대한흉부영상의학회 Weekly Chest Cases

Case No : 1421 Date 2025-01-13

Courtesy of Kyung Hee Lee / Inha University Hospital
Age/Sex 56 / F
Chief ComplaintEpigastric pain, radiating pain to back.

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Diagnosis With Brief Discussion

Diagnosis: Mullerian cyst
Radiologic Findings: Fig. 1-4. Fluid attenuated, non enhancing mass with fluid-fluid level in posterior mediastinum abutting descending thoracic aorta.
Fig. 5. Fat suppressed T2WI shows well-demarcated mass with homogeneous high signal intensity.
Fig. 6. ADC maps shows no diffusion restriction.
Fig. 7. The posterior mediastinal lesion is high SI on T1WI and not enhanced on post contrast T1WI.
Brief Review: Mediastinal cysts have a broad range of etiologies, such as bronchogenic, thymic, neuroenteric cysts and Müllerian cysts. Mullerian cysts arise from remnants of the Mullerian duct and can be located anywhere along the path of Mullerian duct regression. The pelvis is the most common localization, but in extremely rare instances, they may be found in the mediastinum. The origin of mediastinal Mullerian cysts is unclear. Mediastinal Müllerian cysts are found in the paravertebral area and are often treated based on the clinical diagnosis of a bronchogenic cyst or neurogenic tumor
Making a correct preoperative diagnosis of mediastinal Müllerian cysts is clinically difficult. Diagnosis can be made by histological finding, ciliated epithelium with Müllerian differentiation.
Immunohistochemical studies may be helpful in the diagnosis process. Additionally, estrogen and progesterone receptors are known to be the best markers for this type of cyst. Mediastinal Müllerian cysts follow a benign course with no reported recurrence so that surgical excision is the treatment of choice.
Although rare, the possibility of a Müllerian cyst should be considered in woman with a cystic lesion in the posterior mediastinum because of its distinct Müllerian histogenesis.
References: 1. Kobayashi S, Inoue T, Karube Y, Hayama M, Oyaizu T, Honma K, et al. A case of Mullerian cyst arising in posterior mediastinum. Ann Thorac Cardiovasc Surg 2012;18:39-41.
2. Simmons M, Duckworth LV, Scherer K, Drew P, Ruch D. Mullerian cysts of the posterior mediastinum: report of two cases and review of the literature. JTD 2013;5(1)
Keywords

No. of Applicants : 61

▶ Correct Answer : 16/61, 26.2%

- Ishikawa Matto Central Hospital , Japan MANABU AKIMOTO
- , Japan SUZUNE TSUKAMOTO
- medical scanning , Japan HIROAKI ARAKAWA
- Kyoto University , Japan AKIHIKO SAKATA
- Healthy Longevity Medical Center , Japan SHIN-ICHI CHO
- Osaka University , Japan AKINORI HATA
- , Japan YOSHIKI ISHII
- University of Yamanashi , Japan HIROAKI WATANABE
- , Japan SHUNJIRO NOGUCHI
- , Japan MARINO TANIGUCHI
- University of Tsukuba, Dept of Radiology , Japan MANABU MINAMI
- Mie university , Japan SHIKO OKABE
- Fukuoka university , Japan KEISUKE SATO
- Matsunami General Hospital , Japan TARO TAKEDA
- Toyota Kosei Hospital , Japan YUKI HAYASHI
- University of Yamanashi , Japan KOJIRO ONOHARA

▶ Correct Answer as Differential Diagnosis : 7/61, 11.5%

- The University of Tokyo Hospital , Japan TOSHIHIRO FURUTA
- Osaka Metropolitan University Hospital , Japan SHU MATSUSHITA
- Jichi Medical University, School of Medicine , Japan MITSURU MATSUKI
- Shiga General Hospital , Japan YUSAKU MORIBATA
- Kyoto University , Japan SHO KOYASU
- Yonsei University,Severance Hospital , Korea (South) SEO BUM CHO
- Kantou Rousai Hospital , Japan KAORU SUMIDA

대한흉부영상의학회 Korean Society of Thoracic Radiology

Archive of Old Cases

Case No : 1421 Date 2025-01-13

Discussion

No. of Applicants : 61