Abstract
We present a 66 year-old man with recurrent mesothelial cyst arising from the periumbimulcal peritoneum after a laparoscopic excision. The symptom was postprandial umbilical discomfort. A monoloculated abdominal cyst was detected on CT. The cyst was located under the umbilicus without any enteric or urinary tract connection. Aspiration cytology of the fluid was negative. containing scanty mesothelial cells. The cyst was continuous with the umbilical fibrous tissue, resulting in the incomplete excision through the laparoscopic route. The lining epithelium was immunohistochermically positive for cytokeratin. negative for Factor VIII and vimentin. Thus the histological diagnosis was a mesothelial cyst occurring from periumbilical peritoneum. Since the cystic mass grew larger, it was resected under laparotomy 16 months after the laparoscopic surgery.
The monoluculated mesothelial cyst is a kind of retention cyst. The lararoscopic excision may be accepted as the first trial prior to laparotomy. When the correct diagnosis can be entabilshed, the injection of a sclerosing agent may be one of choice prior to surgery as is effective in multicystic mesothelioma. We think that the laparoscopic excision should be recommended to the patient after he or she accepts our detailed explanation about a possible local recurrence with the procedure.
