Indian Journal of Urology
CASE REPORT
Year
: 2001  |  Volume : 17  |  Issue : 2  |  Page : 176--177

Mullerian duct cyst: Presenting as recurrent abdominal mass


Girdhar Gopal Gupta, Avdhesh Prasad Pandey 
 Department of Urology, Christian Medical College and Hospital, Vellore, India

Correspondence Address:
Avdhesh Prasad Pandey
Department of Urology, Chiristian Medical College & Hospital, Vellore - 632 004
India




How to cite this article:
Gupta GG, Pandey AP. Mullerian duct cyst: Presenting as recurrent abdominal mass.Indian J Urol 2001;17:176-177


How to cite this URL:
Gupta GG, Pandey AP. Mullerian duct cyst: Presenting as recurrent abdominal mass. Indian J Urol [serial online] 2001 [cited 2021 Dec 6 ];17:176-177
Available from: https://www.indianjurol.com/text.asp?2001/17/2/176/21058


Full Text

 Case Report



A 29-year-old male from Bangladesh was referred to our hospital with recurrent lower abdominal mass. He also com­plained of obstructive urinary symptoms and constipation for last 3˝ years. There was no history of haematuria. He had exploratory laparotomy and partial excision of the mass thrice during the last 1˝ years with subsequent recurrences. There was a large soft, non-tender mass with restricted mobility in the suprapubic region. Rectal examination re­vealed tense cystic mass merging with the prostate. Upper limit was not reachable. Pertinent investigations showed normal renal parameters and urinalysis. Serum PSA was 3.2 ng/ml. CT abdomen and pelvis showed 16 x 12 x 18 cm complex cystic mass in rectovesical pouch displacing blad­der antero-superiorly, extending inferiorly up to the pros­tate [Figure 1]. Other abdominal organs were normal. On exploration there was a large cystic mass in the pelvis densely adherent to rectum and bladder. Bladder base and anterior rectal wall injured during the excision of mass were repaired along with end sigmoid colostomy.

Reactionary haemorrhage on the fifth postoperative day necessitated exploration and bilateral ligation of internal iliac artery was performed as salvage procedure. Later the patient developed small bowel fistula and inspite of aggres­sive management he expired. Gross examination of specimen showed a multiloculated cystic mass with cysts rang­ing from 0.2 cm to 12 cm filled with thin brownish fluid. Microscopy revealed cysts lined by cuboidal to squamoid epithelium with occasional ciliated epithelium resembling fallopian tube epithelium [Figure 2]. Prostatic tissue and smooth muscle elements and lining of stratified squamous epithelium were also seen in few sections. Spermatozoa were not seen. There was no evidence of malignancy.

 Comment



Mullerian duct cyst is a rare clinical entity, arises from remnants of Mullerian duct which usually undergo degen­eration. Cyst usually become symptomatic in third and fourth decades of life. The presenting symptoms include constipa­tion, urinary retention, haematuria, incontinence, pyuria, epididymitis, abdominal pain, bloody urethral discharge and pain during ejaculation. Per rectal examination usually re­veals a normal prostate above which lies the midline cystic mass. These cysts are attached to verumontanum but have no communication to posterior urethra. Cyst contain brown or green fluid devoid of spermatozoa. Cystourethrogram re­veals elevation of bladder floor and bladder neck without opacification of the cyst. CT and MRI are the most useful diagnostic tools. The various treatment options reported in literature are prostatic massage, endoscopic cyst catheteriza­tion and aspiration, cyst orifice dilatation, resection of cyst roof and marsipulization of cyst into the bladder. These pro­cedures are associated with high recurrence rate. Complete cyst excision is the treatment of choice. It can be performed via transperitoneal, perineal, posterior parasacral or transvesical transtrigonal route. Laparoscopic excision of cyst has also been described by McDougall et al. [1] Histologically epithelium of Mullerian duct is variously described as flat, cuboidal, low columnar or transitional in shape. Occasion­ally cyst may contain calculi and rarely malignant degenera­tion may occurs. Chapato et al and Nishino et al have reported huge Mullerian duct cyst extending into the abdomen. [2],[3] Present case highlights the difficulties encountered during the excision of the cyst leading to catastrophic complications and subsequent mortality.

References

1McDougall EM. Clayman RV. Bowles WT. Laparoscopic Excision of Mullerian duct remnant. J Urol 1994; 152: 482-484.
2Chapato MS, Angulo JC. Giant Mullerian duct cyst mimicking prostatic malignancy. Scand J Urol Nephrol 1995; 29: 229-231.
3Nishino Y, Yamahato N, Ishihara S et al. Mullerian duct cyst extending into the abdomen. Urology 1999; 53: 624-626.