JOURNAL OF THE LOUISIANA STATE MEDICAL SOCIETY
A Müllerian Cyst
Resected from the Posterior Mediastinum
Ronald Mowad, MD; Navdeep Singh Samra, MD; Vyas Rao, MD
Differential diagnoses ofmediastinal masses are often based on the anatomic locations. Traditionally the posterior mediastinum has been home to esophageal and neurogenic cysts, but a new entity has been found to be prevalent since its initial report in 2005: the Müllerian cyst. We present a 49-year-old with history of cough who was found to have such amass.Wewill discuss the surgical outcome and the details of this interesting entity. The literature pertinent to this type of cyst will be evaluated. In all cases reported, the literature demonstrates that surgical removal results in uneventful follow-up with no evidence of malignancy or cyst recurrence.
Due to worsening cough and concern for malignancy, the patient and our surgical team planned for surgical removal of the mass. A left posterolateral thoracotomy was performed. The cyst was adhered to the aortic arch in the left paravertebral location and was entered during surgical removal. The cyst was pink and the cystic fluid had a serous, pink-tinged appearance. The fluid and cyst were sent for permanent pathology. There was no malignancy or atypia and the cyst was lined by Müllerian type epithelium (WT-1, ER, PR, PAX-8 and CK-7 immunoreactive) (Figure 3). The patient had an uneventful postoperative course and was discharged home. Thus far she has had no evidence of recurrence.
INTRODUCTION
Traditionally, cysts found within the posterior mediastinum have been universally diagnosed as masses of neurogenic or bronchogenic origin. However, since Hattori first noted the Müllerian cyst within the mediastinum, increasing case reports have mirrored his findings. 1
DISCUSSION
Our patient described above follows the typical course of the Müllerian cyst when compared to the literature: A posterior mediastinal mass is discovered either incidentally or during workup of respiratory or cardiac symptoms, the mass is resected, and barring any surgical complications the patient has a benign follow-up. Hattori first described the Müllerian cyst in 2005. In the decade since this publication, multiple case reports have examined similar lesions. In 2007, Businger et al. published a similar case treated by Video-Assisted Thoracoscopic Surgery who was on hormone replacement therapy. 2 In 2010, Batt published a case report of the first Müllerian cyst within the USA, which also had a typical presentationwhen compared to the literature. 3 Kobayashi in 2012, Simmons in 2013 (who reported two separate cases), and Chon in 2014 reported mediastinal cysts that had expectant
CASE PRESENTATION
Our patient is a 49-year-old black woman with a known history of a posterior mediastinal mass discovered after developing a non-productive cough. Her past medical history includes gastroesophageal reflux disease (GERD) and obesity. On exam, our patient had clear breath sounds bilaterally with no abnormal vital signs and no history of fever. A radiograph (Figure 1) revealed a left-sided posterior mediastinal mass. Computer tomography (CT) scan with IV contrast (Figure 2) showed a 3.4 x 3.6 x 3.0 cm mass posterior to the aortic arch in the left paravertebral location.
J La State Med Soc VOL 169 MARCH/APRIL 2017 43
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