Mesenteric cysts and intra-abdominal cystic lymphangiomas

Laparoscopic treatment of a huge mesenteric pseudocyst - case report

Intra-abdominal cysts and pseudocysts are rarely occurring lesions. Their incidence is reported to be 1 per 100 000-250 000 hospitalizations. The lesions' rarity and their mostly asymptomatic development causes troubles in early recognition and treatment. The patients' complaints are unspecific and mostly occur when the cysts are enlarged. Sometimes these entities may cause signs of peritoneal irritation and be the reason for immediate operation. It may happen in the event of cyst rupture, torsion, haemorrhages into the lesion or signs of compression of neighbouring structures. Many radiological methods are helpful in revealing intra-abdominal cysts. Unfortunately they cannot accurately distinguish the character of the lesion. The most common surgical procedure of treatment is excision during laparotomy. However, in some cases the laparoscopic approach can be equal to open surgery. This article presents a case of a young woman with a large intra-abdominal pseudocyst treated with laparoscopy.

Is laparoscopic cholecystectomy safe for lymphangioma of the gallbladder? A complicated case mimicking subhepatic abscess

Lymphangiomas are rare benign neoplasms of the lymphatic tissue generally occurring in the childhood. Cystic lymphangioma of the gallbladder is an extremely rare tumor with only eight cases having been reported in the literature. The aspecific and potentially misleading clinical presentation of these tumors requires complex preoperative imaging in the setting of clinical suspicion to make the correct diagnosis. The treatment of choice is complete excision with negative margins to avoid local recurrence. Their tendency to locally invade the surrounding tissues requires sometimes extended resections. Laparoscopic cholecystectomy can be a questionable choice in this setting; however, the procedures can be performed safely in most cases, although complicated. We report the case of a hemorrhagic cystic lymphangioma of the gallbladder mimicking a subhepatic abscess and operated in emergency with laparoscopic approach.

[Clinical aspects of intraabdominal cystic lymphangioma in Korea]

BACKGROUND/AIMS

cystic lymphangioma is an uncommon disease, and rarely develops in the intraabdomen. The aim of this article was to discuss about clinical characteristics of intraabdominal cystic lymphangioma developed in Korea.

METHODS

age, sex, symptoms, locations and size of the lesions, diagnostic methods, treatments, complications and recurrence were analyzed in 13 pathologically confirmed cases of intraabdominal cystic lymphangioma and 18 cases of literature consideration reported in Korea.

RESULTS

intraabdominal cystic lymphangioma commonly developed in adults compared to the other lymphangioma, and frequently located in the mesentery. Abdominal pain was the most common symptom, but it was a non-specific finding. Tenderness and abdominal mass were not significantly associated. The size of mass was diverse. Abdominal ultrasonography and abdominal CT were diagnostic tools most commonly used, but preoperative diagnosis was possible only in 22.6%. All patients were discharged without any complications, and no recurrence was reported.

CONCLUSIONS

preoperative diagnosis of intraabdominal cystic lymphangioma is difficult and symptoms and signs are not specific. Intraabdominal cystic lymphangioma should be suspected in patients with non specific abdominal pain and intraabdominal mass and active diagnostic evaluation is mandatory.

Jejunal cavernous lymphangioma

Cavernous lymphangiomas are usually identified in infants and children with the majority of lesions found around the head and neck, trunk or extremities. Tumours affecting the intra-abdominal organs are rare. The authors report a case of small bowel cavernous lymphangioma arising within the jejunum of a 34-year-old woman presenting with dyspnoea and anaemia, and review the existing literature relating to this uncommon tumour.

Giant cystic lymphangioma of the liver

BACKGROUND

Giant cystic lymphangiomas of the liver are rare malformations of the lymphatic system usually found in children.

CASE PRESENTATION

A 35-year-old man presenting with right upper quadrant abdominal pain for 7 months visited our clinic. Ultrasound, CT, and MRI examination demonstrated a giant cystic mass in the right trisegment of the liver. The patient underwent surgical resection and histological results of the resected specimen confirmed the diagnosis of giant cystic lymphangioma. The right upper quadrant abdominal pain subsided after the surgical resection and the patient recovered well.

CONCLUSION

Surgical resection is an effective therapy in treating giant cystic lymphangioma.

Jejunal lymphangioma presenting as an ovarian mass

Intra-abdominal lymphangiomas are rare benign tumours that usually arise in the mesentery of the small bowel. We present the case of an intra-abdominal lymphangioma that involved both the jejunum and its adjacent mesentery that ultrasound and CT scanning suggested was an ovarian tumour. Laparoscopy confirmed normal ovaries and a jejunal mass which was resected at laparotomy. This circumstance has very rarely been described in the literature and represents a diagnostic dilemma of which clinicians should be aware. Intra-abdominal lymphangioma should be included with other non-gynaecological diseases in the differential diagnosis of a pelvic mass, and requires a multi-specialty approach.

Mesenteric lymphangioma in adult: a case series with a review of the literature

Mesenteric lymphangioma is a rare benign tumor with nonspecific clinical features. A case series of three adult patients who had mesenteric lymphangioma is reported along with a review of literature. Two patients presented with painless abdominal swelling who were being managed as a case of abdominal tuberculosis and a third one had features of intestinal obstruction. In our cases, preoperative diagnosis of mesenteric lymphangioma was not suspected and all the patients had laparotomy. Peroperative findings revealed mesenteric masses, which were simulating cavitatory form of mesenteric node tuberculosis. It is stressed that mimicking of mesenteric lymphangioma with a cavitatory form of tuberculosis of mesenteric nodes in areas of high prevalence may lead to its misdiagnosis. Histopathology confirmed diagnosis of mesenteric lymphangioma in each case. Although rare and difficult to diagnose preoperatively, surgical resection is to be considered gold standard treatment for mesenteric lymphangioma.

Acquired omental cystic lymphangioma after subtotal gastrectomy: a case report

We herein describe a case of cystic lymphangioma in the greater omentum of the remnant stomach, which is thought it to be related with subtotal gastrectomy 10 yr ago for early gastric cancer. A 76-yr-old man was admitted to our department with postprandial abdominal discomfort and bowel habit change. Intraabdominal multilocular cystic mass was detected by ultrasonography and computed tomography. We performed a complete En-bloc tumor resection including spleen and distal pancreas, and histological examination confirmed cystic lymphangioma originated from the greater omentum of the remnant stomach. Although the etiology of omental lymphangioma remains largely unclear, these findings suggested strongly that obstruction of the lymphatic vessels after gastric resection for gastric carcinoma might be the most plausible cause. The surgical extirpation with resection of organs involved appears to be a treatment of choice for such unusual case.

Pediatric chylolymphatic mesenteric cyst - a separate entity from cystic lymphangioma: a case series

Introduction

Chylolymphatic mesenteric cysts are rare entities with variable presentations and this has surgical implications in the pediatric age group.

Case presentation

We carried out a retrospective analysis of the clinical and histopathological records of pediatric patients diagnosed and treated for chylolymphatic mesenteric cysts at our institute from 1998 to 2008. Eight patients met the histopathological criteria of chylolymphatic mesenteric cyst. These patients were in the age range 18 months to 10 years with a mean age of 4.5 years. Of these eight patients, four presented with an abdominal lump, and two each with abdominal pain and acute intestinal obstruction. On clinical examination, five out of the eight patients had a palpable abdominal mass. Laparotomy and complete excision of the cyst along with the involved gut was performed in all patients. There were no postoperative complications or any recurrence during the follow-up period which ranged from 4 months to 8 years.

Conclusion

Although very rare, chylolymphatic mesenteric cyst should be kept in mind as one of the differential diagnoses of cystic masses of the abdomen including cystic lymphangioma. Ultrasonography and computed tomography suggest the diagnosis but histopathological examination is required for confirmation. Complete excision of the cyst yields excellent results.

Mesenteric lymphatic malformation associated with acute appendicitis: a case report

Introduction

Mesenteric lymphatic malformations are rare, benign tumors that are most commonly found in children. The presentation of these tumors is variable and may either be innocuous or life threatening. It has been suggested that mesenteric lymphatic malformations are congenital; however, there is evidence that their growth may be stimulated by local trauma.

Case presentation

We describe the first case of a mesenteric lymphatic malformation associated with acute appendicitis in a 13-year-old Caucasian boy. The patient is well six months after surgical excision of the tumor.

Conclusion

The reader should be aware that growth and/or development of mesenteric lymphatic malformations may be associated with trauma and other pro-inflammatory processes.

Pseudomesenteric cyst

Mesenteric cyst and cystic mesenteric tumour are very rare abdominal growth, which is generally encountered, in the second decade of life. Pseudomesenteric cyst is another variant with traumatic and infective etiology is rare in itself. Only 14 cases have been reported previously in the Japanese literature. Emergency operation was performed in only 3 patients. The etiology of the pseudocyst manifested by acute abdomen was unknown [1]. A case of pseudomesenteric cyst presented in the emergency with acute abdomen is reported here.

Colonic lymphangiomatosis associated with anemia

Lymphangioma is an uncommon malformation of lymphatic system. Multiple colonic lymphangioma named as lymphangiomatosis is considered an extremely rare disease. Although lymphangioma is a benign tumor and most colonic lymphangiomas do not cause symptoms and do not require treatment, resection of lymphangioma is necessary in the presence of symptoms such as abdominal pain, bleeding, intussusceptions. We report a case of colonic lymphangiomatosis in a man who presented with abdominal discomfort and anemia, which was diagnosed and treated with endoscopic snare polypectomy.

Urinary retention due to mesenteric cyst: An extremely unusual presentation of a rare complication

Mesenteric cysts are rare intra-abdominal masses, presenting with various clinical signs and symptoms. Mesenteric cysts presenting with a sudden onset of urinary retention is extremely rare. There are no cases reported in the English literature. Here, we report a very rare case of urinary retention, due to mesenteric cyst in a 19-year-old man. The patient presented with abdominal distention with a sudden onset of urinary retention. Ultrasonography and computed tomography scan of the abdomen revealed a huge cystic mass above the bladder that was completely separated from the kidney and bladder. The cyst was removed surgically. The patient experienced no urological difficulty after the surgery. Histological examination confirmed the diagnosis of a mesenteric cyst.

Cystic lymphangioma of the gallbladder: report of a case

Abdominal lymphangioma is usually diagnosed within the first 2 years of life and is extremely rare in adults. The most common location of abdominal lymphangioma is the mesentery, but there are sporadic reports of its development in the gallbladder. A 66-year-old woman was found to have a cystic lesion near the gallbladder. Preoperative studies, including endoscopic ultrasonography, computed tomography, and magnetic resonance imaging, showed a tumor with multilocular cystic structure, originating in the gallbladder fossa. The patient underwent exploratory laparotomy, and the mass was resected en bloc with the gallbladder, as there was no evidence of malignancy on intraoperative ultrasonography. Macroscopically, the tumor was a multilocular cystic mass, 6 x 3 x 2 cm in size, with a rough, sponge-like appearance. Histologically, the cystic tumor was diagnosed as a lymphangioma, originating in the gallbladder. To our knowledge, only three other cases of a cystic lymphangioma originating in the gallbladder have been reported in the medical literature of the world.

Hepatic lymphangioma: a rare cause of abdominal pain in a 30-year-old female

BACKGROUND

Lymphangiomas are rare tumours usually found in the paediatric population in extra abdominal sites.

AIM

To report on a patient with a hepatic lymphangioma.

RESULT

A 30-year-old woman presented with a 4-year history of right upper quadrant pain. Ultrasound and CT imaging demonstrated a cystic mass adjacent to the gallbladder. Histology of the resected specimen conferred a diagnosis of hepatic lymphangioma.

CONCLUSION

We present a case of hepatic lymphangioma together with a review of diagnostic and therapeutic strategies currently available.

Unusual presentation of cystic lymphangioma of the gallbladder

Cystic lymphangioma of the gallbladder is quite a rare tumor with only a few cases having been reported in the literature. We describe here a rare case of cystic lymphangioma of the gallbladder, which was unusual in that the patient presented with biliary pain and an abnormal liver test. Ultrasonography and computed tomography of the abdomen showed a multi-septated cystic mass in the gallbladder fossa and an adjacent compressed gallbladder. Endoscopic retrograde cholangiography showed there was no communication between the bile tract and the lesion, and there were no other abnormal findings with the exception of a laterally compressed gallbladder. After performing endoscopic sphincterotomy, a small amount of sludge was released from the bile duct. The histological findings were consistent with a cystic lymphangioma originating from the subserosal layer of the gallbladder. This unusual clinical presentation of a gallbladder cystic lymphangioma was attributed to biliary sludge, and this was induced by gallbladder dysfunction that was possibly from compression of the gallbladder due to the mass.

Spontaneous regression of a cystic tumor in a postpartum woman; is it a cystic lymphangioma?

Spontaneous regression of intra-abdominal cystic tumors in adults is unusual. Here, we present the case of an apparently spontaneous regression of a large intra-abdominal cystic mass found in the postpartum period of an 18-year-old woman. The regression was demonstrated using serial computed tomography (CT) examinations over a two-year period.

Gallbladder lymphangioma: A case report and review of the literature

Lymphangiomas are rare, benign tumors of the lymphatic system, usually present in children aged 5 years and younger. Because they are asymptomatic until the mass enlarges to cause symptoms, most lymphangiomas are diagnosed at adulthood incidentally. We experienced a case of a 60-year-old man diagnosed with a cystic lymphangioma of the gallbladder, which was successfully resected without any complication. Magnetic resonance imaging and magnetic resonance cholangiopancreatography were very helpful for the diagnosis of the cystic lesion around the gallbladder as were ultrasonography and computed tomography scan. These showed a multi-lobulated cystic mass with intact cystic duct and bile duct in the gallbladder fossa. The patient underwent an open cholecystectomy and the histological findings were consistent with a cystic lymphangioma of the gallbladder. We here report the case of cystic lymphangioma of the gallbladder with a review of the literature.

Surgery for cystic lymphangioma in Gorlin–Goltz syndrome

INTRODUCTION

We present a case of three major lymphomesenteric cysts in a female patient with known basal cell nevus syndrome (BCNS or Gorlin-Goltz syndrome).

DISCUSSION

Although those cysts have been reported to appear in this syndrome, the exact prevalence is not known. In this case, the patient suffered from severe and recurrent abdominal pain due to bowel obstruction.

CONCLUSION

By causing severe symptoms, cystic lymphangiomas are an important complication of the BCNS despite of their seldom occurrence. Surgeons confronted with intraabdominal masses in a patient with BCNS should always be aware of this manifestation of the disorder and plan interdisciplinary operations.

A huge omental lymphangioma with extension into labia majorae: a case report

BACKGROUND

Abdominal cystic lymphangiomas are uncommon congenital benign tumors.

CASE PRESENTATION

We present a case of a 4 year old female child with a cystic lymphangioma arising from greater omentum and occupying whole of the abdomen and protruding through labia mejora. Ultrasonography and CT scan confirmed the diagnosis. Complete excision of the cyst along with omentectomy done with no clinical or radiological evidence of recurrence till 6 months.

CONCLUSION

Due to variable presentation of abdominal lymphangiomas, extensive imaging studies are necessary for evaluation and diagnosis. Complete surgical resection is a treatment of choice.

Abdominal lymphangiomas in adults

Abdominal lymphangiomas are rare benign cystic tumors that can become locally invasive and often require resection. They arise in all ages and have a variable presentation. We performed a retrospective review of a single institution surgical experience with this lesion in adults. The pathology prospective database was reviewed to identify patients with surgically resected abdominal lymphangiomas from January 1986 to May 2004. Retrospective review and follow-up was performed for each patient. The six patients with abdominal lymphangiomas ranged in age from 38 to 66 years. They presented with a variety of signs and symptoms. All underwent CT scan that demonstrated a cystic lesion, but in only one third was the diagnosis made preoperatively. Tumors were located in the retroperitoneum, small bowel mesentery, liver, and pancreas. Five of the six tumors were completely resected. Two of the six required resection of adjacent or involved organs. Follow-up ranged between 6 months and 18 years. All had symptomatic relief after resection, and no patient showed evidence of recurrence in this time period. Abdominal lymphangiomas are rare. The correct diagnosis often remains elusive until tissue is obtained. The treatment of choice is complete surgical resection. When completely resected, these lesions seem not to recur, and the overall prognosis is excellent.

Gallbladder lymphangioma: a case report and review of the literature

Lymphangiomas are benign neoplasms usually occurring in childhood and located in the head and neck. Intraabdominal lymphangiomas account for less than 5% of cases. The involvement of the gallbladder is rare. We report a case of a 29-year-old woman who presented with right upper quadrant pain that had persisted for 6 months. Imaging with ultrasound and magnetic resonance imaging (MRI) revealed a multiseptated lesion surrounding the gallbladder. The patient underwent an exploratory laporatomy, and the mass was resected en bloc with the gallbladder. Histological evaluation of the cystic mass revealed findings consistent with lymphangioma. The prognosis is generally good after complete surgical excision, as was the case for our patient.

Retroperitoneal lymphangioma

Lymphangiomas are rare cystic tumours that may present as cystic masses in the retroperitoneum. Retroperitoneal lymphangiomas account for approximately 1% of all lymphangiomas. Confusion with other cystic tumours of the retroperitoneum including those arising from the liver, kidney and pancreas is common. A case of a retroperitoneal cystic lymphangioma occurring in a 41-year-old woman raising interesting diagnostic and management issues is reported. The patient presented with vague abdominal pain and persistent nausea. Radiological imaging demonstrated a large multiloculated thin-walled cyst involving the upper retroperitoneum. Surgical resection was complete, revealing a benign cavernous lymphangioma. The patient made a complete recovery and was disease-free 30 months postoperatively.

Ileocecal hobnail hemangioendothelioma: report of a case and review of the literature

Hobnail hemangioendothelioma is a rare vascular neoplasm that belongs to the category of vascular neoplasms of borderline (or low-grade) malignancy, defined by a significant potential for local recurrence but very low numbers of metastatic or fatal events. It is typically found in the skin, and rarely in the oral mucosa of children and young adults. We report the first case of hobnail hemangioendothelioma located in the intestine (ileocecal valve).

Recurrent retroperitoneal cystic lymphangioma

Retroperitoneal cystic lymphangioma is a rare congenital malformation. The majority of lymphangiomas are present at birth and nearly all present before the age of two years. We report a case of giant cystic retroperitoneal lymphangioma in a patient who first presented with symptoms at the age of 7, underwent surgery, and who then suffered a recurrent mass 11 years later.

Intra-abdominal and retroperitoneal lymphangiomas in pediatric and adult patients

Intra-abdominal and retroperitoneal lymphangiomas are a rare, congenital malformations of the lymphatics, which are found predominantly in children. The aim of this study is to evaluate the clinical features of this tumor, highlighting the differences in adults and pediatric patients. We also evaluate the preoperative diagnosis, radiological features, surgical treatment, and outcome of this rare condition. Between 1990 and 2004, 14 patients who underwent surgical resection of an intra-abdominal lymphangioma were reviewed retrospectively. There were five pediatric patients between fetal age and 17 years of age and nine adults between 31 and 62 years of age. Overall, females outnumbered males in the series, with a male-to-female ratio of 3:4. However, males predominated in the pediatric age group with a male-to-female ratio of 1.5:1. The clinical presentation of children was more acute ranging from 3 days to 2 months. In adults, four patients were asymptomatic, and the remaining five had symptom duration ranging from 2 weeks to a year. The lymphangiomas occurred in the mesentery (n = 4), retroperitoneum (n = 4), omentum (n = 3), pancreas (n = 2), and spleen (n = 1). All the patients underwent total surgical resection with or without organ resection, and there were no recurrences at a median follow-up of 2 years (range; 3 months--13 years). This series demonstrates that abdominal lymphangiomas have a male preponderance and present more acutely in pediatric patients, whereas in adults, female patients predominate and the history is more chronic.

[Increasing abdominal pain caused by abdominal tumor in a 21-year-old female]

Lymphangiomas are congenital malformations which occur mostly in the neck and head region of children. They are rarely located in the mesenterium or retroperitoneum in adults. We present a case of mesenteric cystic lymphangioma in a young woman who was admitted to hospital with a history of increasing abdominal pain. We discuss diagnostic means, differential diagnosis, and therapeutic management of the disease.

Lymphangioma of the falciform ligament--a case report

A rare case of a lymphangioma of the falciform ligament in a child is described. He presented with abdominal pain and was found to have an unusual intraabdominal mass. Resection was curative.

[IMesenteric and mesocolic cystic lymphangiomas. Diagnostic and therapeutic management]

STUDY AIM

Study of clinical, diagnostic and therapeutic aspects of mesenteric and mesocolic cystic lymphangiomas.

MATERIAL AND METHODS

15 cases were retrospectively analysed: 5 adults (mean age 36.8 years, range 26 to 46) and 10 children (mean age 23 months, range 0 to 5 years). Diagnosis was prenatal in 1 case. Symptoms were: abdominal pain (80%), fever (20%), abdominal mass (46%), occlusive syndrome (33%), chylous ascitis 1 case. Tumours were mesenteric (86%) or mesocolic (13%).

RESULTS

Complete resection was performed in 11 cases (including 10 bowel resections), incomplete resections in 3 and doxycycline sclerotherapy once. Mean follow-up is 5 years. One recurrence occurred 6 years after complete resection and 1 tumour increased after incomplete resection. Patient treated by sclerotherapy was non symptomatic with a 3.5 years follow-up after last injection.

CONCLUSION

Mesenteric and mesocolic cystic lymphangiomas are congenital benign tumours. Complete resection should be performed whenever possible. Intracystic sclerotherapy with doxycyclin is possible for unresectable lymphangiomas.

Prenatal ultrasound findings of fetal neoplasms

A variety of neoplasms can develop in each fetal organ. Most fetal neoplasms can be detected by careful prenatal ultrasonographic examination. Some neoplasms show specific ultrasonographic findings suggesting the differential diagnosis, but others do not. Knowledge of the presence of a neoplasm in the fetus may alter the prenatal management of a pregnancy and the mode of delivery, and facilitates immediate postnatal treatment. During the last five years, we experienced 32 cases of fetal neoplasms in a variety of organs. We describe their typical ultrasonographic findings with correlating postnatal CT, MRI, and pathologic findings.

Laparoscopic excision of mesenteric cysts: a report of two cases

The authors report two cases of mesenteric cysts that were excised laparoscopically. Resection was accomplished with standard minimally invasive techniques and use of an ultrasonic scalpel. Both patients recovered promptly with minimal morbidity and returned to full activity within a short time. This reveals the suitability of minimally invasive surgery for this particular disease process.

Lymphangioma of large intestine: report of ten cases with endoscopic and pathologic correlation

BACKGROUND

Lymphangioma of the intestinal tracts is extremely rare and usually presents as a sessile or pedunculated polyp. The cause of these gross morphologic differences is unknown. The aim of this study was to investigate the characteristic histopathology of the colonic lymphangiomas in comparison with their endoscopic findings.

METHODS

Ten colonic lymphangiomas, diagnosed and resected endoscopically between 1992 and 1999, were microscopically examined and immunohistochemically stained with CD31, CD34, Factor VIII-related antigen, and smooth muscle actin.

RESULTS

The characteristic endoscopic finding was a transparent, fluctuating sessile (7 cases) or pedunculated (3 cases) polypoid mass with the color of normal colonic mucosa. Proliferative and dilated lymphatic tumor vessels were found in the colonic mucosa as well as in the submucosa in seven cases. In three pedunculated lymphangiomas, dilated lymphatics were exclusively restricted to the submucosa. The endothelial lining cells stained positively for both CD31 and Factor VIII-related antigen in all 10 cases tested, but most cases were negative for CD34.

CONCLUSION

A pedicle does not exclude the endoscopic diagnosis of lymphangioma and there is a close correlation between its presence and histologic submucosal localization of dilated lymphatic vessels.

Newborn intraabdominal cystic lymphatic malformations

Cystic lymphatic malformations are rare causes of abdominal masses in the newborn. Also known as mesenteric, omental, or retroperitoneal cysts, they can present in a variety of ways including, intestinal obstruction, volvulus, nonspecific abdominal pain, intracystic hemorrhage, or as an asymptomatic abdominal mass. Abdominal ultrasound scan provides a definitive diagnosis in most suspected cases. Complete resection is possible in most patients except those with extensive retroperitoneal involvement. Recurrence is unusual when complete resection is accomplished. Because most case series with complete data suggest that these entities are lymphatic malformations, the authors suggest the more specific term, cystic lymphatic malformations, be used to describe these lesions.

Protein-loss into retroperitoneal lymphangioma: demonstration by lymphoscintigraphy and blood-pool scintigraphy with Tc-99m-human serum albumin

A rare, benign congenital lymphangioma has been reported to occur frequently in the neck and axilla, but rarely in the retroperitoneal space. We report a case of a retroperitoneal lymphangioma associated with hypoproteinemia caused by protein-loss into the tumor. In this case, lymphoscintigraphy with subcutaneously injected Tc-99m-human serum albumin (HSA) disclosed the communication between the tumor and the lymphatic system, and sequential abdominal scintigraphy with intravenously injected Tc-99m-HSA revealed the protein loss into the tumor. Abdominal scintigraphy with Tc-99m-HSA injected intravenously or subcutaneously is occasionally useful for determining the etiology of hypoproteinemia.

Cystic lymphangioma of the small-bowel mesentery: case report and a review of the literature

Cystic lymphangioma of the small-bowel mesentery is a rare manifestation of an intraabdominal tumor in elderly patients. We present a case of a small-bowel mesentery lymphangioma, causing fever and chills and present clinical and pathologic features. Furthermore, etiology and differential diagnosis of this tumor are discussed.

Mesenteric cysts--a series of six cases with a review of the literature

BACKGROUND

Symptomatic mesenteric cysts account for only 1 in 100,000 acute adult and 1 in 20,000 acute paediatric admissions. Acute symptoms are related to compression of intra-abdominal organs or stretching of the mesentery by rapid expansion. An abdominal mass, mobile in transverse but not longitudinal plane, is often the only physical finding.

METHOD

We outline the presentation, management and histological findings of 6 cases that presented to this hospital from 1987-1997.

RESULTS

There were 5 adults aged 32-79 yr and an 8 yr old boy. The child presented acutely with a painful tender abdominal mass. Of the adults, 1 presented acutely, 2 with chronic symptoms and 2 were incidental findings. Mesenteric cysts were successfully resected in all cases.

CONCLUSION

Surgical intervention is recommended and resection of adjacent bowel may be necessary for complete excision. Successful minimal access surgery via the laparoscope has been reported and may become more widely applicable.