Peritoneal Inclusion Cysts in Adolescent Females: A Clinicopathological Characterization of Four Cases

Amesse, Lawrence S.; Gibbs, Paul; Hardy, John; Jones, Kimberly R.; Pfaff-Amesse, Teresa

doi:10.1016/j.jpag.2008.02.003

« Previous Next »Journal of Pediatric and Adolescent Gynecology
Volume 22, Issue 1 , Pages 41-48, February 2009

Peritoneal Inclusion Cysts in Adolescent Females: A Clinicopathological Characterization of Four Cases

Lawrence S. Amesse, MD, PhD, HCLD
- Section of Pediatric and Adolescent Gynecology, Department of Obstetrics and Gynecology, Wright State University Boonshoft School of Medicine
- Address corsrespondence to: Lawrence S. Amesse, MD, PhD, Department of Obstetrics and Gynecology, Wright State University, Boonshoft School of Medicine, 128 E. Apple Street, Suite 3800 CHE, Dayton, Ohio 45409-2793.
Paul Gibbs, MD
- Department of Pathology, Miami Valley Hospital, Dayton, Ohio, USA
John Hardy, MD
- Section of Pediatric and Adolescent Gynecology, Department of Obstetrics and Gynecology, Wright State University Boonshoft School of Medicine
Kimberly R. Jones
- Section of Pediatric and Adolescent Gynecology, Department of Obstetrics and Gynecology, Wright State University Boonshoft School of Medicine
Teresa Pfaff-Amesse, MD
- Section of Pediatric and Adolescent Gynecology, Department of Obstetrics and Gynecology, Wright State University Boonshoft School of Medicine

Abstract

Study Objective

To identify adolescent females with peritoneal inclusion cysts and characterize the clinicopathologic features.

Design

Observational and chart review along with immunohistochemical studies.

Setting

University pediatric and adolescent clinic.

Results

Medical records of all subjects, ages 10–18 years, diagnosed with peritoneal inclusion cysts over a 4-year period were retrospectively reviewed. Four patients, ages 11–16 years (mean, 13.8 yrs) were identified. Pelvic pain was the most common presenting symptom. No palpable abdominal or pelvic masses were detected. However, pelvic lesions were identified by radiographic studies in three of the four patients. Half experienced tenderness on examination. With one exception, all had a prior history of abdominal surgery. Twelve peritoneal inclusion cysts were identified, ranging from 1 cm to 7 cm in greatest diameter. Most were uninvolved in coexisting adhesions and non-adherent to pelvic or abdominal structures. Each had a well-defined pedicle connection to the peritoneum. No associated complications were identified. Their appearance conformed to established morphologic and immunohistochemical criteria, although accompanying mesothelial-associated changes occasionally reported in other populations were not detected. No recurrences were recorded.

Conclusion

Young female adolescents with peritoneal inclusion cysts share presenting symptoms and histories of previous abdominal surgery similar to those reported in older female adolescents and adults. A palpable mass may not be detected on examination, but can often be identified using radiographic studies. Our cases differ from previous reports by smaller cyst size, presence of a pedicle, and uncomplicated gross and microscopic appearances. Additionally, local recurrences and associated complications occurred less than reported in adults.

Key Words: Peritoneal inclusion cysts, Adolescent females, Benign cystic mesothelioma, Multicystic mesothelioma, Inflammatory cysts of the peritoneum