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Mhand M, Rhoul C, Bouhout T, Serji B. Cystic Lymphangioma of the Mesentery in an Adult: A Case Report and Literature Review. Cureus 2024; 16:e63412. [PMID: 39070310 PMCID: PMC11283881 DOI: 10.7759/cureus.63412] [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] [Accepted: 06/28/2024] [Indexed: 07/30/2024] Open
Abstract
Lymphangiomas are rare benign cystic tumors. Surgical excision is the primary treatment, aiming for complete removal. Diagnosis relies on imaging and histological confirmation. Malignant transformation is exceptionally rare. We report a 25-year-old man admitted for peri-umbilical abdominal pain and an abdominal mass. Imaging revealed multilocular peritoneal cystic formations with infiltration of adjacent mesenteric fat. Laboratory findings were unremarkable, and exploratory laparotomy was performed. A voluminous cystic mass originating from the mesentery was discovered, requiring intestinal sacrifice for complete resection. Immediate postoperative recovery was smooth. Pathological analysis confirmed the diagnosis of mesenteric cystic lymphangioma. The patient had a favorable outcome with no tumor recurrence at a three-year follow-up. We emphasize the significance of complete surgical removal to prevent complications associated with cystic lymphangioma and reduce the risk of recurrence.
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Affiliation(s)
- Mohammed Mhand
- Department of Surgical Oncology, Mohammed VI University Hospital, Regional Oncology Center, Faculty of Medicine and Pharmacy of Oujda, Oujda, MAR
| | - Chafik Rhoul
- Department of Surgical Oncology, Mohammed VI University Hospital, Regional Oncology Center, Faculty of Medicine and Pharmacy of Oujda, Oujda, MAR
| | - Tariq Bouhout
- Department of Surgical Oncology, Mohammed VI University Hospital, Regional Oncology Center, Faculty of Medicine and Pharmacy of Oujda, Oujda, MAR
| | - Badr Serji
- Department of Surgical Oncology, Mohammed VI University Hospital, Regional Oncology Center, Faculty of Medicine and Pharmacy of Oujda, Oujda, MAR
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2
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Ahmed MM, Shareef FU, Abdul Aziz JM, Mohammed SK, Karim HA, Maulud MA, Fareeq DH, Aziz DF, Rashid MJ. Unusual acute right abdominal pain. Distal ileum mesenteric cystic lymphangioma in adult, a rare case and literature review. J Surg Case Rep 2024; 2024:rjae322. [PMID: 38800506 PMCID: PMC11126340 DOI: 10.1093/jscr/rjae322] [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: 03/13/2024] [Accepted: 05/01/2024] [Indexed: 05/29/2024] Open
Abstract
Lymphangiomas in the peritoneal cavity are rare in adults, with most cases occurring in children. We present the case of a 49-year-old woman who was admitted with severe lower abdominal pain. The diagnostic assessment revealed a multiloculated cystic structure in the mesentery of the distal ileum, suggesting a lymphangioma. The patient underwent laparotomy and resection, with successful removal of the mass. Histopathological examination confirmed the diagnosis of intestinal lymphangioma, a rare benign vascular neoplasm of the small bowel. Postoperatively, the patient experienced resolution of postoperative ileus and mild back and abdominal pain, with no complaints during follow-up. Awareness of this uncommon condition is crucial for accurate diagnosis and appropriate treatment. Surgical resection, supported by radiological and histopathological investigations, is the primary treatment modality for symptomatic lymphangioma. Regular follow-up with imaging may be necessary to monitor recurrence.
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Affiliation(s)
- Muhsin Mohammed Ahmed
- Biomedical Science Department, Komar University of Science and Technology, Sulaymaniyah, Kurdistan Region 46001, Iraq
| | - Farman Uthman Shareef
- Medical Laboratory Science Department, College of Science, Charmo University, Sulaymaniyah, Kurdistan Region 46001, Iraq
| | - Jeza Muhamad Abdul Aziz
- Biomedical Science Department, Komar University of Science and Technology, Sulaymaniyah, Kurdistan Region 46001, Iraq
- Baxshin Research Center, Baxshin Hospital, Sulaymaniyah, Kurdistan Region 46001, Iraq
| | - San Khasraw Mohammed
- Sulaymaniyah General Directorate of Health, Shar Hospital, Sulaymaniyah, Kurdistan Region 46001, Iraq
| | - Hawnaz Atta Karim
- Baxshin Research Center, Baxshin Hospital, Sulaymaniyah, Kurdistan Region 46001, Iraq
- Histopathology Department, Baxshin Hospital, Sulaymaniyah, Kurdistan Region 46001, Iraq
| | | | - Daro Hadi Fareeq
- Sulaymaniyah General Directorate of Health, Shar Hospital, Sulaymaniyah, Kurdistan Region 46001, Iraq
| | - Dlivan Fattah Aziz
- College of Pharmacy, University of Sulaimani, Sulaymaniyah, Kurdistan Region 46001, Iraq
| | - Muhammad Jabar Rashid
- Baxshin Research Center, Baxshin Hospital, Sulaymaniyah, Kurdistan Region 46001, Iraq
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3
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Mede A, Chotai PN, Huh WJ, Tan M. Intra-abdominal Cystic Lymphangiomas: The Vanderbilt Experience. J Surg Res 2023; 285:197-204. [PMID: 36696706 DOI: 10.1016/j.jss.2022.12.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Revised: 11/21/2022] [Accepted: 12/24/2022] [Indexed: 01/24/2023]
Abstract
INTRODUCTION Lymphangiomas are rare, cystic tumors that represent congenital malformation of the lymphatic vessels. We reviewed our institution's experience treating abdominal lymphangiomas with the purpose of describing the clinical features, management, and outcomes of this rare pathology. METHODS This is a single-institution, institutional review board-approved retrospective review of abdominal lymphangiomas presenting between January 2010 and February 2021. The diagnosis of lymphangioma was made on histopathology from either endoscopic or excisional biopsy of the lesion. Demographics, diagnostic imaging, histopathologic characteristics, and outcomes were analyzed. RESULTS We identified 48 patients, of whom 29 (60%) were female, >18 y (38; 79%), with a mean age of 43 y at the time of diagnosis (range, 4 d-87 y). Tumors ranged in size from <1 cm to 30 cm. Only 1/3 were symptomatic, most commonly with abdominal pain (9; 19%) On preoperative imaging, mural nodules or thickened walls were present in one case, in which pathology was consistent with benign lymphangioma. The majority of lymphangiomas were associated with the small bowel or its mesentery (31; 65%), followed by the colon/omentum (7; 15%). Most patients underwent surgical excision (29; 60%) with incomplete excision in one patient due to extensive local invasion, and three (10%) patients required multivisceral resection. The median duration of the follow-up was 13 mo (range, 1-105 mo), during which time, none of the patients developed malignancy. CONCLUSIONS Most abdominal lymphangiomas arise from the small bowel and are found incidentally and have a favorable prognosis. Resection should be reserved for symptomatic lesions or when there is a diagnostic uncertainty.
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Affiliation(s)
- Annmarie Mede
- Vanderbilt University School of Medicine, Nashville, Tennessee
| | - Pranit N Chotai
- Division of Transplantation, Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio; Division of Surgical Oncology and Endocrine Surgery, Department of Surgery, Section of Surgical Sciences, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Won Jae Huh
- Department of Pathology, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Marcus Tan
- Division of Surgical Oncology and Endocrine Surgery, Department of Surgery, Section of Surgical Sciences, Vanderbilt University Medical Center, Nashville, Tennessee.
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Mansour S, Kluger Y, Khuri S. Adult Primary Retroperitoneal Lymphangioma: Updated Facts. World J Oncol 2023; 14:15-20. [PMID: 36896002 PMCID: PMC9990737 DOI: 10.14740/wjon1561] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Accepted: 01/04/2023] [Indexed: 02/28/2023] Open
Abstract
Lymphangioma is a rare, benign tumor of the lymphatic system. It is believed to be a congenital malformation, when part of the lymphatic channels fail to connect to the main lymphatic system. Lymphangioma is a tumor of the pediatric age, with 50% of patients presenting at birth. The head and neck are the main affected sites (75%), while the retroperitoneal cavity is the least affected area, and comprises less than 1% of cases. Adult lymphangioma is an extremely rare tumor, and adult retroperitoneal lymphangioma (ARL) is even a rarer tumor. Over the last two decades, we have experienced a significant increase in reports published in the English literature discussing ARL. As reports have increased, several questions about previously known facts regarding this tumor arose: For years, it was known that ARL is usually an asymptomatic tumor which is incidentally found - is it a true claim? Is abdominal magnetic resonance imaging the radiological test of choice for diagnosis? What is the best therapeutic option? The main aim for this article is to review the current and old English literature concerning ARL, in order to collect data regarding demographic features, clinical presentation, imaging tests used for diagnosis, therapeutic options and follow-up. This in turn will give precise updated answers for the previous questions. In addition, it will raise awareness for the treating physician regarding the most effective approach for early diagnosis and best therapeutic option to be selected.
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Affiliation(s)
- Subhi Mansour
- General Surgery Department, Rambam Medical Center, Haifa, Israel
| | - Yoram Kluger
- General Surgery Department, Rambam Medical Center, Haifa, Israel
- HPB and Surgical Oncology Unit, Rambam Medical Center, Haifa, Israel
| | - Safi Khuri
- General Surgery Department, Rambam Medical Center, Haifa, Israel
- HPB and Surgical Oncology Unit, Rambam Medical Center, Haifa, Israel
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5
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Ono H, Honda S, Miyagi H, Minato M, Ara M, Kondo T, Okumura K, Okada T, Taketomi A. Management of severe symptomatic abdominal lymphatic malformation complicated by abscess formation, protein-losing gastroenteropathy, and bleeding. ANNALS OF PEDIATRIC SURGERY 2022. [DOI: 10.1186/s43159-022-00230-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Abstract
Background
The optimal strategy for the management of patients with severe symptomatic abdominal lymphatic malformation (ALM) complicated by abscess formation, protein-losing gastroenteropathy, and bleeding has not yet been established. The present study aimed to determine an appropriate management for patients with severe symptomatic ALM, particularly for those with abdominal complications.
Materials and methods
Eight infants and young adults who underwent emergency surgery for ALM in our department, between the years 1997 and 2020, were selected for the study. We also evaluated and compared the operative procedures, operative timing, and postoperative surgical outcomes.
Results
Emergency resection was performed in all patients with bleeding. Some patients presented with ALMs that invaded the adjacent organs. Resections that included the involved organs were necessary to achieve full resolution in three patients. After evaluating the diagnostic modalities for symptomatic ALM, we also performed elective surgery for patients without bleeding.
Conclusions
Clinicians should be aware of severe symptomatic ALM with or without bleeding, as well as its associated complications, in order to select the best surgical management plan.
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Maghrebi H, Yakoubi C, Beji H, Letaief F, Megdich S, Makni A, Boukriba S, Frikha W, Ayadi M, Kacem M. Intra-abdominal cystic lymphangioma in adults: A case series of 32 patients and literature review. Ann Med Surg (Lond) 2022; 81:104460. [PMID: 36147158 PMCID: PMC9486738 DOI: 10.1016/j.amsu.2022.104460] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2022] [Revised: 08/14/2022] [Accepted: 08/14/2022] [Indexed: 11/27/2022] Open
Abstract
Introduction Cystic lymphangioma (CL) is a benign tumor originating from the lymph vessels. Lymphangiomas in the abdominal cavity are extremely rare, particularly in adults. This article was designed to study the epidemiological, diagnostic difficulties, and therapeutic principles of intra-abdominal cystic lymphangioma (ACL) in adults. Material and methods We conducted a single-center, retrospective study of 32 adult patients with ACL admitted to surgical department “A” in “La Rabta Hospital” in Tunis, from January 1998 through December 2020. The demographic, clinical, biological, radiological characteristics, histopathologic, and therapeutic data were collected, as well as the surgical intervention used and the postoperative immediate and late complications. Results Thirty-two adult patients with ACL were recruited, including 20 females and 12 males. The median age at treatment was 47 (range 14–80) years. The most prevalent sites were the retroperitoneum (25%), the mesentery (21.9%), and the paracolic gutters (n = 18. 7%). Twenty patients underwent open surgery (62.5%), whereas 12 cases (37.5%) had laparoscopic surgery. Twenty-eight patients received total cystectomy (87%). Three recurrences were observed during follow-up (9.4%). Conclusion The clinical features of CL in adults remain unclear. The diagnosis is only confirmed by histopathological examination after complete surgical resection. The laparoscopic approach is considered safe and feasible. Lymphangiomas in the abdominal cavity are extremely rare, particularly in adults. Cystic lymphangioma is a benign tumor originating from the lymph vessels. The clinical presentation is various. Whenever possible, laparoscopic resection should be the treatment of choice. To prevent a recurrence, complete excision is the best option.
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7
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Barghash M, Nassif S, Alkurdi Y, Mansour M. Mesenteric Lymphangioma Presenting With Small Bowel Volvulus in an Adult. Cureus 2021; 13:e16771. [PMID: 34513383 PMCID: PMC8405412 DOI: 10.7759/cureus.16771] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/31/2021] [Indexed: 11/25/2022] Open
Abstract
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.
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Affiliation(s)
| | - Suad Nassif
- General Surgery, North Manchester General Hospital, Manchester, GBR
| | - Yazan Alkurdi
- General Surgery, North Manchester General Hospital, Manchester, GBR
| | - Moustafa Mansour
- General Surgery, North Manchester General Hospital, Manchester, GBR
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8
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Yacoub JH, Clark JA, Paal EE, Manning MA. Approach to Cystic Lesions in the Abdomen and Pelvis, with Radiologic-Pathologic Correlation. Radiographics 2021; 41:1368-1386. [PMID: 34469214 DOI: 10.1148/rg.2021200207] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Cystic lesions found in and around the peritoneal cavity can often be challenging to diagnose owing to significant overlap in imaging appearance between the different entities. When the cystic lesion can be recognized to arise from one of the solid abdominal organs, the differential considerations can be more straightforward; however, many cystic lesions, particularly when large, cannot be clearly associated with one of the solid organs. Cystic lesions arising from the mesentery and peritoneum are less commonly encountered and can be caused by relatively rare entities or by a variant appearance of less-rare entities. The authors provide an overview of the classification of cystic and cystic-appearing lesions and the basic imaging principles in evaluating them, followed by a summary of the clinical, radiologic, and pathologic features of various cystic and cystic-appearing lesions found in and around the peritoneal cavity, organized by site of origin. Emphasis is given to lesions arising from the mesentery, peritoneum, or gastrointestinal tract. Cystic lesions arising from the liver, spleen, gallbladder, pancreas, urachus, adnexa, or soft tissue are briefly discussed and illustrated with cases to demonstrate the overlap in imaging appearance with mesenteric and peritoneal cystic lesions. When approaching a cystic lesion, the key imaging features to assess include cyst content, locularity, wall thickness, and presence of internal septa, solid components, calcifications, or any associated enhancement. While definitive diagnosis is not always possible with imaging, careful assessment of the imaging appearance, location, and relationship to adjacent structures can help narrow the differential diagnosis. Online supplemental material is available for this article. ©RSNA, 2021.
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Affiliation(s)
- Joseph H Yacoub
- From the Department of Radiology, MedStar Georgetown University Hospital, 3800 Reservoir Rd NW, Washington, DC 20007 (J.H.Y., J.A.C., M.A.M.); Pathology and Laboratory Medicine Service, VA Medical Center, Washington, DC (E.E.P.); Department of Pathology, George Washington University School of Medicine and Health Sciences, Washington, DC (E.E.P.); and American Institute for Radiologic Pathology, Silver Spring, Md (M.A.M.)
| | - Jennifer A Clark
- From the Department of Radiology, MedStar Georgetown University Hospital, 3800 Reservoir Rd NW, Washington, DC 20007 (J.H.Y., J.A.C., M.A.M.); Pathology and Laboratory Medicine Service, VA Medical Center, Washington, DC (E.E.P.); Department of Pathology, George Washington University School of Medicine and Health Sciences, Washington, DC (E.E.P.); and American Institute for Radiologic Pathology, Silver Spring, Md (M.A.M.)
| | - Edina E Paal
- From the Department of Radiology, MedStar Georgetown University Hospital, 3800 Reservoir Rd NW, Washington, DC 20007 (J.H.Y., J.A.C., M.A.M.); Pathology and Laboratory Medicine Service, VA Medical Center, Washington, DC (E.E.P.); Department of Pathology, George Washington University School of Medicine and Health Sciences, Washington, DC (E.E.P.); and American Institute for Radiologic Pathology, Silver Spring, Md (M.A.M.)
| | - Maria A Manning
- From the Department of Radiology, MedStar Georgetown University Hospital, 3800 Reservoir Rd NW, Washington, DC 20007 (J.H.Y., J.A.C., M.A.M.); Pathology and Laboratory Medicine Service, VA Medical Center, Washington, DC (E.E.P.); Department of Pathology, George Washington University School of Medicine and Health Sciences, Washington, DC (E.E.P.); and American Institute for Radiologic Pathology, Silver Spring, Md (M.A.M.)
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Lal A, Gupta P, Singhal M, Sinha SK, Lal S, Rana S, Khandelwal N. Abdominal lymphatic malformation: Spectrum of imaging findings. Indian J Radiol Imaging 2021; 26:423-428. [PMID: 28104932 PMCID: PMC5201068 DOI: 10.4103/0971-3026.195777] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Lymphatic malformations are congenital vascular malformations with lymphatic differentiation. Although the most common locations for lymphatic malformation are the neck and axilla, they can occur at several locations in the body including the abdomen. The abdominal location is rather rare and accounts for approximately 5% of all lymphatic malformation. Abdominal lymphatic malformation can arise from mesentery, omentum, gastrointestinal tract, and retroperitoneum. Clinical presentation includes an abdominal lump, vague abdominal discomfort, and secondary complications including intestinal obstruction, volvulus, ischemia, and bleeding. There is a broad spectrum of radiological manifestation. In the present review, we discuss the imaging appearance of abdominal lymphatic malformation. The diagnosis of lymphatic malformation in our series was based on the histopathological examination (in cases who underwent surgery) and fine needle aspiration cytology.
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Affiliation(s)
- Anupam Lal
- Department of Radiodiagnosis and Imaging, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Pankaj Gupta
- Department of Radiodiagnosis and Imaging, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Manphool Singhal
- Department of Radiodiagnosis and Imaging, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Saroj K Sinha
- Department of Gastroenterology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Sadhana Lal
- Department of Gastroenterology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Surinder Rana
- Department of Gastroenterology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Niranjan Khandelwal
- Department of Radiodiagnosis and Imaging, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
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10
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Clinical Case of Fetal Lymphangioma. Fam Med 2021. [DOI: 10.30841/2307-5112.1.2021.231941] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Lymphangioma is a benign lymphatic system tumor, often congenital, mainly affecting lymph nodes in various anatomic localizations. Postnatally mostly common lymphangioma manifestation occurs during the first year of life.
Today it can be readily diagnosed prenatally.
Diagnosis is based on non-invasive visualization, such as sonography and computed tomography.
The objective: is to present clinical case of manifest fetal lymphangioma diagnosed during pregnancy.
Fetal ultrasound (US) was performed at 28, 32, 34 weeks of gestation. As a result fetus was diagnosed with hypoechogenic mass in right axillary region, growing in dynamics gradually from 34×28 mm, 38×34 mm to 49×37 mm. Mass had clear even contours, hyperechogenic capsule with fine dispersed suspension content. Color doppler imaging showed avascular mass character.
After delivery at 37–38 weeks of gestation (planned Cesarean section) at newborn examination we visualized asymmetric soft elastic consistency protrusion along right midclavicular and anterior axillary region.
Described clinical case of fetal lymphangioma is a good illustration of dynamic prenatal and postnatal dynamic observation and its US interpretation.
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Pathological Discrepancy: Simple Mesenteric Cyst vs. Mesenteric Lymphangioma. Case Rep Surg 2021; 2021:8848462. [PMID: 33815861 PMCID: PMC7994076 DOI: 10.1155/2021/8848462] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Revised: 02/08/2021] [Accepted: 03/05/2021] [Indexed: 12/16/2022] Open
Abstract
Introduction Both mesenteric cysts and cystic lymphangiomas are scarce and clinically and radiologically almost identical derivatives, but their histological structure is fundamentally different. Case Presentation. A 52-year-old woman was consulted by a surgeon for a derivative felt in her abdomen. The patient said she felt a growing derivative in the abdomen about a month ago. After consulting and testing, a sigmoid colon mesenteric cyst (13 cm × 11 cm × 10 cm) was found. Complete excision of the cyst within healthy tissues was performed through laparotomy. The surgery had no complications. The initial pathological answer was a simple mesothelial cyst (a rare histological finding). However, immunohistochemical tests were performed that showed that diagnosis was mesenteric cystic lymphangioma (ML). Cystic lymphangiomas that have a link to the mesentery have been described less than 200 times. Conclusions Final differential diagnosis between different cystic derivatives is possible only based on histopathological examinations. Mesenteric lymphangioma is most common at a very young age, but in rare cases, it also occurs in adults. All clinicians should increase their awareness of the disease.
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Joret MO, Nanayakkara A, Kulasegaran S, Martin R. A case of cystic lymphatic malformation mimicking acute appendicitis in an adult patient: a rare diagnostic pitfall. BMJ Case Rep 2021; 14:14/3/e239509. [PMID: 33692052 PMCID: PMC7949445 DOI: 10.1136/bcr-2020-239509] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Abdominal cystic lymphatic malformations are rare pathological entities of uncertain aetiology that usually present in early childhood with indolent abdominal distention. We report the case of a 17-year-old man who presented to our hospital with acute right lower quadrant pain, nausea and anorexia. His blood tests revealed a raised white cell count and elevated inflammatory markers. Clinical examination revealed signs of localised right lower quadrant peritonism. A diagnosis of clinical appendicitis was made, and in keeping with local management protocols, the patient proceeded to theatre for a diagnostic laparoscopy without radiological investigations. Operative findings yielded a normal appendix and a large abdominal cystic malformation. This article highlights the need to keep a broad differential diagnosis when performing surgery on patients with clinically presumed appendicitis and the importance of radiological investigations in clinical decision-making, we also review abdominal cystic lymphatic malformations as a rare diagnostic pitfall.
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Affiliation(s)
- Maximilian Olavi Joret
- Department of General Surgery, Waitemata District Health Board, Takapuna, New Zealand .,Department of General Surgery, Taranaki District Health Board, New Plymouth, New Zealand
| | - Asanga Nanayakkara
- Department of General Surgery, Waitemata District Health Board, Takapuna, New Zealand
| | - Suheelan Kulasegaran
- Department of General Surgery, Waitemata District Health Board, Takapuna, New Zealand
| | - Richard Martin
- Department of General Surgery, Waitemata District Health Board, Takapuna, New Zealand
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13
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Ali HA, Zeriouh B, Bouzayan L, Jabi R, Bouziane M. Giant cystic lymphangioma of the stomach: A case report. Ann Med Surg (Lond) 2020; 61:8-12. [PMID: 33363719 PMCID: PMC7750175 DOI: 10.1016/j.amsu.2020.12.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Revised: 12/04/2020] [Accepted: 12/05/2020] [Indexed: 11/05/2022] Open
Abstract
Introduction Cystic lymphangioma is a benign tumor originating from the lymph vessels. It commonly occurs in childhood, in the head or neck regions. However, abdominal Cystic lymphangioma is extremely rare in adult patients and often asymptomatic. Considering abdominal space, it may attain huge sizes whilst causing minimal symptoms. Due to this insidious presentation, these tumors become massive and can be diagnosed late at the complication stage. Presentation of case This case report describes a rare and exceptional case of giant cystic lymphangioma of the stomach presented with a perforation in the abdominal cavity. The diagnosis was suspected following an abdominal CT scan, but could not confirm that the lesion was derived from the stomach. Therefore, an exploratory laparotomy found a multi-cystic mass occupying most of the abdominal space, adherent to the small gastric curvature and without delimitation line. This mass presents a small perforation responsible for an ascites of medium abundance. Then, the patient underwent a subtotal gastrectomy removing the entire cystic mass. Pathological analysis of the surgical specimen confirmed the diagnosis of cystic lymphangioma of the stomach. The postoperative recovery was uneventful, and the patient was discharged after 6 days. At the 3-month follow-up, the patient was in good health. Discussion The cystic lymphangioma of the stomach is rare and exceptionally described in the literature. However, if this tumor is benign, it has the potential to grow, invade vital structures, and develop life-threatening complications. Conclusion We stress the importance of complete surgical excision to prevent cyst complications and to reduce the recurrence risk. Cystic lymphangiomas of the stomach are rare benign tumors originating from the lymph. Its clinical presentation is usually variable and often asymptomatic. However, it can cause mass effect and result in serious complications. The radical resection remains a sufficiently safe and effective treatment to avoid cyst complications and recurrence risk. Long-term follow-up is required after incomplete resection.
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Affiliation(s)
- Hassane Ait Ali
- Department of General Surgery, Mohamed VI University Hospital Center, Oujda, Morocco
| | - Brahim Zeriouh
- Department of General Surgery, Mohamed VI University Hospital Center, Oujda, Morocco
| | - Leila Bouzayan
- Department of General Surgery, Mohamed VI University Hospital Center, Oujda, Morocco
| | - Rachid Jabi
- Department of General Surgery, Mohamed VI University Hospital Center, Oujda, Morocco
| | - Mohammed Bouziane
- Department of General Surgery, Mohamed VI University Hospital Center, Oujda, Morocco
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Parker DR, Kiely P, Smith R. Complete resection of a massive mesenteric lymphangioma in an adult. BMJ Case Rep 2020; 13:13/3/e233714. [PMID: 32188614 DOI: 10.1136/bcr-2019-233714] [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] [Indexed: 11/09/2022] Open
Abstract
Mesenteric lymphangioma is a benign cystic tumour of the lymphatic vessels that occurs rarely in adults. Due to the infrequency of cases and the insidious presentation, these tumours can be diagnosed late and become massive. Resection of mesenteric lymphangioma in its entirety is the recommended management in order to prevent recurrence. This case report describes the finding of a massive mesenteric lymphangioma (dimensions 420×470×100 mm) in a young man, the investigations leading to diagnosis, and the subsequent surgical management. The substantial size of this tumour produced considerable challenges for the surgical team, including involvement of adjacent small bowel and mesenteric vasculature. Preoperative diagnosis and assessment of the anatomy was pivotal in achieving a complete resection and a good patient outcome.
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Affiliation(s)
- Dominic Robert Parker
- Trauma and Surgical Oncology Unit, Royal Adelaide Hospital, Adelaide, South Australia, Australia .,Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, South Australia, Australia
| | - Philip Kiely
- Trauma and Surgical Oncology Unit, Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Richard Smith
- Trauma and Surgical Oncology Unit, Royal Adelaide Hospital, Adelaide, South Australia, Australia
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15
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Lymphangioma of the Small Intestine Case Report and Review of the Literature. SERBIAN JOURNAL OF EXPERIMENTAL AND CLINICAL RESEARCH 2019. [DOI: 10.2478/sjecr-2018-0001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Abstract
Lymphangioma usually occurs in children and usually involves the skin. Mesenteric lymphangiomas are extremely rare in adults (1,2,3). Lymphangioma of the small-bowel mesentery is rare, representing less than 1% of all lymphangiomas (4).
We report a case of a 62-year-old female who presented with abdominal pain, discomfort, nausea and vomiting. Pre-operative tests including abdominal ultrasonography and magnetic resonance imaging were performed, but they could not accurately determine the nature of the tumour. Laparotomy was performed; the tumour was excised completely, and a large cystic tumour of the small bowel mesentery was found. Histopathological examination diagnosed the tumour as a cystic lymphangioma. Lymphangiomas are extremely rare, especially in the abdomen of adults, and are asymptomatic for the most part; they often present as acute abdominal conditions, causing life-threatening complications such as secondary infection, rupture with haemorrhage, and volvulus or intestinal obstruction when the tumour increases in size, requiring emergent surgery. Lymphangioma is often difficult to diagnose, and surgical resection is selected in many cases for both diagnosis and treatment.
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16
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Chen J, Du L, Wang DR. Experience in the diagnosis and treatment of mesenteric lymphangioma in adults: A case report and review of literature. World J Gastrointest Oncol 2018; 10:522-527. [PMID: 30595806 PMCID: PMC6304307 DOI: 10.4251/wjgo.v10.i12.522] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2018] [Revised: 11/02/2018] [Accepted: 11/07/2018] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Mesenteric lymphangioma (ML) in adults is a very rare disease. We report six hospitalized adult patients with ML in our hospital between January 2013 and July 2018 to investigate the characteristics and prognosis of ML in adults.
CASE SUMMARY The male-to-female ratio was 3:3, and the median age at diagnosis was 55.2 years. Clinical manifestations varied; however, most were acute cases (5/6). No history of trauma was reported. None (0/6) of the patients were accurately diagnosed with ML in the emergency and outpatient departments. Mesenteric cysts were identified in four patients (66.7%) by abdominal ultrasound and in five patients (83.3%) by computed tomography. ML was postoperatively confirmed by pathology. Most MLs (4/6) were associated with infection of other systems. ML was located in the mesentery of the small intestine (n = 4), ileum (n = 1) and rectum (n = 1). Cyst fluid was clear (n = 4), chylous (n = 1) and bloody (n = 1). Surgical procedures included complete tumor removal and partial intestinal excision (n = 6). Recurrence and adhesive intestinal obstruction were not observed during the 3-12 mo follow-up period.
CONCLUSION ML in adults is a rare benign acquired disease that can be cured by surgical treatment. Infection may be a cause of ML.
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Affiliation(s)
- Jie Chen
- Department of Gastroenterology, Northern Jiangsu Province People’s Hospital, Yangzhou 225001, Jiangsu Province, China
| | - Lin Du
- Department of Cardiovascular, Affiliated Hospital of Yangzhou University, Yangzhou 225001, Jiangsu Province, China
| | - Dao-Rong Wang
- Department of Gastroenterology, Northern Jiangsu Province People’s Hospital, Yangzhou 225001, Jiangsu Province, China
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17
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Durgakeri P, Penington B. Cystic mesenteric lymphangioma: a case report. ANZ J Surg 2017; 88:E861-E862. [PMID: 28419699 DOI: 10.1111/ans.13950] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2016] [Revised: 12/10/2016] [Accepted: 01/29/2017] [Indexed: 11/25/2022]
Affiliation(s)
- Pramod Durgakeri
- Department of Surgery, Box Hill Hospital, Eastern Health, Melbourne, Victoria, Australia
| | - Beth Penington
- Department of Surgery, Bendigo Base Hospital, Bendigo Health, Bendigo, Victoria, Australia
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18
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Wei MYK, Chua J, Cheng Y, Grossberg P. Small bowel volvulus in an adult with mesenteric lymphangioma and ascariasis. ANZ J Surg 2017; 88:E859-E860. [PMID: 28266164 DOI: 10.1111/ans.13953] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2016] [Revised: 12/21/2016] [Accepted: 01/29/2017] [Indexed: 11/30/2022]
Affiliation(s)
- Matthew Yuan-Kun Wei
- Department of General Surgery, Box Hill Hospital, Eastern Health, Melbourne, Victoria, Australia
| | - Jonathan Chua
- Department of General Surgery, Box Hill Hospital, Eastern Health, Melbourne, Victoria, Australia
| | - Yuan Cheng
- Department of General Surgery, Box Hill Hospital, Eastern Health, Melbourne, Victoria, Australia
| | - Peter Grossberg
- Department of General Surgery, Box Hill Hospital, Eastern Health, Melbourne, Victoria, Australia
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19
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Complete resection of a complicated huge mesenteric lymphangioma guided by mesenteric computed tomography angiography with three-dimensional reconstruction: report of a case. Int Surg 2016; 100:574-8. [PMID: 25785347 DOI: 10.9738/intsurg-d-14-00112.1] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
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.
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20
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Hubli P, Rohith M, Sachin BM. A Giant Retroperitoneal Lymphangioma: A Case Report. J Clin Diagn Res 2016; 10:PD14-5. [PMID: 27630902 DOI: 10.7860/jcdr/2016/19989.8142] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2016] [Accepted: 06/10/2016] [Indexed: 11/24/2022]
Abstract
Lymphangioma is a congenital lesion of childhood. They usually present in head and neck region. Intra-abdominal lymphangioma in an adult is a rare lesion which poses diagnostic difficulty. Although asymptomatic, they may present with an acute abdomen. Here, we report a rare case of huge asymptomatic retro-peritoneal lymphangioma who underwent complete surgical excision with an uneventful postoperative period.
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Affiliation(s)
- Prabhu Hubli
- Professor, Department of Surgery, Vijayanagar Institute of Medical Sciences , Bellary, India
| | - Muddasetty Rohith
- Post Graduate, Department of Surgery, Vijayanagar Institute of Medical Sciences , Bellary, India
| | - Basavaraju M Sachin
- Post Graduate, Department of Surgery, Vijayanagar Institute of Medical Sciences , Bellary, India
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21
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Hitzerd E, van Hamont D, Pijnenborg JMA. Mesenteric lymphangioma mimicking a cystic ovarian mass on imaging. BMJ Case Rep 2016; 2016:bcr-2015-213727. [PMID: 26833955 DOI: 10.1136/bcr-2015-213727] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Pelvic cystic masses are frequently observed in women. Most lesions are benign and of ovarian origin. However, non-ovarian lesions can be easily confused with cystic ovarian masses on imaging, which hampers diagnostic and therapeutic management. In this report, a rare case of mesenteric lymphangioma mimicking an ovarian cystic mass, discovered as an incidental finding on orthopaedic MRI in an adult female, is presented. The report highlights the sometimes difficult diagnostic process of pelvic cystic masses, due to an extensive differential diagnosis and the fact that imaging is often inconclusive. Even though most cystic masses are of ovarian origin, non-ovarian causes can mimic ovarian masses and should be considered as differential diagnoses. Surgical exploration may be necessary to exclude malignant causes.
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Affiliation(s)
- Emilie Hitzerd
- Department of Obstetrics and Gynaecology, Amphia Hospital, Breda, The Netherlands
| | - Dennis van Hamont
- Department of Obstetrics and Gynaecology, Amphia Hospital, Breda, The Netherlands
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22
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Jang WY, Do MY, Ahn BC, Park MS, Kim HA, Ryu SY, Kim SP, Park KU. Lymphangioma involving whole mesentery confirmed by core needle biopsy. Yeungnam Univ J Med 2016. [DOI: 10.12701/yujm.2016.33.2.130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
- Won Young Jang
- Department of Internal Medicine, Keimyung University Dongsan Hospital, Keimyung University College of Medicine, Daegu, Korea
| | - Min Young Do
- Department of Internal Medicine, Keimyung University Dongsan Hospital, Keimyung University College of Medicine, Daegu, Korea
| | - Byung Chan Ahn
- Department of Internal Medicine, Keimyung University Dongsan Hospital, Keimyung University College of Medicine, Daegu, Korea
| | - Myeong Soon Park
- Department of Internal Medicine, Keimyung University Dongsan Hospital, Keimyung University College of Medicine, Daegu, Korea
| | - Hyun Ah Kim
- Department of Internal Medicine, Keimyung University Dongsan Hospital, Keimyung University College of Medicine, Daegu, Korea
| | - Seong-Yeol Ryu
- Department of Internal Medicine, Keimyung University Dongsan Hospital, Keimyung University College of Medicine, Daegu, Korea
| | - Sang Pyo Kim
- Department of Pathology, Keimyung University Dongsan Hospital, Keimyung University College of Medicine, Daegu, Korea
| | - Keon Uk Park
- Department of Internal Medicine, Keimyung University Dongsan Hospital, Keimyung University College of Medicine, Daegu, Korea
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23
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Serrano-Rodríguez P, Desai CS. [Gastrocolic omental cyst in an adult: Case presentation and review of literature]. CIR CIR 2015; 84:509-512. [PMID: 26688477 DOI: 10.1016/j.circir.2015.10.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2015] [Accepted: 06/19/2015] [Indexed: 10/22/2022]
Abstract
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.
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Affiliation(s)
- Pablo Serrano-Rodríguez
- Servicio de Cirugía 3, Trasplante de Órganos Abdominales, Centro Médico Nacional 20 de Noviembre, Instituto de Seguridad y Servicios Sociales de los Trabajadores del Estado, Ciudad de México, México.
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24
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Watanabe A, Suzuki H, Kubo N, Kobayashi T, Araki K, Sasaki S, Shimura T, Oyama T, Kuwano H. A case of mesenteric cystic lymphangioma in an adult which caused duodenal stenosis after resection. Int J Surg Case Rep 2012; 4:212-5. [PMID: 23287062 DOI: 10.1016/j.ijscr.2012.10.023] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2012] [Revised: 10/09/2012] [Accepted: 10/09/2012] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION We present a rare case of mesenteric lymphangioma in a middle-aged female. PRESENTATION OF CASE A 56-year-old female was admitted to the hospital with upper abdominal pain. Abdominal computed tomography revealed a multicystic mass surrounding the mesentery. We made the decision to resect the mass, suspecting that was a mesenteric lymphangioma based on additional imaging studies. The tumor adhered strongly to parts of the duodenum and the upper jejunum. In order to preserve the jejunum, we dissected its serosa away from the tumor. Approximately 1 week after surgery the patient experienced a constriction of the third portion of the duodenum. Her symptoms were improved with conservative therapy, and she was discharged from the hospital 62 days after surgery. DISCUSSION Lymphangioma originating from the mesentery may have cause adhesions due to exfoliated tumor cells; it is necessary to be concerned about postoperative obstruction. CONCLUSION The preoperative diagnosis of lymphangioma is based on various imaging modalities.
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Affiliation(s)
- Akira Watanabe
- Department of General Surgical Science, Gunma University Graduate School of Medicine, 3-39-22 Maebashi, Gunma 371-8511, Japan.
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25
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Francesco G, Alfonso C, Antonio F, Giovanni A. An unusual cause of "appendicular pain" in a young girl: mesenteric cystic lymphangioma. J Surg Case Rep 2012; 2012:15. [PMID: 24960684 PMCID: PMC3862248 DOI: 10.1093/jscr/2012.6.15] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Pain of the right iliac fossa in young girls can relate to several pathologies of the gastrointestinal and genitor-urinary tract. On the other hand, lymphangiomas in the peritoneal cavity are extremely rare. We report the case of a young woman with pain in the right iliac fossa caused by a cystic lymphangioma. A 17-year-old caucasian female patient presented with abdominal pain in the right iliac fossa and flank of a 1-month duration. The patient was apyrexic and laboratory tests were negative. CT/MRI of abdomen showed a cystic mass (max diameter 60 mm) in the retrocaecl adipose tissue in connection with the caecum and appendix. The patient underwent a total excision of the lesion and appendicectomy. Histopathological examination was consistent with the diagnosis of mesenteric lymphangioma. This case shows a rare but possible cause of right iliac fossa pain in young women to be considered in the differential diagnosis.
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Affiliation(s)
- G Francesco
- University of Naples "Federico II", Naples, Italy
| | - C Alfonso
- University of Naples "Federico II", Naples, Italy
| | - F Antonio
- University of Naples "Federico II", Naples, Italy
| | - A Giovanni
- University of Naples "Federico II", Naples, Italy
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26
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Vennarecci G, Ceribelli C, Laurenzi A, Moroni E, Ettorre GM. Giant cavernous mesenteric lymphangioma in adult. Updates Surg 2012; 65:317-9. [PMID: 22585680 DOI: 10.1007/s13304-012-0157-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2012] [Accepted: 04/25/2012] [Indexed: 10/28/2022]
Affiliation(s)
- Giovanni Vennarecci
- Department of General Surgery and Liver Transplantation, Hospital San Camillo, Circonvallazione Gianicolense 87, 00152, Rome, Italy,
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27
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Maa J, Wa C, Jaigirdir A, Cho SJ, Corvera CU. Giant mesenteric cystic lymphangioma presenting with abdominal pain and masquerading as a gynecologic malignancy. Rare Tumors 2009; 1:e48. [PMID: 21139927 PMCID: PMC2994469 DOI: 10.4081/rt.2009.e48] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2009] [Accepted: 10/21/2009] [Indexed: 12/21/2022] Open
Abstract
Lymphangiomas are congenital malformations of the lymphatic system that account for about 5% of all benign tumors in infants and children.1 The most common sites are the neck and axilla, which account for 95% of cases.2 Abdominal cystic lymphangiomas are quite rare, and can arise from either the retroperitoneum, gastrointestinal tract, or the mesentery of the abdominal viscera.3 The presenting symptoms are painless abdominal distension, a palpable mass, or secondary complications in the abdomen such as intestinal obstruction, volvulus, intestinal infarction, or bleeding.4 Typically diagnosed during childhood, these tumors prompt surgical intervention. We describe an atypical case of an abdominal cystic lymphangioma, which did not manifest until adulthood, with atypical symptoms of a rapidly expanding and symptomatic mass.
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Affiliation(s)
- John Maa
- Department of Surgery, University of California
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