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Yan J, Fu Y, Liu S, Bai Y, Chen Y. Mesenteric and omental lymphatic malformations in children: seven-year surgical experience from two centers in China. BMC Pediatr 2024; 24:360. [PMID: 38783260 PMCID: PMC11112925 DOI: 10.1186/s12887-024-04808-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Accepted: 05/02/2024] [Indexed: 05/25/2024] Open
Abstract
PURPOSE To compare the clinical characteristics, surgical management and prognosis of mesenteric lymphatic malformations (ML) and omental lymphatic malformations (OL) in children. METHODS This retrospective study included 148 ML patients and 53 OL patients who underwent surgical treatment at two centers between January 2016 and December 2022. Details about the patients' clinical characteristics, cyst characteristics, preoperative complications, surgical methods, and prognosis were retrieved and compared. RESULTS No significant differences in sex ratio, prenatal diagnosis, or age of diagnosis were noted between ML and OL patients. Vomiting was more common in ML patients than in OL patients (46.6% vs. 22.6%, P = 0.002), but OL patients were more likely to be misdiagnosed (35.8% vs. 18.9%, P = 0.012). The size of the cysts in OL patients was significantly larger than that in ML patients (14.0 [4.0-30.0] vs. 10.0 [2.0-50.0] cm, P<0.001), and cysts with turbid fluid were more common in OL patients (38.0% vs. 20.6%, P<0.001). More OL patients than ML patients had preoperative hemorrhage or infection of cysts (41.5% vs. 31.8%, P<0.016). Cyst excision was performed in 137 (92.6%) ML patients and 51 (96.2%) OL patients, and the incidence of postoperative complications was lower (12.6% vs. 4.2%, P = 0.165) among OL patients. The main postoperative complications included adhesive ileus and recurrence of cysts. Additionally, more OL patients than ML patients were treated with laparoscopic surgery (69.8% vs. 39.2%, P<0.001). CONCLUSIONS There were differences in clinical characteristics, cyst characteristics and preoperative complications between ML and OL patients. Cyst excision was the most common surgical method that was used to treat both ML and OL patients, and laparoscopic surgery could be a feasible surgical approach for treating OL patients with a good prognosis. TRIAL REGISTRATION Retrospectively registered.
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Affiliation(s)
- Jiayu Yan
- Department of General Surgery, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, 100045, China
| | - Yao Fu
- School of Public Health, China Medical University, Shenyang, 110122, China
| | - Shuting Liu
- Department of Pediatric Surgery, Shengjing Hospital of China Medical University, Shenyang, 110004, China
| | - Yuzuo Bai
- Department of Pediatric Surgery, Shengjing Hospital of China Medical University, Shenyang, 110004, China.
| | - Yajun Chen
- Department of General Surgery, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, 100045, China.
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Tabrizi Z, Dadkhah A, soleimani S, Moaddab M. Generalized cystic lymphangiomatosis incidentally diagnosed in an asymptomatic adult: Imaging findings of a very rare case. Radiol Case Rep 2024; 19:130-135. [PMID: 37941984 PMCID: PMC10628799 DOI: 10.1016/j.radcr.2023.10.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Revised: 10/01/2023] [Accepted: 10/05/2023] [Indexed: 11/10/2023] Open
Abstract
Lymphangiomas are benign lesions of vascular origin with lymphatic differentiation, most commonly found in the head and neck. Generalized lymphangiomatosis is a very rare condition in adults, which is characterized by a diffuse proliferation of lymphatic vessels. The lymphangioma is composed of lymphatic endothelium-lined cystic spaces. This condition can be histologically differentiated from other vascular disorders such as cavernous or capillary hemangioma. However, many cases of lymphangioma can be confused with other vascular disorders, because of overlapping histologic findings. radiologic examinations, such as CT scan and MR imaging, are useful for assessing the morphologic feature and also the extent of disease, it is important to know the radiologic findings of generalized lymphangiomatosis. In this paper, we report a case of generalized lymphangiomatosis in a 42-year-old male who presented with left flank pain and hematuria. The first differential diagnosis was renal colic; hence he underwent an abdominopelvic computed tomography scan (CT scan). In the performed CT scan multiple cystic lesions were seen in the liver and spleen. Also, lytic lesions were seen in bones. CT-guided biopsy was performed and the result was compatible with generalized lymphangiomatosis, confirmed by cytology. Generalized lymphangiomatosis is a rarely reported disease in children and young adults. Delayed diagnosis in older patients or misdiagnosis is common due to its rarity and nonspecific clinical presentation. Different imaging modalities can incidentally diagnose the disease in asymptomatic patients. So radiologists should be aware of the disease manifestations in imaging modalities to diagnose the disease sooner and help the clinician start the therapy if needed.
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Affiliation(s)
- Zhale Tabrizi
- Department of Radiology, Iran University of Medical Science, Tehran, Iran
| | - Adeleh Dadkhah
- Department of Radiology, Hasheminejad Kidney Center (HKC), Iran University of Medical Science, Tehran, Iran
| | - Shakiba soleimani
- Department of Radiology, Iran University of Medical Science, Tehran, Iran
| | - Maryam Moaddab
- Department of Radiology, Iran University of Medical Science, Tehran, Iran
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Yan J, Wang L, Xie C, Peng C, Pang W, Chen Y. Preoperative complications in children with mesenteric lymphatic malformations: Incidence, risk factors and outcomes. Front Pediatr 2022; 10:1033897. [PMID: 36245723 PMCID: PMC9557770 DOI: 10.3389/fped.2022.1033897] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Accepted: 09/16/2022] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Preoperative complications of mesenteric lymphatic malformations (ML) in children are various and complex. We aim to analyze the incidences and risk factors of three major preoperative complications (hemorrhage of the cyst, infection of the cyst and intestinal volvulus) in ML patients, and explore their influence on the outcomes. METHODS This retrospective cohort study enrolled ML patients undergoing surgery at Beijing Children's Hospital between June 2016 and June 2022 and classified them according to different preoperative complications, preoperative hemorrhage or infection, and preoperative intestinal volvulus. The groups were examined and compared according to sex, age at admission, presenting symptoms, laboratory examinations, imaging examinations, preoperative treatments, cyst characteristics, surgical details, perioperative clinical data, and follow-up. Logistic regression analysis was performed to identify the independent risk factors for preoperative hemorrhage or infection, and preoperative intestinal volvulus. RESULTS Of the 104 enrolled ML patients, 27 (26.0%) had preoperative hemorrhage or infection, and 22 (21.2%) had preoperative intestinal volvulus. Univariate analysis showed that patients with preoperative hemorrhage or infection had a higher rate of ML in the mesocolon (44.4 vs. 23.4%, p < 0.038) and larger cysts (10 vs. 8 cm, p = 0.042) than patients without preoperative hemorrhage or infection. Multivariable logistic regression analysis found that the location (OR, 3.1; 95% CI, 1.1-8.6; p = 0.026) and size of the cyst (≥7.5 cm) (OR, 6.2; 95% CI, 1.6-23.4; p = 0.007) were independent risk factors for preoperative hemorrhage or infection. Preoperative intestinal volvulus was only found in ML at the intestinal mesentery. Further analysis showed that ML in the jejunal mesentery was an independent risk factor for preoperative intestinal volvulus (OR, 3.3; 95% CI, 1.1-10.0; p = 0.027). Patients with preoperative hemorrhage or infection spent more on hospitalization costs than patients without preoperative hemorrhage or infection (3,000 vs. 2,674 dollars, p = 0.038). CONCLUSIONS ML patients should be treated as soon as possible after diagnosis. The location and size of the cyst were independent risk factors for preoperative hemorrhage or infection. ML in the jejunal mesentery was an independent risk factor for preoperative intestinal volvulus.
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Affiliation(s)
- Jiayu Yan
- Department of General Surgery, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
| | - Li Wang
- Department of Emergency Surgery, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
| | - Chuanping Xie
- Department of General Surgery, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
| | - Chunhui Peng
- Department of General Surgery, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
| | - Wenbo Pang
- Department of General Surgery, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
| | - Yajun Chen
- Department of General Surgery, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
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Trivedi HM, Megison S, Peters CA. Inguinal prolapse of a retroperitoneal lymphovascular malformation. Urol Case Rep 2021; 39:101786. [PMID: 34381693 PMCID: PMC8340136 DOI: 10.1016/j.eucr.2021.101786] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2021] [Revised: 07/16/2021] [Accepted: 07/21/2021] [Indexed: 11/29/2022] Open
Abstract
Abdominal lymphovascular malformations (ALMs) are rare cystic masses that can present with nonspecific symptoms. We present a case of a 7-month-old boy who, during an uncomplicated communicating hydrocele repair, was found to have an incidental large, prolapsed mesenteric abdominal lymphovascular malformation. The case serves to highlight the variability in presentation and natural history of ALMs, and the ease with which they can be disguised by more common pathology. We further underscore the importance of individualized therapy with regards to ALMs, emphasized by our course of active surveillance allowing our patient to avoid ionizing radiation and additional surgical intervention.
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Affiliation(s)
- Hersh M Trivedi
- Dept. of Surgery, Div. of Pediatric Surgery, University of Texas Southwestern, Dallas, TX, USA
| | - Steve Megison
- Dept. of Surgery, Div. of Pediatric Surgery, University of Texas Southwestern, Dallas, TX, USA
| | - Craig A Peters
- Dept. of Urology, Div. Pediatric Urology, University of Texas Southwestern, Dallas, TX, USA
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Kronfli AP, McLaughlin CJ, Moroco AE, Grant CN. Lymphatic malformations: a 20-year single institution experience. Pediatr Surg Int 2021; 37:783-790. [PMID: 33586010 DOI: 10.1007/s00383-021-04859-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/06/2021] [Indexed: 12/21/2022]
Abstract
PURPOSE Lymphatic malformations (LMs) are congenital abnormalities which result from disturbances in the embryologic development of the lymphatic system. We sought to determine the characteristics and treatment patterns for LMs in a rural setting, and the effect of a specialized vascular malformations clinic on triage and follow-up. METHODS This is a retrospective cohort study at a single tertiary care institution. Sixty-two patients were identified; chart review was completed to obtain demographic, surgery/sclerotherapy session and follow-up information. RESULTS The head/neck region was the most predominant LM location (N = 26, 41.9%), followed by trunk (N = 16, 25.8%), extremity (N = 11, 17.7%), and intraabdominal/retroperitoneal (N = 7, 11.3%). Twenty-eight patients were managed non-surgically, while 21, 7 and 6 patients required surgery, sclerotherapy, or both. Head/neck LMs were the most likely to recur (73%, p = 0.028). Patients seen in specialty clinic had similar duration of follow-up and time to intervention, but were more often below 1 year of age (p = 0.030). Average LM volume among patients with available imaging was much larger in those referred to specialty clinic (73.2 cm3 versus 14.8 cm3, p = 0.022). CONCLUSION Our experience reiterates not only the wide variety of clinical presentations of lymphatic malformations, but also demonstrates the necessity of multiple subspecialties and their collaboration to achieve prompt and efficacious treatment.
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Affiliation(s)
- Anthony P Kronfli
- Department of Surgery, Milton S. Hershey Medical Center, The Pennsylvania State University, 500 University Drive, P. O. Box 850, Hershey, PA, 17033-0850, USA.
| | - Christopher J McLaughlin
- Department of Surgery, Milton S. Hershey Medical Center, The Pennsylvania State University, 500 University Drive, P. O. Box 850, Hershey, PA, 17033-0850, USA
| | | | - Christa N Grant
- Department of Surgery, Milton S. Hershey Medical Center, The Pennsylvania State University, 500 University Drive, P. O. Box 850, Hershey, PA, 17033-0850, USA
- Penn State College of Medicine, Hershey, PA, USA
- Division of Pediatric Surgery, Penn State Children's Hospital, Hershey, PA, USA
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Rupasinghe M, Houshyar R, Chahine C, Bui TL, Glavis-Bloom J, Cheng C, Tseng J. A 61-year-old woman with jejunal lymphatic malformation visualized on computed tomography: a case report. J Med Case Rep 2021; 15:302. [PMID: 34039402 PMCID: PMC8157699 DOI: 10.1186/s13256-021-02872-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Accepted: 04/19/2021] [Indexed: 11/23/2022] Open
Abstract
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.
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Affiliation(s)
- Mark Rupasinghe
- Department of Radiological Sciences, University of California Irvine, 101 The City Drive South, Route 140, Orange, CA 92868 USA
| | - Roozbeh Houshyar
- Department of Radiological Sciences, University of California Irvine, 101 The City Drive South, Route 140, Orange, CA 92868 USA
| | - Chantal Chahine
- Department of Radiological Sciences, University of California Irvine, 101 The City Drive South, Route 140, Orange, CA 92868 USA
| | - Thanh-Lan Bui
- Department of Radiological Sciences, University of California Irvine, 101 The City Drive South, Route 140, Orange, CA 92868 USA
| | - Justin Glavis-Bloom
- Department of Radiological Sciences, University of California Irvine, 101 The City Drive South, Route 140, Orange, CA 92868 USA
| | - Caleb Cheng
- Department of Pathology & Laboratory Medicine, University of California Irvine School of Medicine, Irvine, CA 92697 USA
| | - Jill Tseng
- Department of Obstetrics and Gynecology, University of California Irvine, 333 City Boulevard West, Suite 1400, Orange, CA 92868 USA
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Elbaaly H, Piché N, Rypens F, Kleiber N, Lapierre C, Dubois J. Intra-abdominal lymphatic malformation management in light of the updated International Society for the Study of Vascular Anomalies classification. Pediatr Radiol 2021; 51:760-772. [PMID: 33559726 DOI: 10.1007/s00247-020-04930-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Revised: 09/26/2020] [Accepted: 12/07/2020] [Indexed: 10/22/2022]
Abstract
BACKGROUND The International Society for the Study of Vascular Anomalies (ISSVA) classification distinguishes between common lymphatic malformations and complex lymphatic anomalies. These entities have overlapping features but differing responses to treatment. Surgery has been the mainstream treatment in intra-abdominal lymphatic malformation, with variable reported success in the literature. OBJECTIVE The aim of this study was to review the outcome of different treatments for intra-abdominal lymphatic malformations in children. MATERIALS AND METHODS We retrospectively reviewed all intra-abdominal lymphatic malformations from 1999 to 2019 in children treated by the surgical team or followed in the vascular anomalies clinic of our institution. Children were classified into one of three groups: group A, isolated intra-abdominal lymphatic malformation; group B, common lymphatic malformation in continuity with other regions; or group C, intra-abdominal involvement as part of a complex lymphatic anomaly or associated syndrome. RESULTS Fifty intra-abdominal lymphatic malformations were diagnosed; five of these were excluded. In group A (n=28), the treatment was surgical resection (n=26) or sclerosing treatment (n=1), with one case of spontaneous regression; no recurrence was observed in 25 patients. In group B (n=7), three patients had partial resection and all had recurrence; four had sclerotherapy alone with good response. In group C (n=10), therapeutic options included surgery, sclerosing treatment and pharmacotherapy, with variable outcomes. CONCLUSION The management of intra-abdominal malformations requires a team approach. Sclerotherapy is successful in treating macrocystic lymphatic malformation. Surgery is successful in treating isolated intra-abdominal common lymphatic malformation, albeit at times at the cost of intestinal resection, which could be avoided by combining surgery with preoperative sclerotherapy. With surgery there is often limited resectability, and therefore recurrence in intra-abdominal lymphatic malformations that are part of complex lymphatic anomalies associated with syndromes, or in common lymphatic malformations in continuity with other regions. Sclerotherapy is an effective modality in these instances along with pharmacotherapy.
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Affiliation(s)
- Heba Elbaaly
- Medical Imaging Department, CHU Sainte-Justine, 3175 Côte-Sainte-Catherine, Montreal, QC, H3T 1C5, Canada
| | - Nelson Piché
- Surgery Department, CHU Sainte-Justine, Montreal, QC, Canada
| | - Françoise Rypens
- Medical Imaging Department, CHU Sainte-Justine, 3175 Côte-Sainte-Catherine, Montreal, QC, H3T 1C5, Canada
| | - Niina Kleiber
- Pediatrics Department, CHU Sainte-Justine, Montreal, QC, Canada
| | - Chantale Lapierre
- Medical Imaging Department, CHU Sainte-Justine, 3175 Côte-Sainte-Catherine, Montreal, QC, H3T 1C5, Canada
| | - Josée Dubois
- Medical Imaging Department, CHU Sainte-Justine, 3175 Côte-Sainte-Catherine, Montreal, QC, H3T 1C5, Canada.
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Okamoto T, Fukuda K. Intestinal Manifestations of Generalized Lymphatic Anomaly. Intern Med 2020; 59:3241-3242. [PMID: 32830182 PMCID: PMC7807125 DOI: 10.2169/internalmedicine.5345-20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Accepted: 07/05/2020] [Indexed: 11/12/2022] Open
Affiliation(s)
- Takeshi Okamoto
- Department of Gastroenterology, St. Luke's International Hospital, Japan
| | - Katsuyuki Fukuda
- Department of Gastroenterology, St. Luke's International Hospital, Japan
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Le HDT, Vo DS, Le DD, Dang CT, Nguyen Thanh T. Generalized lymphangiomatosis-A rare manifestation of lymphatic malformation. Radiol Case Rep 2020; 16:66-71. [PMID: 33193931 PMCID: PMC7642761 DOI: 10.1016/j.radcr.2020.10.044] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2020] [Revised: 10/22/2020] [Accepted: 10/23/2020] [Indexed: 11/21/2022] Open
Abstract
Lymphangiomatosis is a rare benign proliferation and dilation of the lymphatic channels that can involve multiple organs with a variety of clinical presentations. We report a case of generalized lymphangiomatosis in a 16-year-old male who presented with a subcutaneous swelling and pain over his lower back area. The patient was diagnosed of generalized lymphangiomatosis with involvement of soft tissues, pulmonary, thoracic and lumbosacral vertebrae, and spinal canal which subsequently confirmed by cytology. In this case report, we aim to discuss radiological features of the relevant differentials, and the patient's symptoms. We also briefly discuss the treatment options as well as prognosis.
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Affiliation(s)
- Hoang Di Thu Le
- Department of Radiology, Hue University of Medicine and Pharmacy, Hue University, Hue, Vietnam
| | - Da Suong Vo
- Department of Radiology, Hue University of Medicine and Pharmacy, Hue University, Hue, Vietnam
| | - Dinh Dam Le
- Department of Surgery, Hue University of Medicine and Pharmacy, Hue University, Hue, Vietnam
| | - Cong Thuan Dang
- Department of Histology, Embryology, Pathology & Forensic Medicine, Hue University of Medicine and Pharmacy, Hue University, Hue, Vietnam
| | - Thao Nguyen Thanh
- Department of Radiology, Hue University of Medicine and Pharmacy, Hue University, Hue, Vietnam
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Ishiura R, Mitsui K, Danno K, Banda CH, Inoue M, Narushima M. Successful treatment of large abdominal lymphatic malformations and chylous ascites with intra-abdominal lymphovenous anastomosis. J Vasc Surg Venous Lymphat Disord 2020; 9:499-503. [PMID: 32505686 DOI: 10.1016/j.jvsv.2020.05.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Accepted: 05/26/2020] [Indexed: 12/15/2022]
Abstract
Large abdominal lymphatic malformations (LMs) are rare and may occasionally cause life-threatening illness, especially when they involve the central lymphatic system, lumbar trunks, cisterna chyli, thoracic duct, and their major tributaries, forming complex lymphatic anomalies. These LMs are often accompanied by chylous leak in various locations, and treatment remains challenging. We report a case of large abdominal LM with chylous ascites, protein-losing enteropathy, vaginal chylous leak, and lower limb lymphedema successfully treated with microsurgical intra-abdominal lymphovenous anastomosis and discuss the technical details of the procedure.
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Affiliation(s)
- Ryohei Ishiura
- Department of Plastic and Reconstructive Surgery, Mie University Hospital, Tsu, Mie, Japan.
| | - Kohei Mitsui
- Department of Plastic and Reconstructive Surgery, Mie University Hospital, Tsu, Mie, Japan
| | - Kanako Danno
- Department of Plastic and Reconstructive Surgery, Mie University Hospital, Tsu, Mie, Japan
| | - Chihena Hansini Banda
- Department of Plastic and Reconstructive Surgery, Mie University Hospital, Tsu, Mie, Japan
| | - Mikihiro Inoue
- Department of Gastrointestinal and Pediatric Surgery, Mie University Hospital, Tsu, Mie, Japan
| | - Mitsunaga Narushima
- Department of Plastic and Reconstructive Surgery, Mie University Hospital, Tsu, Mie, Japan
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