Ruptured retroperitoneal mucinous cystadenoma with borderline malignancy could occasionally contribute to death: a rare case report and literature review

We describe a 48-year-old woman with ruptured retroperitoneal mucinous cystadenoma with borderline malignancy resulting in death for postoperative intestinal compression. The patient was referred to our institution for abdominal mass with preoperative ultrasonography and computed tomography (CT) revealing retroperitoneal mass. At operation, the 12×9 cm retroperitoneal tumor had ruptured. Tumor resection was performed and the implants were washed out as completely as possible. The pathological findings showed retroperitoneal mucinous cystadenoma with borderline malignancy. Unfortunately, intestinal compression occurred to the patient on 11 days post-operation. She then underwent laparotomy and colon transversum-terminal ileum anastomosis. However, the condition did not improve and she progressed into septic shock and multiple organ dysfunction soon and died finally. Primary retroperitoneal mucinous cystic tumor (PRMC) is a rare tumor with an obvious predominance for females. Primary diagnosis could be made through preoperative imaging modalities including ultrasonography, CT and magnetic resonance imaging (MRI). Total tumor resection was performed in all previously reported cases. In addition, a total abdominal hysterectomy (TAH) with bilateral salpingo-oophorectomy (BSO) and postoperative adjuvant chemotherapy may make sense in some cases. The overall prognosis of PRMC was good. Among all cases with PRMC, our case was the sixth fatal case, and it was also the seventh case in which the tumor capsule had been injured during operation. The death in perioperative period of PRMC which was presented in our case had never been reported in recent literature. We could conclude that the rupture or not of the tumor during operation was an important prognosis factor for PRMC.