Intra-abdominal lymphangioma

Retroperitoneal cystic lymphangioma: a diagnostic and surgical challenge

A lymphangioma is a benign proliferation of lymph vessels, producing fluid-filled cysts that result from a blockage of the lymphatic system. The incidence of abdominal lymphangiomas is unknown; however they account for from 3% to 9.2% of all pediatric lymphangiomas, with retroperitoneal lymphangioma representing less than 1% of abdominal lymphangiomas. Due to rarity, preoperative diagnosis is often difficult.

The surgical experience for retroperitoneal, mesenteric and omental cyst in children

Purpose

Intra-abdominal cystic masses originating from the retroperitoneum, mesentery or omentum are very rare and mostly benign tumors, but sometimes present as a complicated cyst encasing the major organs.

Methods

We analyzed the clinical findings, histologic diagnosis, and surgical outcomes in children who underwent operation for retroperitoneal, omental, and mesenteric cyst from 1998 to 2010, retrospectively.

Results

Twenty-three patients (male, 12; female, 11) underwent the operation at a median age of 46 months (range, 9 days to 16 years). Among them, 17 cysts presented one or two symptoms such as abdominal mass, abdominal pain or abdominal distension. The median duration of symptoms was 7 days (range, 1 day to 365 days). Five were detected prenatally. Ten cysts were found in retroperitoneum, 8 in the omentum and 5 in the mesentery. The median diameter was 13 cm (range, 3 to 30 cm). Twenty cysts were completely removed. Five mesenteric cysts required bowel resection and anastomosis. Three of retroperitoneal cysts were impossible to complete excise because of location and extensiveness. Pathologically, 20 cysts were lymphangioma and 3 were pseudocyst. The morbidity was one of adhesive ileus and the mortality was one who had extensive retroperitoneal cyst with mesenteric cyst. He died from sepsis. During follow-up period, there was no recurrence.

Conclusion

Preoperative diagnosis and localization for these cysts are very difficult. Complete excision was possible in almost all cases despite the size, bringing a favorable outcome. The possibility of this disease entity should be considered as the cause of acute abdomen.

Surgical management of intra-abdominal cystic lymphangioma. Report of 20 cases

BACKGROUND

Cystic lymphangioma (CL) is a benign rare malformation of lymphatic vessels. Its discovery in adults is rare. Although it can affect any organ, the common forms found in adults are mesenteric and/or retroperitoneal CL. This article was designed to study the epidemiological, diagnostic difficulties, and therapeutic principles of intra-abdominal cystic lymphangioma in adults.

METHODS

We report a retrospective study from January 1998 to September 2010 concerning 20 patients who underwent surgical removal of a CL. We were interested in discovering the clinical, biological, and radiological characteristics of CL. The localization, size, and number of cysts have been reported, as well as the surgical intervention used and the postoperative immediate and late complications.

RESULTS

The median age was 46 years. Abdominal pain was the main symptom and was found in 15 patients (75%). Physical examination revealed an abdominal mass in 12 patients (60%). In four patients (20%), the cystic lymphangioma was incidental. Abdominal ultrasound and abdominal CT scan helped to highlight 22 cystic masses. CL diagnosis was established preoperatively in 13 patients (65%). Six patients (30%) were operated with a diagnosis other than CL. The diagnosis was made intraoperatively in one case (5%). Only two patients (10%) were operated on in emergency: one due to an infected CL and the other was CL complicated with intracystic hemorrhage. A laparotomy in 13 cases (65%) was the surgical approach used, whereas 7 cases (35%) benefited from a laparoscopy. No conversion was noted. The majority of the patients, 18 cases (90%), received a total cystectomy. Only two patients (10%) had recurrences of which only one was reoperated.

CONCLUSIONS

The diagnosis of CL often is facilitated by means of modern imaging; however, other diagnoses may be discussed, particularly hydatid disease endemic areas. If symptomatic lesions or complications arise, complete surgical excision, when possible without major sacrifice, seems to be the best therapeutic option to reduce the risk of recurrence.

Lymphangioma of the gallbladder in adults: review of the literature and a case report

INTRODUCTION

Lymphangiomas of the gallbladder in adults are extremely rare with only 10 cases published worldwide to date.

CASE PRESENTATION

We herein report a case of a 26-year-old male who presented with abdominal right upper quadrant pain, nausea, vomiting, and diarrhea. An ultrasound, computer tomography scan, and magnetic resonance imaging showed a cystic mass interposed between the gallbladder and the liver with characteristics identical to those of lymphangiomas in more common locations. The patient underwent an open excision of the large spongy mass en bloc with the gallbladder.

CONCLUSION

Histological findings confirmed the diagnosis of lymphangioma. Also, we provide a review of 10 cases presented in the literature, with a discussion of the clinical features, diagnosis, and surgical approach.

Giant mesenteric cystic lymphangioma originating from the lesser omentum in the abdominal cavity

A 48 year old woman was diagnosed with a huge cystic mass in her abdominal cavity. She complained of significant abdominal discomfort due to the mass. The abdominal computed tomography revealed a giant multi-lobulated mass, measuring 26×12 cm in size, adjacent to the lesser curvature of the stomach. In the operation field, the mass was found to originate from the lesser omentum, including the right and left gastric vessels and the vagus nerves, and to invade the lesser curvature of the stomach. For curative resection, distal subtotal gastrectomy with mass excision followed by gastroduodenostomy were performed. This mass was pathologically diagnosed to be a mesenteric cystic lymphangioma; in fact, the largest ever reported. The patient had no complications during the postoperative period and was discharged from the hospital on the seventh day after surgery.

Radiological assessment of mesenteric and retroperitoneal cysts in adults: is there a role for chemical shift MRI?

OBJECTIVE

The purpose of this study was to assess the potential role for chemical shift magnetic resonance imaging (MRI) in identifying lymphangiomas from other cystic mesenteric and retroperitoneal masses.

MATERIALS AND METHODS

A retrospective search of radiology database identified 24 consecutive patients with mesenteric and retroperitoneal cysts (nine men, 15 women; mean age, 41 years; age range, 19-75 years) who had undergone MR which included in-phase and opposed-phase chemical shift imaging. Signal intensity (SI) decrease between in-phase and opposed-phase MR images of the cyst was evaluated qualitatively by two radiologists. Ultrasound (US), computed tomography (CT), and MRI findings of the morphological appearances of all the cystic lesions that demonstrated significant signal drop on chemical shift MR were also recorded.

RESULTS

Of mesenteric and retroperitoneal cysts, 33% (8/24) revealed qualitative decrease in intensity on opposed-phase MR images relative to that seen on in-phase images. On ultrasound, these cysts demonstrated anechoic simple fluid. Their mean CT attenuation was 13 HU (range: 5-20 HU). Signal loss on fat-suppressed T1-weighted sequences was displayed only by a single cyst. None of the lesions with qualitative SI decrease on opposed-phase MR showed suggestion of lipid on US and CT.

CONCLUSION

The presence of intra cystic lipid detected by chemical shift MR may not be overt on cross-sectional imaging such as US and CT. Chemical shift MRI provides additional sensitivity and specificity as an imaging test for demonstration of lipid within mesenteric and retroperitoneal cysts enabling a higher diagnostic yield for lymphangioma leading to more appropriate patient management.

[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.

Retroperitoneal cystic lymphangioma in an adult: A case report and review of the literature

Lymphangiomas are rare benign cystic tumors of the lymphatic system. Retroperitoneal lymphangiomas account for 1% of all lymphangiomas, and approximately 186 cases have been reported. They may clinically present as a palpable abdominal mass and can cause diagnostic dilemmas with other retroperitoneal cystic tumors, including those arising from the liver, kidney and pancreas. This report describes the rare case of a cystic retroperitoneal lymphangioma in a 54-year-old male patient. The lymphangioma had progressed to the point of inducing clinical symptoms of abdominal distention, abdominal pain, anorexia, fever, nausea and diarrhea. Radiological imaging revealed a large multiloculated cystic abdominal mass with enhancing septations involving the upper retroperitoneum and extending into the pelvis. Surgical removal of the cyst was accomplished without incident. A benign cystic retroperitoneal lymphangioma was diagnosed on histology and confirmed with immunohistochemical stains.

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.

Giant mesenteric lymphangioma: a rare cause of a life-threatening complication in an adult

Mesenteric cyst lymphangiomas (MCLs) are rare benign tumours of unknown aetiology seen mostly in children. Clinical presentation can be diverse ranging from incidental abdominal cysts to an acute abdomen. A 24-year-old previously fit and healthy young man presented with a 2-week history of cramping, central abdominal pain and vomiting requiring acute hospital admission. He was a diagnostic conundrum despite extensive preoperative investigations. Recurring symptoms required urgent surgical exploration, resection and histological confirmation with a successful outcome. We review the literature and present here this rare case in an adult of MCL that has the potential to grow, invade and develop major life-threatening complications.

Cystic lymphangioma of the mesocolon

A 46-year-old gentleman presented to our hospital with a short story of abdominal pain and distension. On examination, gross ascites was noted and confirmed on subsequent imaging with no other notable features. CT scan after ascitic drainage showed a cystic mass extending from the lower pole of the spleen to the left iliac fossa in keeping with an intraperitoneal cyst. At laparatomy, a cystic lymphangioma was resected. Lymphangiomas are rare benign tumours and are reported to occur preferentially in the neck of axilla in children. Abdominal lymphangiomas are extremely rare particularly in adults but important to recognise due to a potential for serious consequences.

Solitary hepatic lymphangioma: report of a case

A 52-year-old woman presented with upper abdominal pain. Abdominal ultrasonography showed a 4-cm well-defined mass containing solid and cystic components in segment IV of the liver, and contrast-enhanced T1-weighted magnetic resonance imaging revealed heterogeneous enhancement within the tumor, indicating a solid or fibrous component. There were no cystic lesions in any other organs. A partial hepatectomy was performed, based on a preoperative diagnosis of sclerosing hemangioma and biliary cystadenoma or cystadenocarcinoma. Pathologically, the tumor appeared to be a multilocular and cystic lesion lined by attenuated endothelial- like cells with no atypia. Immunohistochemistry demonstrated the endothelial-like cells to be positive for the lymphatic-specific markers D2-40, LYVE-1, and Prox-1, which proved helpful for confirming the diagnosis as solitary hepatic lymphangioma. This case is presented with details of the pathologic and radiologic findings, because solitary hepatic lymphangioma is an extremely rare tumor and no previous reports have provided details of the immunohistochemical characteristics.

Solitary hepatic lymphangioma: report of a case

A 52-year-old woman presented with upper abdominal pain. Abdominal ultrasonography showed a 4-cm well-defined mass containing solid and cystic components in segment IV of the liver, and contrast-enhanced T1-weighted magnetic resonance imaging revealed heterogeneous enhancement within the tumor, indicating a solid or fibrous component. There were no cystic lesions in any other organs. A partial hepatectomy was performed, based on a preoperative diagnosis of sclerosing hemangioma and biliary cystadenoma or cystadenocarcinoma. Pathologically, the tumor appeared to be a multilocular and cystic lesion lined by attenuated endothelial- like cells with no atypia. Immunohistochemistry demonstrated the endothelial-like cells to be positive for the lymphatic-specific markers D2-40, LYVE-1, and Prox-1, which proved helpful for confirming the diagnosis as solitary hepatic lymphangioma. This case is presented with details of the pathologic and radiologic findings, because solitary hepatic lymphangioma is an extremely rare tumor and no previous reports have provided details of the immunohistochemical characteristics.

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.

Total laparoscopic excision of retroperitoneal cystic lymphangioma

Retroperitoneal cystic lymphangioma is a rare benign tumor of the retroperitoneal lymphatics that usually manifests in infancy. If surgical excision is used in treatment, it needs to be as complete as possible to reduce the risk of recurrence. Two pediatric patients, an 18-month-old girl and a 4-yearold boy, underwent laparoscopic excision of symptomatic retroperitoneal cystic lymphangiomas. Macroscopically, the resection was complete in both cases. The postoperative course in both cases was uneventful. Both children remained asymptomatic and no recurrence was observed at 18-month follow-up. Complete laparoscopic excision should be considered as a therapeutic option to treat retroperitoneal cystic lymphangioma.

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.

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.

Successful management of a bilateral diaphragmatic lymphangioma

A 5-year-old boy developed two episodes of massive chylothorax due to a huge bilateral diaphragmatic lymphangioma. Two episodes of chylothorax were well controlled only after parenternal octreotide. The lymphangioma showed more than 90% shrinkage after intralesional sclerotherapy with bleomycin.

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.

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.

Lymphangiomatosis Masquerading as Metastatic Melanoma

A patient undergoing evaluation for malignant melanoma was thought to have a metastatic process involving the anterior mediastinum, axilla, spleen, and possibly liver based on radiologic findings from positron emission tomography and computed tomography scans. The clinical picture did not corroborate this suspicion, and biopsies ultimately confirmed lymphangioma in the accessory spleen and subcutaneous tissues, leading to a diagnosis of lymphangiomatosis. Diagnosis and management of lymphangiomatosis is clinically challenging. This report reviews the literature on the pathology, diagnostic imaging, and management of lymphangiomatosis.

Fetal abdomino-perineal lymphangioma: differential diagnosis and management

Fetal lymphangiomas are rare congenital anomalies of the lymphatic system most commonly presenting in the head and neck. Cystic abdominal lymphangiomas are more rare with only a few cases reported prenatally. We report a case of a prenatally detected abdomino-perineal lymphangioma that mimicked the more fatal prenatally detected sacrococcygeal teratoma (SCT), which resulted in one caregiver suggesting termination of the pregnancy. This case demonstrates the importance of carefully considering the differential diagnosis of fetal abdomino-perineal masses when counseling parents.

Endoscopic Ultrasound Diagnosis and Laparoscopic Excision of an Omental Lymphangioma

Omental lymphangiomas are rare intra-abdominal tumors. We describe a case of an omental lymphangioma which appeared on computed tomography scan as a possible gastric duplication cyst. The lesion was correctly diagnosed preoperatively via endoscopic ultrasound and complete excision of the cyst was performed laparoscopically.

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.

Cystic lymphangioma of the jejunal mesentery in an adult: A case report

We herein describe the case of a 27-year-old female, who presented with a large mass of the upper left abdominal cavity discovered incidentally, through an annual health examination. Preoperative studies including abdominal ultrasonography and magnetic resonance imaging were performed, but they could not accurately determine the nature of the tumor. At laparotomy, a large cystic tumor of the small bowel mesentery was found. Histopathologic examination diagnosed the tumor as a cystic lymphangioma. Although lymphangiomas are rare, especially in the abdomen of adults, they may sometimes present as acute abdomen, causing complications that require emergent surgery.

Diffuse neonatal abdominal lymphangiomatosis: management by limited surgical excision and sclerotherapy

Complete excision of diffuse abdominal lymphangiomatosis in the newborn is next to impossible. A 3-day-old female infant was found to have diffuse abdominal lymphangiomatosis predominantly in the left mesocolon and retroperitoneum. Initial management was by marsupialization, which was complicated by chylous ascites requiring periodic paracentesis and nutritional support. At the age of 45 days, left hemicolectomy and partial excision of the retroperitoneal cysts were performed together with intracystic injection of OK-432 into the residual cysts. The patient's progress after the second operation was satisfactory. Initial marsupialization followed by delayed partial resection together with injection of OK-432 into the residual cysts is an effective method of managing diffuse abdominal lymphangiomatosis in the newborn.

Cystic lymphangioma associated with enteric duplication as a cause of recurrent vomiting

We describe a case report of a 6-year-old boy with a 4-year history of recurrent vomiting with a cyclical vomiting pattern. Although initially labelled with and treated for Cyclical Vomiting Syndrome the cause was subsequently found to be an enteric duplication associated with cystic lymphangioma, an association not previously described.

Cavernous lymphangioma arising from uterine corpus

BACKGROUND

A rare case of giant uterine lymphangioma was experienced.

CASE

A 44-year-old female noted a rapidly grown abdominal tumor and its accompanied symptoms, progressive abdominal distension, lumbago, and developed leg edema. Ultrasonography made a possible diagnosis of a huge ovarian tumor; postoperative diagnosis was cavernous lymphangioma arising from the uterus.

CONCLUSION

According to the literature, lymphangioma itself is a rare tumor, and giant lymphangioma arising from uterine corpus is extremely rare. We experienced an extremely rare case of uterine lymphangioma and ultrasound tomography better imaged the tumor inside.

Cystic lymphangioma with special reference to rare sites

A 10 year retrospective study of 45 cases of cystic lymphangioma (CL) in children is presented. There were 25 females and 20 males. Age ranged from 6 months to 8 years. Common sites were involved in 38 and rare sites in 7 patients. Rare sites were--gluteal region (1), pelvis (1), retroperitoneum (1), mesentery (2), inguinal region (1) and inguinoscrotal region (1). The clinical presentation included sudden increase in size (25), lump abdomen (3), gluteal abscess (1), abdominal distension (1) and inguinal swelling (2). Diagnosis was established preoperatively in 38 cases, and after surgery and histopathology in 7 cases. Near total or subtotal excision was carried out in all cases. Facial nerve palsy (1) and recurrence (2) were the complications of surgery. The study is presented to highlight the occurrence of the cystic lymphangioma at rare sites to avoid diagnostic errors and unnecessary mutilating surgery.

Bilateral adrenal cystic lymphangiomas in nevoid basal cell carcinoma (Gorlin-Goltz) syndrome: US, CT, and MR findings

We present a case of bilateral adrenal cystic lymphangioma in a patient with the Gorlin-Goltz syndrome. This case is unique as it is the first illustrated case (US, CT, and MR findings) of a cystic lymphangioma arising within the adrenal gland. In addition, the coexistence of cystic adrenal lymphangioma with the Gorlin-Goltz syndrome has not been described previously.

Retro-peritoneal cystic lymphangioma in association with fetal hydantoin syndrome

Antiepileptic drugs are known to be teratogenic. Use of phenytoin during pregnancy can cause various congenital malformations leading to 'fetal hydantoin syndrome'. One such case reported is unique in the sense that it occurred with retroperitoneal cystic lymphangioma, itself a rare condition. Such an association is not described elsewhere.

A clinicopathologic and immunohistochemical study of ten pancreatic lymphangiomas and a review of the literature

BACKGROUND

Pancreatic lymphangiomas are rare benign tumors, of which only a few cases have been reported in the literature. In this study, the authors present a series of primary pancreatic lymphangiomas.

METHODS

Cases of nonepithelial pancreatic cystic tumors (lymphangiomas) diagnosed between 1966 and 1994 were retrieved from the Endocrine Pathology Registry of the Armed Forces Institute of Pathology. Histologic features (in 10 cases) as well as histochemical and immunohistochemical studies (in 6 cases) were reviewed. Long term patient follow-up data were obtained in 9 cases.

RESULTS

The patients included 8 females and 2 males ages 2-61 years (mean age, 28.9 years) at initial presentation. The tumors were circumscribed and occurred predominantly (in 6 of 10 cases) in the tail of the pancreas. The multicystic, serous, or chylous fluid-filled cystic tumors ranged from 3 to 20 cm (average, 12.7 cm) in greatest dimension. Histologically, the tumors consisted of multilocular cystic spaces of various sizes, lined by endothelial cells. The stroma contained smooth muscle and mature lymphocytes. Immunohistochemistry determined the endothelial lining cells to be factor VIII-R antigen and CD31 positive (in all cases tested) but usually CD34 negative. All patients for whom follow-up data were obtained (n=9) were alive without evidence of disease an average of 7.2 years after initial diagnosis.

CONCLUSIONS

Pancreatic lymphangiomas occur predominantly in females within a wide age range. Multilocular, fluid-filled cysts, with endothelial immunoreactivity for factor VIII-R antigen and CD31, are characteristic of these tumors. Complete surgical excision of these benign tumors resulted in excellent long term prognoses for all patients studied.

Lymphangiomas of the ileum: a report of two cases and a review of the literature

Lymphangiomas of the gastrointestinal tract are seen very rarely, especially in adults. We herein present two cases of ileal lymphangioma which were found during surgery. One case was a 43-year-old man with a palpable mass, and the other was a 19-year-old man who presented with symptoms of pyloric stenosis. Although radiologic studies helped us, we could only be certain about the diagnosis after both the operation and histopathologic studies. We performed a total excision with ileal resection in both cases.

Abdomino-scrotal lymphangioma

Retroperitoneum, pelvis and scrotum are unusual sites of lymphangiomas. Retroperitoneal lymphangiomas presenting as inguino-scrotal masses are extremely rare. An unusual case of retroperitoneal lymphangioma extending into scrotum, presenting as acute scrotum is reported due to its unusual location. Complete surgical excision with careful attention to avoid damaging contiguous structures is the treatment of choice.

Abdominal mass and haematuria

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