Giant Primary Retroperitoneal Serous Cystadenoma: A Rare Entity Mimicking Multiple Neoplastic and Nonneoplastic Processes

Abstract

Serous cystadenoma, often known as ovarian serous cystadenoma, is one of the common benign ovarian neoplasms. On the other hand, primary retroperitoneal serous cystadenoma is an extremely rare benign entity whose pathogenesis has not been well understood. Clinical presentation and symptomatology vary greatly and are highly dependent on the size and location of the lesion. Primary retroperitoneal serous cystadenomas are homogeneous, unilocular, thin-walled cystic masses. If they grow large enough, they tend to compress and deform adjacent organs, giving clinicians a misimpression of malignant pattern of behavior. Therefore, it is crucial to differentiate benign primary retroperitoneal serous cystadenomas from other epithelial and nonepithelial cystic lesions or masses involving retroperitoneal regions. Management-wise, complete cyst excision without rupture or spillage of the cyst contents is the recommended therapeutic method for primary retroperitoneal serous cystadenomas. This review will highlight the current knowledge on its pathogenesis and discuss its histopathologic features and differential diagnoses from the pathologist's point of view.

Primary Retroperitoneal Serous Cyst Adenoma: A Case Report and Literature Review

“…Few case reports suggest an association with elevated serum tumor markers like CEA, CA125, CA19-9, and CA15-3. Some reports also suggest a diagnostic value of tumor markers in aspirated cystic fluid, but these are neither sensitive nor specific [1,[5][6][7][8].…”

“…As such, the incidence of PRSCs is difficult to estimate [ 1 , 5 ]. However, these patients have ranged in age from 28 to 79 years and are exclusively female based on the reported cases [ 1 , 6 , 7 ]. The pathogenesis of PRSCs is also not well understood.…”

“…When symptomatic they commonly present as a palpable abdominal mass or, as in this case, with abdominal pain. Other symptoms like fever, decreased appetite, and or weight loss may indicate underlying malignancy [ 1 , 6 ].…”

“…Despite this fact, MRI is considered a better modality than CT when assessing retroperitoneal lesions. MRI allows better assessment for internal septae and mural nodules, local extent, and likely organ of origin, if not primarily retroperitoneal [ 1 , 6 , 13 ].…”

“…Unfortunately, however, this can only be distinguished pathologically (once the lesion is excised surgically) [ 14 ]. The classic macroscopic description of a PRSC, as shown in Figure 5 , is a smooth, unilocular cyst, encapsulated by a thin layer of fibrous tissue in the retroperitoneal space and no direct involvement with intra-abdominal viscera [ 6 ].…”