Benign retroperitoneal cysts of müllerian type: a clinicopathologic study of three cases and review of the literature.

Benign retroperitoneal cysts (RPCs) of müllerian type may present as a pelvic mass in a perimenopausal or postmenopausal woman, and thus clinically can mimic an ovarian malignancy. We report three women, aged 73, 45, and 68 years, who presented with large RPC masses ranging from 8 to 17 cm in diameter. Histologically, the cysts were lined by benign müllerian-type epithelium: serous epithelium in two patients and mucinous epithelium in one patient. A malignant component was not present in any of the cases. Preoperative diagnosis in two patients was ovarian carcinoma based on clinical and computerized tomography findings. Two patients are alive without evidence of disease 44 and 56 months following surgical excision, whereas one patient died of perioperative complications unrelated to the cystic lesion. Similar previously reported cases and their possible pathogenetic mechanisms are discussed. Although the müllerian type of RPCs behave in a benign manner, a malignant component has to be searched for. Thus, complete excision with careful histologic examination rather than drainage or marsupialization is recommended.

Cat-scratch disease presenting as abdominal visceral granulomas.

Three cases of atypical, clinically unsuspected cat-scratch disease (CSD), diagnosed by demonstration of the CSD bacillus in an abdominal visceral organ, are presented. In two cases CSD bacilli were demonstrated for the first time in splenic granulomas in a child and in an adult with acquired immunodeficiency syndrome (AIDS)-related complex. In both cases, there was granulomatous hepatitis as well as splenitis. In the third case, the CSD bacillus was present in hepatic granulomas in an adult with granulomatous hepatitis. In all cases, granulomatous inflammation with suppuration in the viscera was identical to that previously described for lymph nodes in CSD. All patients eventually recovered completely. Clinical awareness of the broad spectrum of CSD should avoid the cost and morbidity of prolonged hospitalization, medications, and invasive surgery for a disease that is self-limited and not clearly responsive to antibiotics and that can usually be diagnosed by noninvasive means.