Intra-abdominal lymphangioma

Lymphangioma of small bowel in adults: A rare cause of abdominal symptoms

BACKGROUND

Lymphangioma is unusual malformation of the lymphatic system and rarely occurred in adults below diaphragm. Lymphangioma in small intestine sometimes caused unspecific symptoms and even bleeding, however, this area was most difficult for endoscopic examination and worth investigation.

METHODS

From 1999 to 2019, we retrospectively collected eighteen adult patients with the pathological diagnosis of lymphangioma from duodenum to terminal ileum. The clinical symptoms, origin site, predisposing factor, pre-operative image surveillance, surgical intervention, histopathological findings, follow-up period, and outcome were reviewed and analyzed.

RESULTS

The mean age of diagnosis was 50.11 years old with female predominance. The most common symptoms were abdominal pain (77.78%), palpable mass (27.78%) and intestinal bleeding (16.67%). With the different gross and microscopic findings, the adult intestinal lymphangioma could be classified as "simple", "polyposis", and "cystic cavernous".

CONCLUSION

Intestinal lymphangioma in adults is a rare cause of abdominal discomfort but should be listed in differential diagnosis during daily practice. The morphology and classification may be different from pediatric group, and more large-scale studies are need for thorough investigation.

A rare incidence of retroperitoneal Cystic Lymphangioma in a 45-year-old female - A Case Report

Introduction and importance

Cystic lymphangioma is an extremely rare benign vascular neoplasm of mesodermal origin, arising from lymphatic vessels and occurring principally in male children. The retroperitoneum is the rarest site, accounting for <1 % of all types of lymphangioma. The incidence of cystic lymphangioma is unknown due to the scarcity of published data.

Case presentation

A 45-year-old female presented to our hospital complaining of vague abdominal pain and intermittent episodes of vomiting over four months. Preoperative imaging via ultrasound and Computed Tomography revealed a well-demarcated retroperitoneal cystic mass between the right kidney and the liver.

Clinical discussion

The mass was excised laparoscopically. Histopathological examination confirmed a cystic hygroma (a subtype of cystic lymphangioma).

Conclusion

Cystic lymphangioma is rare, often misdiagnosed and may present with vague symptoms. Complete resection may be feasible and can be curative.

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Cystic lymphangioma is a rare benign lymphatic neoplasm presenting almost exclusively in children.

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Retroperitoneal lymphangiomas comprise <1 % of all lymphangiomas.

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Presenting symptoms may be non-specific, as in our case.

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The mass could become infected, bleed or rupture.

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Complete surgical resection is the treatment of choice for such lesions.

Case report: Omental lymphangioma mimicking gastric cystic tumor

Omental lymphangioma is a rare pathology presented in the abdomen, and it can mimic several clinical conditions. Owing to its variable signs and symptoms, making a correct diagnosis by clinicians may be difficult. Surgical excision is the gold standard treatment. In this article, we report a case who presented with nonspecific abdominal complaints, and underwent surgery. Final pathologic diagnosis revealed omental cystic lymphangioma.

Extensive abdominal lymphangiomatosis involving the small bowel mesentery: A case report

BACKGROUND

Abdominal lymphangiomatosis is a rare benign condition accounting for less than 1% of all the cases of lymphangiomatosis. Management usually involves radical surgical excision; however, depending upon the extent of involvement, patient condition, and absence of complications, conservative management can be also considered.

CASE SUMMARY

We present the case of a 32-year-old male who presented with short onset abdominal pain and melena. Physical examination findings were within normal limits, except for left lower abdominal tenderness. Upper gastrointestinal endoscopy was within normal limits. Abdominal and pelvic ultrasound and computed tomography (CT) scan revealed numerous, variably-sized cystic lesions within the abdominal cavity, exclusively and extensively affecting the small bowel mesentery with sparing of the retroperitoneum. The diagnosis was confirmed by CT and cytological examination. Radical surgical excision was technically impossible in this patient because of the extensive involvement of the mesentery; therefore, the patient was managed conservatively.

CONCLUSION

Extensive and exclusive small bowel mesentery involvement in abdominal lymphangiomatosis is rare. Imaging modalities play an important role in establishing the diagnosis and conservative management can be considered when surgery is technically impossible.

Mesenteric Lymphangioma Presenting With Small Bowel Volvulus in an Adult

Benign tumours of vascular and lymphatic origin are known as lymphangiomas. In this report, we present a case of a 26-year-old lady admitted with symptoms of small bowel obstruction. Her computed tomography (CT) scan showed a well-defined mass in the small bowel mesentery associated with small bowel volvulus. Segmental resection of the bowel, including the mass, was performed. Microscopic examination and immunohistochemistry of the specimen were consistent with lymphangioma of the small bowel mesentery.

A 61-year-old woman with jejunal lymphatic malformation visualized on computed tomography: a case report

BACKGROUND

Jejunal lymphatic malformations are congenital lesions that are seldom diagnosed in adults and rarely seen on imaging.

CASE PRESENTATION

A 61-year-old Caucasian woman was initially diagnosed and treated for mucinous ovarian carcinoma. After an exploratory laparotomy with left salpingo-oophorectomy, a computed tomography scan of the abdomen and pelvis demonstrated suspicious fluid-containing lesions involving a segment of jejunum and adjacent mesentery. Resection of the lesion during subsequent debulking surgery revealed that the lesion seen on imaging was a jejunal lymphatic malformation and not a cancerous implant.

CONCLUSIONS

Abdominal lymphatic malformations are difficult to diagnose solely on imaging but should remain on the differential in adult cancer patients with persistent cystic abdominal lesions despite chemotherapy and must be differentiated from metastatic implants.

A case of giant retroperitoneal lymphangioma and IgG4-positive fibrosis: Causality or coincidence?

Several chronic inflammatory diseases have been found to be a subtype of IgG4-related disease, all of which have a typical clinical and histological change, which is based in particular on an overexpression of IgG4 and subsequent fibrosis. At least a part of the retroperitoneal fibrosis, which was originally classified as idiopathic, seems to be assigned to IgG4-related disease. Lymphangiomas are benign, cystic tumors that rarely occur in adults. However, there is no firm association with IgG4-related disease described in the literature to date. This report is about a patient suffering from acute renal failure due to a giant retroperitoneal cyst. Surgical resection remains incomplete in the iliac vessel area due to severe fibrosis and histology revealed features of both lymphangioma and IgG4⁺ fibrosis. The case description is followed by a brief overview of IgG4-related disease and a consideration of whether lymphangiomas might be assigned to this topic.

Mesenteric Lymphatic Malformation Causing Midgut Volvulus in an Adult: An Unusual Presentation

Mesentery is an uncommon location for occurrence of lymphatic malformations. Lymphatic malformations causing midgut volvulus are described in pediatric population; however, it is a rare presentation in adults. We present case of 20-year-old man with a large mesenteric lymphatic malformation who presented with acute abdominal complaints. On radiological work up, the lymphatic malformation was seen causing midgut volvulus and closed loop small bowel obstruction with the presence of classical whirlpool sign. The patient underwent emergency surgery and the lymphatic malformation was completely excised along with resection of a segment of small bowel loop.

Solitary hepatic lymphangioma mimicking liver malignancy: A case report and literature review

BACKGROUND

Hepatic lymphangioma, a malformation of the liver lymphatic system, is a rare benign neoplasm and usually coexists with other visceral lymphangiomas. Solitary hepatic lymphangioma is much more rarely seen and could cause a clinical misinterpretation as malignancy.

CASE SUMMARY

A 50-year-old woman with a liver mass of approximately 3.5 cm was initially diagnosed with hepatocellular carcinoma given the risk factors for liver cancer that she presented with, including Schistosome japonicum infection and jaundice, and also together with imaging results, which showed the mass enhanced quickly in the arterial phase and faded fast in the venous phase. The patient did not have the surgery first but received three rounds of transarterial chemoembolization because of her anxiety and fears for operation. Finally, the patient underwent laparoscopic liver segment 4b resection and cholecystectomy and was discharged from the hospital only 10 d after the operation. The pathological examination indicated the mass as hepatic lymphangioma. The patient has been followed up for 30 mo without recurrence. To raise the awareness of this misdiagnosed case and to better diagnose and treat this rare disease in future, we reviewed the published literature of solitary hepatic lymphangioma for its clinical symptoms, imaging presentation, operative techniques, histology features and prognosis.

CONCLUSION

Solitary hepatic lymphangioma mimicking malignancy makes diagnosis difficult. Complete surgical resection is the first choice to treat solitary hepatic lymphangioma.

Update on MR Imaging of cystic retroperitoneal masses

OBJECTIVE

This article reviews the MRI appearance of cystic retroperitoneal (RP) masses.

CONCLUSION

Lymphangiomas are the most common RP cystic masses and typically appear simple; microscopic fat is a specific but insensitive finding. Location, internal complexity, and enhancement pattern suggest alternative diagnoses which range from normal anatomic variants to congenital abnormalities and importantly include benign, neurogenic, and malignant neoplasms. An approach to the MR imaging of cystic RP masses is presented.

A case report of recurrent intussusception caused by small bowel lymphangioma in an adult

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Lymphangioma is a benign tumor that rarely arises in gastrointestinal tract.

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Small bowel lymphangioma can cause intussusception in adults.

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The symptoms of small bowel intussusception in adults resemble those of adhesive small bowel obstruction.

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Reduction is not sufficient and surgical resection of affected bowel should be performed.

Introduction

Adult intussusception and lymphangioma in gastrointestinal tract are uncommon entities respectively. Recurrent intussusception due to lymphangioma of the small intestine is extremely rare and mimics adhesive small bowel obstruction (SBO).

Presentation of case

A 37 year old man presented with acute abdominal pain and vomiting. He had been admitted several times for adhesive SBO after laparoscopic cholecystectomy at age 21. He was initially managed with a long tube placement, with which he used to get well. This time, the symptoms once relieved but soon relapsed, so an exploratory laparotomy was performed. Intraabdominal adhesiolysis was performed alongside the excision of a small segment of damaged jejunum. Intussusception of jejunum was noted and its reduction was also performed. Unfortunately, the symptoms continued after the operation, and computed tomography revealed a recurred intussusception of the jejunum. A reoperation with an additional resection of small intestine surrounding intussusception was performed. The symptoms subsided after the second operation and the patient was discharged. Pathological examination revealed lymphangioma within the affected lumen.

Discussion

Intussusception in an adult is often caused by a tumor but can be caused by postoperative adhesion. The reduction is a potential option of treatment if there is no tumor suspected, but sometimes it would be uneasy to affirm the non-existence of tumors.

Conclusion

We present this rare case of recurrent jejuno-jejunal intussusception caused by small bowel lymphangioma with review of literature. Taking the possibility of recurrence and malignancy into account, the resection should always be considered in such patients.

Cystic lymphangioma of the stomach with marked reactive changes: a rare cause of gastric outlet obstruction in adult

Cystic lymphangiomas are benign lymphatic tumours which usually affect the paediatric population and are predominantly located in the head and neck region. Its occurrence during adulthood and an intra-abdominal location are both extremely uncommon. Clinically and radiologically, these lesions often mimic malignancy. Infrequently, these tumours can undergo degenerative and reactive changes obscuring the diagnostic features. We describe hereby an anecdote of cystic lymphangioma with marked reactive changes presenting with the features of gastric outlet obstruction in an adult patient.

Αdnexal cystic lymphangiomas in patients with massive leiomyomatous uterus: a not so uncommon finding on pelvic MRI

PURPOSE

To investigate any association between the presence of an adnexal cystic lymphangioma (ACL) and an enlarged leiomyomatous uterus.

METHODS

A retrospective observational study was conducted by two expert radiologists using a 10-year MRI database (2008-2018); 85 patients (mean age: 45.5 years ± 10.9) were considered eligible due to the presence of a single (n = 31) or multiple (n = 54) leiomyomas causing distortion of the uterine contour and uterine enlargement. The association of specific leiomyoma features (longest diameter (Dmax), location, number) and uterine volume with the presence of ACL was statistically tested. Diagnosis of ACL was based on typical imaging features (n = 14) and intraoperative/histological findings (n = 3).

RESULTS

ACL (unilateral = 9, bilateral = 8) was recorded in 17/85 (20%) of patients; it was more frequently observed when the largest leiomyoma was located in the uterine fundus (33.3%). Patients with ACL had significantly more leiomyomas (median: 5 vs. 2, p = 0.043), greater Dmax of largest leiomyoma (median: 13.3 vs. 7.2 cm, p < 0.001), and larger uterine volumes (median: 676.7 vs. 223.1 cm³, p < 0.001) compared to patients without ACL. ROC curve analysis for a number of leiomyomas showed that the optimal cut-off for the prediction of ACL was the presence of 5 leiomyomas with 53.8% sensitivity and 84% specificity (AUC = 0.65, 95% CI 0.51-0.83, p = 0.049), Dmax of largest leiomyoma 9.1 cm with 76.5% sensitivity and 77.9% specificity (AUC = 0.83, 95% CI 0.73-0.94, p < 0.001), and uterine volume 311 cm³ with 71% sensitivity and 75% specificity (AUC = 0.79, 95% CI 0.66-0.92, p < 0.001).

CONCLUSIONS

The presence of ACL is significantly associated with number of leiomyomas, Dmax of largest leiomyoma, and uterine volume; prospective evaluation of our results is needed to investigate its clinical significance.

A rare case of retroperitoneal and mesenteric lymphangiomatosis

Lymphagiomatosis are rare benign malformations of the lymphatic system. They are more commonly seen during childhood and are frequently asymptomatic and incidentally found in the adult patient. We report a case of a 31-year-old male who presented initially with melena. Computer tomography scan revealed multiple confluent, fluid-density lesions encasing the retroperitoneum and mesentery. A laparotomy and incisional biopsy of the mesenteric lesion was performed. Histologic examination demonstrated fibrofatty tissue with prominent, thick-walled endothelial-lined vessels. The histologic and computer tomography findings were consistent with a diagnosis of retroperitoneal and mesenteric lymphangiomatosis. The patient was subsequently discharged home well.

Cystic lymphangioma in the peripheral jejunal mesentery in an adult and excision with laparoscopic-assisted surgery: a case report

Background

Lymphangiomas are uncommon congenital malformations that present mainly in the head, neck, and axillar regions in pediatric patients. Mesenteric cystic lymphangiomas (MCLs), which occasionally present with substantial growth and the invasion of adjacent vital structures, are rarely reported in adults. We report a case of MCL in an adult who was treated with laparoscopic-assisted excision.

Case presentation

A 40-year-old Japanese man visited his family physician for prolonged periumbilical pain. Plain computed tomography (CT) showed a low-density mass in his left abdomen, and he was referred to our hospital 2 weeks later. His abdomen was flat and soft, and no mass was felt upon palpation. Routine laboratory data showed no abnormalities in the blood cell counts. The levels of tumor markers, such as carcinoembryonic antigen (CEA), carbohydrate antigen 19-9 (CA19-9), and cancer antigen 125 (CA125), were within normal ranges. Contrast-enhanced CT was performed, and a low-density mass was observed with an irregular outline and poor contrast, as well as involvement of the peripheral mesenteric artery and partial compression of the adjacent jejunum without dilatation of the oral side of the bowel. The patient was diagnosed with lymphatic cysts and observed for 1 month without symptom exacerbation. Follow-up CT showed no increase in the size of the mass but showed apparent invasion of the jejunal wall without bowel obstruction. Magnetic resonance imaging (MRI) showed intermediate intensity on T1-weighted imaging (T1WI) and high intensity on T2-weighted imaging (T2WI). The coronal view on T2WI clearly showed an accumulation of cystic lesions. We performed tumor excision with partial resection of the jejunum in a laparoscopic-assisted manner. Pathological examination showed multicystic lesions with an attenuated endothelial lining, surrounding rich adipose tissue and scattered smooth muscle fibers; the patient was diagnosed with MCL.

Immunohistochemical assays supported this diagnosis.

Conclusions

This is rare case of MCL presenting in an adult who underwent successful laparoscopic-assisted resection. Mesenteric lymphangioma (ML) should be considered in the differential diagnosis of patients with intraabdominal cysts. Radical excision is optimal, even when the patient is asymptomatic. Laparoscopic-assisted tumor resection is a suitable surgical method for treating MLs located in the peripheral mesentery.

A rare case of retroperitoneal hemolymphangioma

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Accurate diagnosis of hemolymphangioma preoperatively is difficult.

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Disease may vary from simple cystic to aggressive lesions, mimicking malignancy.

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Complete excision provides the best results with a lower recurrence rate.

Introduction

Hemolymphangioma, a rare vascular developmental condition, is characterized by malformed venous and lymphatic components in various proportions. Herein, we report a case of a retroperitoneal cystic tumor in an adult patient.

Presentation of case

A 68-year-old man presented to our hospital with complaints of abdominal pain and vomiting. His abdomen was distended with upper tenderness but without rebound tenderness. Computed tomography (CT) scanning demonstrated a retroperitoneal cystic tumor at the dorsal part of the pancreatic head. Thus, a diagnosis of liposarcoma or lymphoma was made. The patient was scheduled for surgery after his general condition became stable. Intraoperatively, the cystic tumor was found to have originated from the retroperitoneal space. The tumor was in contact with the pancreatic head, abdominal aorta, and inferior vena cava. There was no invasion into the surrounding tissue. The cystic tumor was resected completely. Histopathological examination revealed that the resected retroperitoneal cystic tumor was a hemolymphangioma. The patient had no recurrence during the 12-month follow-up.

Discussion

Hemolymphangioma is a rare benign tumor, and its accurate diagnosis before surgery is still difficult. Disease presentation may vary from simple well-defined cystic lesions to aggressive ill-defined lesions, mimicking malignancy. Complete excision provides the best results with a low recurrence rate.

Conclusion

Further research is needed on the preoperative radiological diagnosis of such tumors and on how to determine tumor resectability in such cases.

Giant Ovarian Lymphangioma: Case Report and Review of the Literature

INTRODUCTION

Lymphangiomas are benign tumors/malformations, characterized by proliferation of the lymphatic vessels. They may arise anywhere, although the most common localizations are the head-neck region and the axilla. To date, only 21 cases of lymphangioma of the ovary in a 60-year literature survey have been reported.

CASE REPORT

A 16-year-old female patient with long standing abdominal distension had 40 cm × 15 cm × 29 cm ovarian lymphangioma.

CONCLUSIONS

Our case highlights that lymphangiomas can occur in the adolescent population and should be added to the differential diagnosis of ovarian masses in this age group.

Management of small bowel polyps: A literature review

Despite the small bowel comprising 90% of the mucosal surface area of the gastrointestinal tract, it is a rare site for neoplasia and only accounts for a little over 3% of the tumors that arise in the digestive tract. Benign small bowel lesions include lipomas, lymphangiomas, leiomyomas, neurofibromas, nodular lymphoid hyperplasia and adenomas, many of which are precursors to malignant lesions. Several polyposis syndromes are associated with small bowel polyps as well, including familial adenomatous polyposis syndrome, lynch syndrome, Peutz-Jeghers syndrome, Cowden syndrome and juvenile polyposis syndrome. Our aim was to review non-malignant small bowel polyps and discuss the prevalence, typical location, clinical presentation, diagnosis, endoscopic and histologic description and lastly management of each of these lesions.

An adult case of lymphangioma of the hepatoduodenal ligament mimicking a hepatic cyst

Background

Intra-abdominal lymphangiomas are rare, benign tumors in adults. This report is the third documented case of a lymphangioma originating in the hepatoduodenal ligament that mimicked a simple liver cyst.

Case presentation

A 50-year-old woman was admitted with a cystic tumor in the right lobe of her liver and underwent laparoscopic excision of the cyst. Operative findings revealed that the cyst had developed in the hepatoduodenal ligament, not in the liver. A small part of the cystic wall remained on the dorsal surface of the hepatoduodenal ligament. Immunohistochemically, the tumor cells stained positive only for D2-40, leading to a diagnosis of lymphangioma (cystic type). Six months later, a cystic tumor recurred and was completely excised via laparotomy. No recurrence was observed after the second operation.

Conclusions

The incomplete excision of the cystic tumor led us to re-operate 6 months after the first operation for the local disease recurrence.

Laparoscopic excision of a large retroperitoneal lymphovascular malformation in an adult

Retroperitoneal lymphangioma is a rare benign tumour of the retroperitoneal lymphatics that usually manifests in infancy. It is worth reporting of an unexpected presentation, especially in an adult. They frequently affect the neck (75%) and the axilla (20%). Intra-abdominal lymphangiomas (<5%) have been reported in the mesentery, gastrointestinal tract, spleen, liver and pancreas. Retroperitoneal lymphangiomas account for nearly 1% of all lymphangiomas and are uncommon incidental findings usually at surgery, autopsy or lymphography. Differentiating cystic lymphangiomas from other cystic growths by imaging studies alone is often inconclusive, and surgery is frequently required for definitive diagnosis. An interesting and rare case of a retroperitoneal lymphangioma in an adult patient which was removed laparoscopically is described here.

Clinical Analysis of Intraperitoneal Lymphangioma

BACKGROUND

Intraperitoneal lymphangioma (IL) used to be thought of as a benign lymphatic malformation with a low rate of preoperative diagnosis. This retrospective study aimed to explore the connection between the cysts and clinical manifestation and imaging characteristics, and to study diagnostic confusion, therapeutic principles and potential recurrent reasons, to further enhance the comprehension of this rare disease.

METHODS

Here, we retrospectively reviewed 21 patients diagnosed with IL. Age, sex, complaints, physical findings, and imaging features of each patient were documented. The therapies, postoperative complications and treatments were discussed.

RESULTS

Symptomatology included eight patients (38%) with intermittent dull pain in the abdomen, and three patients (14%) complained of abdominal persistent pain. The physical examination revealed an abdominal mass in 16 patients (76%), and eight (38%) were reported no discomfort. IL was correctly established preoperatively in 19 patients (90%). Patients were treated using laparotomy, except one who was treated with laparoscopy. Two recurrences were noted during follow-up.

CONCLUSIONS

IL should be suspected in any patient with a mobile abdominal mass and surgery is required immediately after discovery of the tumor.

Lymphangiomatosis of the sigmoid colon - a rare cause of lower gastrointestinal bleeding: A case report and review of the literature

The present study reports the case of a 79-year-old Chinese man who presented to The First Affiliated Hospital of Xi'an Jiaotong University (Xi'an, China) for the treatment of lower gastrointestinal bleeding. Multiple cystic masses in the sigmoid colon were observed with colonoscopy, and through endoscopic ultrasound (EUS), these cystic masses were confirmed to be echo-free and to exhibit septal walls in the submucosal layer; in consequence, lymphangiomatosis of the sigmoid colon was diagnosed. Considering the repeated bleeding, laparoscopy-assisted partial sigmoid colon resection was performed. The excised specimens were multiple vesicular and soft masses of ~1 cm in diameter, which were located in the submucosal layer and were surrounded by flat endothelial cells. Immunohistochemistry revealed that the specimens were positive for the specific lymphatic endothelial marker D2-40. The pathological diagnosis was consistent with the EUS findings. In the 2-year follow-up after the operation, no bleeding or other complications were noticed.

Complete resection of a complicated huge mesenteric lymphangioma guided by mesenteric computed tomography angiography with three-dimensional reconstruction: report of a case

We herein describe the case of an adult with a complicated huge lymphangioma of the small bowel mesentery. Computed tomography (CT) confirmed a 45 × 30 × 14 cm multiple and separate, mixed and solid cystic tumor without enhancement by contrast medium in the abdominal cavity. Mesenteric CT angiography with three-dimensional (3D) reconstruction showed that the tumor did not involve the first jejunal artery, although the tumor did involve the subsequent jejunal and ileal arteries and the corresponding segment of the small bowel. Under anatomic guidance based on mesenteric CT angiography with 3D reconstruction, we were able to successfully excise the tumor. Mesenteric lymphangioma should be excised even when the tumor is asymptomatic. Mesenteric CT angiography with 3D reconstruction is useful for the surgical treatment of huge mesenteric tumors.

A Huge Cystic Retroperitoneal Lymphangioma Presenting with Back Pain

Retroperitoneal lymphangioma is a rare location and type of benign abdominal tumors. The clinical presentation of this rare disease is nonspecific, ranging from abdominal distention to sepsis. Here we present a 73-year-old female patient with 3-month history of back pain. USG and CT revealed a huge cystic mass which was surgically excised and appeared to be lymphangioma on histopathology.

Case report of solitary giant hepatic lymphangioma

A hepatic lymphangioma is a rare benign neoplasm that is usually associated with systemic lymphangiomatosis. A solitary hepatic lymphangioma is extremely rare. Therefore, we present a rare case of a female patient who underwent right hepatectomy for solitary giant hepatic lymphangioma. A 42-year-old female presented to the emergency department with complaint of severe abdominal pain of the right upper quadrant. Abdominal computed tomography showed an approximately 23×30-cm sized, giant, relatively well-defined, homogenous cystic mass with few septa in the right liver (segments VII and VIII). The preoperative diagnosis was a giant hepatic cystadenoma or cystadenocarcinoma. We performed right hepatectomy. The permanent histopathological report revealed cystic lymphangioma of the liver. Although the prognosis of solitary hepatic lymphangioma after surgical resection is favorable, recurrence has been reported in literature.

Abdominal Lymphatic Malformation Presenting as Acute Abdominal Pain: A Common Pediatric Complaint, but an Unusual Diagnosis

We present the clinical and radiological findings involving a mesenteric lymphatic malformation causing volvulus in a toddler presenting with acute abdominal pain, as well as its treatment options.

Hemolymphangioma of Greater Omentum: A Rare Case Report

Hemolymphangioma is a rare vascular developmental error. It comprises malformed venous and lymphatic component in various proportion. To the best of our knowledge, only a few cases have been reported in the literature so far. Here, we report a case of huge intraperitoneal cystic mass in a 3-year-old boy that was presented to hospital with intractable abdominal pain. On examination, he had fever along with associated symptoms like cough and sputum. Abdomen was distended with no tenderness or rebound tenderness. On computed tomography scan, huge cystic mass was seen and was diagnosed as intraperitoneal benign cystic lesion. Excisional surgery of the lesion was planned. On surgery, lesion was found to be originated from greater omentum and no adhesion was seen in surrounding tissue. Complete excision of the lesion was done. Histopathological specimen after surgery suggested it to be hemolymphangioma. Follow-up for 6 months showed no recurrence.Hemolymphangioma of the greater omentum is benign tumor and accurate diagnosis before surgery is still a challenge. Presentation of disease may vary from simple well-defined cystic lesion to aggressive ill-defined lesion mimicking malignancy. Therefore, further research is needed to help doctor with preoperative radiological diagnosis and avoid unnecessary radical surgery.

Giant cystic lymphangioma originating from the cardia of the stomach: A case report

Cystic lymphangiomas are rare benign tumors involving the neck, head, and axilla, and most frequently occur in children before the age of 5 years. In the present study, the case of a giant cystic lymphangioma originating in the cardia of the stomach was reported in an 18-year-old female complaining of abdominal distention. Contrast-enhanced computed tomography and endoscopic ultrasonography revealed a large, multilobulated cystic mass located between the cardia and esophagogastric junction with a diameter of 4.0 cm. The lesion was successfully removed by endoscopic submucosal dissection. Subsequent immunohistochemical analysis of the lymphatic endothelium-specific O-linked sialoglycoprotein D2-40 confirmed the diagnosis of cystic lymphangioma. No complications associated with the tumor dissection occurred, and the patient did not report any further complaints or any signs of recurrence at 6- and 18-month follow-up. The present case demonstrates that a diagnosis of cystic lymphangioma should be considered in non-pediatric patients suffering aspecific abdominal complaints.

[Gastrocolic omental cyst in an adult: Case presentation and review of literature]

BACKGROUND

Mesenteric lymphangioma are rare tumours. They usually present early on in life, if congenital, or soon after trauma. The usual sites of presentation of lymphangiomas are in the neck, and axillae. In the abdomen they are more common in the mesentery, primarily of the ileum, or retroperitoneal.

OBJECTIVE

A rare case is presented of a mesenteric lymphangioma.

CLINICAL CASE

It involves an elderly African-American male, many years after trauma, and characterised with early satiety, causing weight loss, but without gastric outlet obstruction or vomiting. Its diagnosis, management and review of literature are presented.

CONCLUSIONS

Mesenteric cysts are rare tumours that should be included as differential diagnosis in elderly patients with a history of previous abdominal trauma.

Cystic Lymhangioma of the Lesser Sac in Adult Presenting with Features of Gastric Outlet Obstruction - A Case Report

Cystic lymphangioma is a paediatric benign tumour, occurs commonly in head and neck region. Adult intraabdominal lymphangiomas are uncommon and only few cases of lesser sac cystic lymphangioma are reported in the literature. We present a case of lesser sac cystic lymphangioma in a 26-year-old lady who presented with features of gastric outlet obstruction. Clinical examination revealed a 10x10 cm firm, non tender, mobile intraabdominal lump in the epigastrium. An upper gastrointestinal endoscopy showed possible external compression at the body of the stomach. Ultrasound demonstrated a multicystic lesion, with internal echoes in one locule. CECT showed a large multiloculated cystic lesion with hyper-dense content in the lesser sac extending up to the left lobe of the liver and indenting the stomach, lesser sac, and upper border of pancreas. On surgical exploration, a 10X8 cm multi cystic lesion with clear fluid was found in the lesser sac very close to the lesser curvature of stomach. Histopathological examination of the excised lesion showed features of cystic lymphangioma. Though very rare, intraabdominal cystic lymphangiomas should be considered in all atypical cases of gastric outlet obstruction. A reasonable knowledge about these benign lesions will aid in establishing the diagnosis and surgical management.

Rare Case of Ovarian Cystic Lymphangioma Managed at Laparoscopy

Lymphangiomas are rare, usually benign tumors of the lymphatic system. Lymphangiomas may arise in any part of the body. Lymphangioma of the ovary is very rare tumor, which is usually slow-growing, remains asymptomatic for a long time, and identified incidentally at histopathological examination after excision. It is advisable to excise the lesion with microscopically clear margins. Many times, diagnosis becomes difficult because of confusion with malignant ovarian mass, especially in post-menopausal woman. A 72-year-old post-menopausal woman had a symptomatic pelvic mass. Imaging studies demonstrated a complex right ovarian cyst. Laparoscopic total hysterectomy with bilateral salpingo-oophorectomy was performed successfully. Cystic Lymphangioma should be included in the differential diagnosis of an ovarian cystic mass, and laparoscopic excision may be the method of treatment.

Solitary hepatic lymphangioma: a one-case report

Hepatic lymphangiomas, malformations of the liver lymphatic system, are extremely rare conditions in adults. A 41-year-old man presented with right upper abdominal pain for 6 months was introduced in this report. Ultrasound (US) and computed tomography (CT) scan demonstrated a giant cystictumor with a pedunculatedextrahepatic growth pattern. Due to diagnostic uncertainty, a partial hepatectomy was performed and pathological results confirmed the diagnosis of solitary hepatic lymphangioma. In this article, we reviewed the clinical and pathology features, preoperative diagnostic challenges, and treatments of hepaticlymphangiomas.

Mesenteric lymphatic hygroma in adults: A case report with a review of the literature

Mesenteric lymphatic hygroma is a benign tumor of lymphatic origin that is rarely observed in adult patients. Congenital and developed non-specific symptoms, including abdominal distension, pain and ileus, develop at an early age in patients. This type of disease is usually reported by pediatric doctors, as referred to in the literature. The current study presents the case of a 23-year-old male in whom a polycystic mass in the mesentery was identified by computed tomography. The size of the tumor was measured to be 30×20×15 cm during surgery. The mass was excised completely with preservation of the intestine, duodenum, pancreas and other neighboring organs. Histopathological examination confirmed the diagnosis of lymphatic hygroma. The post-operative recovery was uneventful, with the exception of chylous leakage for one week, which was relieved spontaneously. In addition, the present study presents a review of the previous literature concerning mesenteric lymphatic hygroma.

A very rare case of duodenal hemolymphangioma presenting with iron deficiency anemia

INTRODUCTION

Intraabdominal lymphangiomas account for less than 5% of all lymphangiomas and small intestinal hemolymphangioma is a very rare benign tumor.

PRESENTATION OF CASE

Here we describe the first case of primary ulcerated duodenal hemolymphangioma in a 24-year-old woman, causing occult bleeding from gastrointestinal tract. She presented with an unexplained refractory iron-deficiency anemia and gastroduodenoscopy revealed an ulcerated and polypoid lesion of the second portion of the duodenum. Partial resection of the duodenum was thus performed and the final pathological diagnosis was hemolymphangioma.

DISCUSSION

There were only two reports, one of a hemolymphangioma of the pancreas invading to the duodenum and another of a small intestinal hemolymphangioma, presenting with gastrointestinal bleeding until May 2012.

CONCLUSION

The aim of this case report is to highlight the difficulty in making an accurate preoperative diagnosis and describe the surgical management of an unusual location for a very rare tumor. To arrive at a definitive diagnosis and exclude malignancy, partial resection of the duodenum was considered to be the required treatment.

Giant cystic lymphangioma originating from the lesser curvature of the stomach

Cystic lymphangiomas are rare benign tumors. Most frequently occurring in children and involving the neck or axilla, these tumors are much less common in adults and very rarely involve the abdomen. The known congenital and acquired (traumatic) etiologies result in failure of the lymphatic channels and consequent proliferation of lymphatic spaces. This case report describes a very rare case of a giant mesenteric cystic lymphangioma in an adult male with no clear etiology and successful resolution by standard radical resection. A previously healthy 44-year-old male presented with a 6-wk history of progressive upper abdominal pain, vomiting, anorexia and unintentional weight loss accompanied by rapid abdominal distension. A palpable mass was detected upon physical examination of the distended abdomen and abdominal computed tomography scan showed a giant multilobulated cystic process, measuring 40 cm in diameter. Exploratory laparotomy revealed an enormous cystic mass containing 6 L of serous fluid. The process appeared to originate from the lesser omentum and the lesser curvature of the stomach. Radical resection of the tumor was performed along with a partial gastrectomy to address potential invasion into the adjacent tissues. Histological analysis confirmed the diagnosis of a multicystic lymphangioma. The postoperative recovery was uneventful and the patient was discharged after 6 d. At 3-mo follow-up, the patient was in good health with no signs of recurrence.

Peripancreatic cystic lymphangioma diagnosed by endoscopic ultrasound/fine-needle aspiration: a rare mesenchymal tumour

A 73-year-old man presented with a 5-month history of intermittent nausea, vomiting, central abdominal discomfort and a 17-pound weight loss over the past year. Laboratory testing, including a complete blood count with differential, liver function testing, amylase and lipase studies were normal. A CT scan showed a bilobed cystic lesion inferior to the body of the pancreas. An endoscopic ultrasound revealed a 5.3×3.9 cm, anechoic, bilobed cystic lesion, extrinsic to the body of the pancreas with a 1-2 mm septation and a normal pancreas. Fine-needle aspiration revealed a milky-white aspirate with negative cytology. Laboratory assessment of the cystic aspirant revealed carcinoembryonic antigen 1.7 ng/mL, amylase 148 units/L, cholesterol 300 mg/dL, and carbohydrate antigen 19-9 3 units/mL. He underwent resection of the mass, with the histopathology confirming a diagnosis of peripancreatic lymphangioma. He did well after the surgery with interval resolution of his symptoms.

Lymphangioma: surrounding the ovarian vein and ovary

Lymphangiomas are usually benign lesions seen in the head and neck region in children. Intra-abdominal localisation is rare and the majority of these cases are in early childhood. Retroperitoneal lymphangiomas constitute approximately 1% of all lymphangiomas. They are generally diagnosed incidentally, may be asymptomatic or may present with a palpable abdominal mass. A limited number of cases of ovarian lymphangiomas have been reported in women, whereas there are no reported cases of paraovarian localisation. We present a rare case of lymphangioma located in bilateral paraovarian region and along the left ovarian vein with radiological findings.

Cystic lymphangiomatosis with severe intra-abdominal bleeding in a newborn: case report

We report the case of a newborn girl with intestinal cystic lymphangiomatosis who presented with abdominal distension and intra-abdominal bleeding following a prenatal ultrasound diagnosis of intestinal anomaly. Postnatal abdominal ultrasound revealed disseminated submucosal and intramural cystic dilatations of various sizes in the bowel and intestinal lymphangiomatosis was diagnosed. The presence of severe bleeding diathesis and widespread disease led to conservative treatment. The patient died on postnatal day 7 and postmortem examination confirmed cystic lymphangiomatosis. Detection of intestinal hyperechogenicity and/or dilatation in prenatal ultrasonography and the persistence of these findings during pregnancy are suggestive for pathologies such as meconium ileus, meconium peritonitis, and intestinal atresia. Although rare, intestinal lymphangiomatosis should be kept in mind in patients whose prenatal sonographic findings persist until birth.