Primary retroperitoneal borderline mucinous cyst of Mullerian origin -

a case report
Cătălina Paranici, Ștefania Vârban, Florin Andrei, Mugur Cristian Ardelean, Irina Ahmed Salem, Camelia
Gîrbea, Maria Sajin, Anamaria Curte

Background and objective

Retroperitoneal mucinous cysts are extremely rare, mostly occurring in women. Our objective is to
present a new case of a retroperitoneal borderline mucinous cyst of Mullerian origin.
Methods
A 38-year-old woman, with a history of laparoscopic surgery performed 3 years ago for a benign
retroperitoneal cyst in the left hypochondrium, was admitted to our hospital for tumour recurrence.
Another laparoscopic intervention was performed with incomplete excision due to adherence to the
left colon wall. No lesion was observed in the ovaries, fallopian tubes, pancreas or kidneys.
Results
The specimen was composed of multiple fragments of cyst wall measuring 80/75/7 mm, with a
smooth, white-greyish surface, and a 7 mm diameter white nodule. Histopathological findings
revealed a densely fibrotic cystic wall, lined by a single layer of columnar cells with areas of nuclear
atypia, either nuclear enlargement or vesicular nuclei. The nodule showed glands lined by a
mucinous epithelium of endocervical-type, with intraluminal projections, some with a more complex
architecture, lined by stratified, enlarged, hyperchromatic nuclei. The nodule stroma had an “ovarian-
like” pattern and was composed of spindle cells with little cytoplasm and indistinct borders.
Immunohistochemistry confirmed the Mullerian origin.
Conclusion
This is a very uncommon case of a retroperitoneal mucinous cyst of Mullerian origin. The
particularities of this case are the borderline aspect, resembling ovarian mucinous tumors and the
“ovarian-like” stroma. Close adherence to surrounding structures prevented the complete excision of
the cyst, leading to a recurrence. Open surgery was proposed to the patient and will probably follow.