Retroperitoneal cystic lymphangioma in an adult: A case report

A rare case of huge intra-abdominal cystic lymphangioma arising from rectovesical pouch; a case report

INTRODUCTION AND IMPORTANCE

Lymphangiomas are benign maldevelopment of the lymphatic vessels; they classically occur in the head and neck region. They are usually seen in newborn and pediatric age groups, especially below two years of age, and rarely occur in adults.

PRESENTATION OF CASE

A 27-year-old male patient presented with progressive abdominal swelling of two-year duration. He had also difficulty breathing from the mass effect of a huge intra-abdominal mass. He was emaciated; vital signs were in the normal range, except for tachypnea. His abdomen was hugely distended, tense, dull to percussion, and the umbilicus was everted. CT scan revealed a multiseptated cystic mass. He underwent complete surgical excision with ligation of the cyst peduncle. The diagnosis of cystic lymphangioma was confirmed after a histopathologic examination.

CLINICAL DISCUSSION

Lymphangiomas have an incidence rate of one in every 20,000 to 250,000 populations. The clinical presentation of abdominal cystic lymphangioma is non-specific and is related to the size, and location of the tumor. The preoperative diagnosis of abdominal cystic lymphangioma is often challenging and leads to misdiagnosis. The management of abdominal cystic lymphangioma depends on the mode of presentation and location of the tumor. It has good prognosis after complete surgical resection of the tumor.

CONCLUSION

Abdominal cystic lymphangioma arising from the rectovesical pouch is a very rare condition. The best management is complete surgical resection to prevent a recurrence. Despite, the rarity of the disease in adults they should be considered as a differential diagnosis in cystic abdominal tumors.

Retroperitoneal lymphangioma as the final diagnosis of a middle-aged woman with abdominal pain: a case report

BACKGROUND

Lymphangiomas are lesions attributed to congenital malformations of the lymphatic system, or acquired chronic obstruction of the lymphatic network due to trauma, radiation, surgical manipulation, inflammation, or infection. Overall, lymaphangiomas are rare, and particularly, retroperitoneal lymphangiomas are far more uncommon per reported cases.

CASE PRESENTATION

A 49-year-old Iranian woman presented with a progressive abdominal pain since approximately 1 month before admission. She was found to have a retroperitoneal lymphangioma after a precise radiological and surgical workup.

CONCLUSION

Retroperitoneal lymphangiomas are rare lesions, sometimes indistinguishable from malignant lesions originating from pancreas and adjacent organs. Complete surgical removal and histologic evaluation of the lesion is the gold standard of treatment and diagnosis.

Review of diagnosis, differential diagnosis, and management of retroperitoneal lymphangioma

Lymphatic malformation (LM) is the currently preferred term for what was previously known as lymphangioma. Retroperitoneal LMs are extremely rare, benign, cystic masses that arise from lymphatic vessels. They can be challenging to diagnose because they resemble other retroperitoneal cystic tumors. The development of treatment strategies for rare diseases, including retroperitoneal LM, requires the acquisition of new knowledge to enhance our understanding of the disease progression. Therefore, we present an update regarding fundamental and advanced issues associated with retroperitoneal LM. This review describes the epidemiology, histopathology, biomedicine, clinical manifestations, radiological features, differential diagnosis, and management of this lesion.

Case report and literature review: Giant retroperitoneal cystic lymphangioma

Background

Cystic lymphangioma is a rare benign tumor of the lymphatic system, which is most commonly observed in the neck, head and armpit.Less than 5% of lymphangiomas occur in the abdominal cavity and even less in the retroperitoneum.

Case description

A 65-year-old male patient was diagnosed with an "abdominal mass that had persisted for 1 year, accompanied by abdominal pain, abdominal distension and dyspnea for 7 days". After abdominal computerd tomography, a giant multilobed abdominal lymphangioma was suspected, which squeezed the intestinal canal and was closely related to the inferior vena cava. The patient underwent an exploratory laparotomy, during which, it was found that the tumor formed extensive adhesions to the transverse colon, small intestine and pelvic wall, and enveloped the abdominal aorta, superior mesenteric artery, inferior mesenteric artery and inferior vena cava to varying degrees. It was diffcult to remove the cyst completely. Postoperative pathology confirmed the diagnosis of retroperitoneal cystic lymphangioma. The patient recovered well after the operation, was eating normally by 5 days postoperatively,and was discharged 10 days postoperatively.The patient was followed up 1 month after postoperatively and no evidence of recurrence was observed.

Conclusion

In this case, we report a patient with giant retroperitoneal cystic lymphangioma who underwent exploratory laparotomy combined with preoperative abdominal computerd tomography and acute abdominal pain, abdominal distension and dyspnea. Because of the large volume of the tumor and its close relationship with the superior mesenteric artery and other blood vessels, the surgeon used scissors to separate the tumor sharply and removed the whole tumor completely.

A rare case of a retroperitoneal lymphangioma causing chronic flank pain in an adult

Retroperitoneal lymphangiomas are exceedingly rare and typically asymptomatic. We present a case of a 27 year-old female with chronic right flank pain and cross-sectional imaging showing a large multi-cystic mass located medial and inferior to the right kidney. The patient underwent an uncomplicated robotic-assisted, laparoscopic resection of the mass with final pathology showing a benign lymphangioma. This case highlights the importance of recognizing retroperitoneal lymphangiomas as atypical causes of chronic flank pain and demonstrates that these benign tumors can be successfully resected robotically. Given today's urology residency training, urologists are likely uniquely positioned to best manage these peri-renal lymphatic malformations.

Pediatric cystic lymphangioma of the retroperitoneum: A case report and review of the literature

RATIONALE

Cystic lymphangioma (CL) is a rare benign tumor resulting from a failure of the lymphatic system development. It may occur at any age but it is more frequent during childhood. Its clinical presentation and location are various but abdominal CL are uncommon. Among those, mesenteric presentation is the most frequent form whereas CL of the retroperitoneum are particularly rare.

PATIENT CONCERNS

Herein, we report the case of a 17-years-old patient with no medical history who presented with right-upper quadrant (RUQ) pain, but no other symptom. Physical examination showed tenderness of the RUQ without distension. Lab tests were unremarkable.

DIAGNOSIS

Abdominal computed tomography (CT) highlighted a retroperitoneal cystic mass potentially infiltrating the mesenterium, raising suspicion of a CL of the retroperitoneum. Diagnosis of CL was confirmed by histological analyses.

INTERVENTION

Patient underwent an exploratory laparoscopy that infirmed infiltration of the mesenterium and allowed for resection.

OUTCOMES

Postoperative course was uneventful and there is no evidence of recurrence after 14 months of follow-up.

LESSONS

Although CL essentially occur in children, pediatric retroperitoneal CL is a rare finding, with only 21 cases identified in the literature.In summary, CL are benign tumors rarely located in the retroperitoneum. Despite performant imaging technologies, preoperative diagnosis is challenging. Whenever possible, laparoscopic resection should be the treatment of choice. Herein, we report the largest CL pediatric case laparoscopically resected, and the first review of the literature on the topic.