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A 47-year-old woman came to our hospital with left lower abdominal pain in April 2013. An abdominal computed tomographic (CT) examination revealed left hydronephrosis secondary to a 7 cm retroperitoneal cyst near the left common iliac artery and ureter. Serum tumor markers including CEA, CA19-9, and CA125 were negative. Although CT guided needle aspiration of the cyst successfully relieved severe left flank pain, the cyst again increased in size, causing left hydronephrosis, though examinations for fluid tumor markers and cytology were negative. Two months later, the patient underwent open fenestration. The final pathological results demonstrated a mesothelial cyst without malignant findings. Six months after the operation, the patient was doing well without recurrence of symptoms.

A 40-year-old woman was referred to our hospital because of pain extending from the left lateral abdomen to the left inferior limb. The abdominal computed tomography (CT) revealed an 8×7×12 cm retroperitoneal serous cystic mass. The serum carcinoembryogenic antigen (CEA) level was slightly elevated to 2.7 ng/ml. Therefore, we suspected it to be malignant, and we performed laparoscopic resection carefully. The retroperitoneal cyst was not adherent to the surrounding tissues and was easily dissected and removed under laparoscopy. Carbohydrale antigen (CA)19-9, CA125 and CEA levels in the fluid were elevated, but a cytology of the fluid was negative and no malignant sign was seen in the cyst wall. To our knowledge, this is the second reported case of retroperitoneal serous cyst resected by laparoscopic surgery in the Japanese literature.

67歳女.後腹膜漿液性嚢胞例を経験した.本例の嚢胞液中CA125, CA19-9が高値を呈し, 免疫染色にて各々の局在が証明できた初めての症例であった, A 67-year-old female presented with left abdominal distension. A huge retroperitoneal cystic mass, measuring over 20 cm in diameter, was found below the left kidney. The cyst was punctured percutaneously, and serous fluid was aspirated. It was noted that the concentrations of CA125 and CA19-9 in the fluid of the cyst were extremely elevated while those in the serum were normal. The cyst was resected easily without any adhesion. Microscopically, the cyst was lined with a mixture of ciliated and cuboidal serous cells and columnal mucinous cells. Immunohistochemical staining of the cyst wall proved positive for CA125 on serous cells, and for CA19-9 on mucinous cells.