quick Round, central nucleus with coarse chromatin. Abundant dense cytoplasm. “Lacy skirt” (where the cytoplasm is denser closer to the nucleus) due to surface microvilli (visible on EM) → causes characteristic “windows” between mesothelial Pap Window Can be multinucleated. Variably prominent nucleoli. In effusions: Cells often present as dispersed single cells. Mesos often adhere to each other in pairs Cell block: H&E In washes: (take during surgery→ larger tissue fragments) Mesos often present in large monolayer sheets Well-organized, honey-comb appearance Little nuclear overlap Mesothelial cells can take on phagocytic roles and essentially exist on a morphologic spectrum with histiocytes, making them sometimes impossible to tell apart morphologically. In response to inflammation/trauma, mesothelial cells can become “Activated” and look very scary! Activated findings include: Prominent nucleoli Larger cell size and Multinucleation Denser, two-toned cytoplasm Mitotic figures Vacuolization (mimicking signet ring cells) Cytoplasmic blebs Pericardial mesos are famous for being Hugging (engulfing/canibalization) other mesos SUPER “activated” (think of all the trauma of BUT, they should still have smooth nuclear continuous beating!). Be very cautious contours diagnosing metastatic carcinoma there and Positive stains: Calretinin, D2-40, CK AE1/AE3, do stains! CK7, CK5/6, WT-1, Mesothelin, Histiocytes Peripherally located grooved/folded/indented/curved nuclei (smaller than mesothelial cell nucleus) Abundant foamy cytoplasm, often containing debris (more cytoplasm than lymphocyte) Sometimes can also see monocytes (which become macrophages after activation), derived from marrow.
    [Show full text]