Abdominal lymphangiomas in adults

An Incidental Finding of a Cecal Lymphangioma Managed Conservatively

Colonic lymphangiomas are rare and mostly incidental findings found on colonoscopy. It is important to be able to differentiate them from other lesions, such as lipomas. Furthermore, when in close proximity to the appendiceal orifice, such as cecal lesions, they must be differentiated from mucocele and carcinoid tumors. We present a case of a cecal lymphangioma that was managed conservatively. By using endoscopic ultrasound (EUS) and computed tomography to better characterize the cecal mass, it was unnecessary to perform a biopsy or polypectomy. This case highlights that biopsy and/or removal of lymphangiomas are not warranted in all cases of colonic lymphangiomas, especially when lesions are less than 2 cm.

Adult Primary Retroperitoneal Lymphangioma: Updated Facts

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.

Intra-abdominal cystic lymphangioma in adults: A case series of 32 patients and literature review

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.

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Lymphangiomas in the abdominal cavity are extremely rare, particularly in adults.

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Cystic lymphangioma is a benign tumor originating from the lymph vessels.

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The clinical presentation is various.

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Whenever possible, laparoscopic resection should be the treatment of choice.

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To prevent a recurrence, complete excision is the best option.

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.

Lymphangioma of Colon Presenting as an Intramural Tumor

Lymphangiomas are rare and benign vascular malformations of the lymphatic system. They may arise in any location and at all ages and have variable presentation. These lesions in the intestinal wall are reported very rarely. In the case of colonic lymphangiomas, it is more common in late adulthood and old age, which, in this age group is thought to be associated with local disturbances of lymphatic circulation secondary to inflammation, degeneration, surgical procedure, trauma or radiation. The clinical presentation of colonic lymphangiomas varies from incidental findings on imaging to presenting with acute abdomen. The imaging features are usually multilocular cyst in intramural colon and submucosal mass on endoscopy. However, in the case of symptomatic lesions with atypical image findings, and the fact that the disease is rare, preoperative diagnosis is often difficult. On the other hand, although these cystic tumors do not transform into malignancy, they can be locally invasive or complicated, and often require resection. We report a 53-year-old male who had a cystic lymphangioma of the transverse colon illustrated by imaging modalities and recognized via postoperative histopathological examination.

Giant cystic lymphangioma of right mesocolon: A case report

Introduction

Cystic lymphangiomas are rare benign tumors of the lymph vessels and are usually found in children. However, abdominal cystic lymphangioma in mesocolon is extremely rare in adult patients.

Presentation of case

We reported a 15-year-old female with giant cystic lymphangioma of the right mesocolon. On examination, only abdominal pain was confirmed. Abdominal computed tomography (CT) showed a large multiseptated cystic mass. The patient underwent a total right mesocolic excision with the lesion. The patient recovered well on postoperative follow-up and was discharged on the fifth day. No evidence of recurrence had also been found in three months follow-up period.

Discussion

The diagnosis of intra-abdominal cystic lymphoma is often dismissed because the clinical symptoms are nonspecific. It is easy confusion because the ultrasound and CT scan images are relatively similar to the mesenteric and omental cysts. Sclerosing therapies may cause long-term consequences such as local recurrences with a very high proportion. Complete resection, including resection of the involved organs, is necessary. With tumors surrounding the colon, surgeons should consider performing removal block colon-lesion.

Conclusion

Complete tumor removal is the optimal choice for the management of intra-abdominal cystic lymphangioma. However, incomplete resection may lead to local recurrence.

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Intra-abdominal cystic lymphangiomas are rare benign tumors.

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The most common location in mesenteric small bowel, in mesocolon is extremely rare.

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Complete tumor removal is optimal choice for lymphangioma

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.

Clinical Case of Fetal Lymphangioma

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.

Imaging features, complications and differential diagnoses of abdominal cystic lymphangiomas

PURPOSE

The aim of the study is to describe the imaging features, complications and differential diagnoses of abdominal cystic lymphangiomas (ACLs).

RESULTS

ACLs are benign lymphatic malformations that mainly arise in the subperitoneal space and the retroperitoneum. The typical presentation of an ACL is a multilocular lesion with homogenous serous content, presenting a thin wall and septa, usually free from adjacent organ compression. Atypical findings, including fat or hemorrhagic content, septal calcifications and unilocular presentation, are not uncommon. Rarely, ACLs can be revealed by acute complications, such as infection, hemorrhage, intussusception, complications with a twisting mechanism (including torsion around its own pedicle) or spontaneous rupture, which can be diagnosed by imaging. Ultrasonography and CT are the most useful modalities in emergency situations. MRI performs best in the noninvasive characterization of cystic lesions. ACLs should be differentiated from normal anatomic structures (e.g., cisterna chyli) or pitfalls (e.g., ascites, extrapancreatic necrosis, lymphocele) that can simulate ACLs. Among other primary peritoneal cystic lesions, benign cystic mesothelioma can be difficult to differentiate from ACL. Some neoplastic peritoneal lesions may have cystic components or content that looks like fluid on imaging (such as mucinous or myxoid content) and be misdiagnosed as ACL. Nodular or thick enhancement of the wall or septa should then be considered worrisome features and should not suggest ACL. ACLs mostly require a simple follow-up. If treatment is necessary, percutaneous sclerotherapy is a safe and effective alternative to surgery.

CONCLUSION

Imaging, especially MRI, allows the noninvasive diagnosis of ACL and helps to exclude potential malignant differential diagnoses.

Unusual location and complication of a cystic lymphangioma: A case report

INTRODUCTION

This paper reports an uncommon location and complication of a cystic lymphangioma. Few cases of infected colonic cystic lymphangioma were described in literature. Symptoms are non-specific and setting the diagnosis on radiological features remain challenging. Urgent open surgery is generally required for therapeutic and diagnostic purposes.

PRESENTATION OF CASE

We describe a case of a young man who presented with an acute abdomen mimicking bile peritonitis, infected tumor of the colon or even a complicated hydatid disease of the liver, which is endemic in our country. CT-scan was compulsory to suspect the diagnosis of infected cystic lymphangioma but remained insufficient to rule out other more frequent diagnoses. The patient underwent an emergency open surgery consisting in a bowel resection, in whose case an infected cystic lymphangioma was barely suspected preoperatively but confirmed by the pathological examination of the specimen. No postoperative complications were noticed.

DISCUSSION

Setting the diagnosis of an infected cystic lymphangioma of the colon is tough. Many differential diagnoses are more frequently suspected and radiological examinations can be helpful. However, an emergency surgery is mandatory in order to avoid septic shock and resect the lesion, sometimes at the cost of bowel resection. Laparoscopic or endoscopic treatments are feasible but are not the standard in emergency cases.

CONCLUSION

Acute presentation of cystic lymphangioma of the colon is very scarce and can be life-threatening leading to urgent open surgery, although endoscopic or laparoscopic treatment remain feasible. Further studies are needed to select which technique is suitable for this disorder.

Complete resection of a massive mesenteric lymphangioma in an adult

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.

Lymphangioma of the ileum causing acute abdominal pain in an adult, a very rare finding during surgery; Case report with literature review

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Lymphangioma of the gastrointestinal tract is very rare, 75 % of the lesions affect the neck and 20 % affect the axillary region.

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The majority of cases are asymptomatic but some cases presented with emergency presentations.

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Complete surgical resection is the main form of therapy whenever possible.

Introduction

Lymphangioma of the gastrointestinal tract is very rare, 75 % of the lesions affect the neck and 20 % affect the axillary region, the rest are seen in the mediastinum, the visceral organs, the retroperitoneum, the mesentery, or in the bones. Lymphangioma of the gastrointestinal tract comprises less than 1 %. The majority of cases are asymptomatic but some cases presented with emergency presentations.

Case presentation

A 31-year-old male presented to emergency department complaining of central abdominal pain for 2 days, with nausea, dyspnea but no vomiting.

The abdominal examination revealed a mildly distended abdomen, with guarding and tenderness mainly in the right lower abdominal quadrant. There were no any palpable masses or organ enlargement. The white blood cells count was elevated (14,000 c/mm).

Abdominal ultrasound showed an evidence of 10*7 cm multiloculated thick walled lesion in the right lower abdomen, suggesting the possibility of an appendicular abscess. The patient was admitted for 2 days with little clinical improvement. Therefore, a laparotomy was performed at which there were 2 yellowish cystic lesions 60 cm from the ileocecal valve that were arising from each side of the small bowel and related to its mesentery causing luminal narrowing. Resection was done with end-end anastomosis. The histopathology results revealed a diagnosis of ill lymphangioma of the ileum.

Conclusion

Complete surgical resection is the main form of therapy whenever possible, sometimes is impossible when there is local invasion. When complete resection is performed long term follow up is not recommended as the recurrence is very rare.

Primary Intestinal Lymphangiectasia Causing Intussusception and Small Bowel Obstruction

Abdominal lymphangiectasia is a rare disease manifestation with a variety of anatomic locations and clinical presentations. The gastrointestinal tract may be affected, and lymphangiectasia originating in the wall of the intestine has rarely been described. We present a case of primary small bowel lymphangiectasia causing intussusception in a 30-year-old woman who presented with emesis and gastrointestinal bleeding. This case emphasizes the clinical presentation, diagnosis, and management in adults with abdominal lymphangiectasia. We highlight the importance of a high clinical suspicion for lymphangiectasia in an adult with acute abdomen to avoid catastrophic morbidity.

Large cystic lymphangioma of pancreas mimicking mucinous neoplasm: case report with a review of histological differential diagnosis

Purpose

Cystic lymphangioma of the pancreas was first recognized in 1913 as a form of benign cyst. It is extremely rare, accounting for less than 1% of the lymphangiomas.

Case report

Herein, we report a case of cystic pancreatic lymphangioma diagnosed in a 51-year-old female patient who was hospitalized for a colicky upper abdominal pain for a month. Radiological imaging revealed a large multiloculated cystic pancreatic mass with enhancing septations. The patient underwent distal pancreatectomy, and the histological examination showed cystic lymphangioma.

Conclusion

Although very uncommon, cystic lymphangioma should be placed in the differential diagnosis list of pancreatic cystic lesions, at least about the multi-septated ones in asymptomatic female patients which are discovered incidentally.

Large intra-abdominal cystic lymphangioma managed by laparoscopic partial excision and modified drain with no need for open resection

A 57-year-old woman was referred to the emergency department after a CT scan ordered by her general practitioner to investigate her abdominal pain showed a large cystic mass. The simple cystic appearance with its location in the small bowel mesentery prompted a provisional diagnosis of cystic lymphangioma. However, concerns regarding the size, location and local involvement of neurovascular structures presented a technical surgical challenge. Here we present a case of minimally invasive laparoscopic drainage using a modified Jackson-Pratt drain that avoided a laparotomy and open resection.

Splenic lymphangioma

INTRODUCTION

Abdominal localization of cyst lymphangioma is rare. The splenic involvement is exceptional.

CASE PRESENTATION

A 63-year-old woman, who was followed for martial anemia evolving associated with abdominal pain in the past 12 months. On clinical examination, she had pallor conjunctival mucosa, with a normal abdominal and lymph node examination. The abdominal ultrasound showed multiple splenic cysts. The abdominal CT scan showed a normal-sized spleen with multiples hypodense cystic lesions. At the laparotomy exploration a multinodular spleen was found which measured 18 cm*15 cm*6 cm. The histological exam results showed concluded to a splenic cavernous lymphangioma without malignity signs. The follow-up after 12 months was normal.

CONCLUSION

splenic lymphangioma is rare and benign tumor. Total splenectomy under laparotomy or laparoscopy is the appropriate treatment.

Is pneumatosis cystoides intestinalis a lymphatic pathology?: A case of small bowel lymphangioma and subsequent development of pneumatosis cystoides intestinalis in a 57-year-old female

The etiology of pneumatosis cystoides intestinalis (PCI) is multifactorial and its corresponding treatment is similarly complex. One causation of PCI, is lymphatic disruption. This association is discussed in this case report involving an incident of abdominal lymphangioma and subsequent development of PCI in a 57-year-old female. The purpose of this paper is to further understand the pathology of PCI, specifically as it relates to lymphatic disruption. Furthermore, the purpose of this article is to define a treatment protocol for this disease when it involves lymphatic pathology; i.e. when a surgical vs conservative approach is warranted.

Large mesenteric lymphangioma in an adult patient: an unusual presentation of a rare disease

Lymphangiomas are most commonly described as a small painless mass in the neck or a vesicular rash in an infant patient. Ninety per cent of cases are diagnosed before the age of 2. Treatment usually involves surgical resection. Intra-abdominal lymphangiomas and mesenteric lymphangiomas, as described in our case report, represent a rare pathology. The exact prevalence of this condition is unclear but it has been suggested in the literature that there have been as few as 820 cases since the 16th century. The clinical presentation is usually subacute and diagnosis made incidentally during a workup of chronic gastrointestinal symptoms. Acute abdominal symptoms, as in our case presentation, are unusual but may be explained by the mass effect of a large intra-abdominal lesion. Cross-sectional imaging is key in preoperative workup and operative planning. Complete surgical resection is recommended and curative in the majority of cases with a low risk of local recurrence.

Rare huge retroperitoneal cystic lymphangioma presenting as acute abdomen in an adult

Cystic lymphangiomas are rare benign tumors. Most are diagnosed in childhood and their presentation in adults is rare. Retroperitoneal cystic lymphangiomas constitute only 1% of lymphangiomas. Unfortunately the differentiation between cystic lymphangiomas and other cystic tumors is often not possible and surgery with histology is essential for confirmation of diagnosis. A 20-year-old lady with retroperitoneal cystic lymphangioma presented with acute abdomen. In the diagnosis of this patient, abdominal Ultrasound, CT and MRI scans were obtained.

Rare Case of Pancreatic Cystic Lymphangioma

Pancreatic cystic lymphangioma is an extremely rare tumor. The characteristic imaging findings are poorly defined, and distinguishing between this disease and other pancreatic cyst-related tumors is very difficult. We herein report a case of a Japanese woman in her 50s with this lesion, located in the tail of the pancreas. Pancreatic cystic lymphangioma should therefore be considered in the differential diagnosis of pancreatic cystic lesions. Laparoscopic resection can be a useful, minimally invasive surgical approach for treating these cysts as well as for the treatment of benign or low-grade malignant tumors located in the pancreatic body or tail.

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.

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.

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.

A Giant Retroperitoneal Lymphangioma: A Case Report

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.

Emergency presentation of cystic lymphangioma of the colon: A case report and literature review

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Lymphangiomas of the colon are benigne tumors.

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They may lead to life-threatening conditions.

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Infection, volvulus, obstruction and bleeding into the lumen of a cyst are usually very difficult to manage.

Introduction

Colonic lymphangioma is an unusual benign malformation. The clinical presentation of lymphangiomas vary from incidental discovery on imaging to presenting with acute abdomen.

Presentation of case

We present the case of a 73-year-old male, undergoing surgery due to acute abdomen associated with severe anemia, in whose case a lymphangioma of the cecum was recognised only in the postoperative histopathological examination.

Discussion

The management of colonic lymphangioma depends on the individual situation; close surveillance or endoscopic therapy may be appropriate for asymptomatic lesions smaller than 2.5 cm in diameter. Surgical intervention can be considered for larger lesions or in patients who develop complications.

Conclusion

The interest in our case lies in the relatively rare diagnosis of colon lymphangioma and how the cardinal sign was anemia, which may be due to the serosanguineous cystic contents of lymphangiomatosis from the internal bleeding and can cause fatal complications that require emergency surgery.

Primary retroperitoneal masses: what is the differential diagnosis?

Primary retroperitoneal masses include a diverse, and often rare, group of neoplastic and non-neoplastic entities that arise within the retroperitoneum but do not originate from any retroperitoneal organ. Their overlapping appearances on cross-sectional imaging may pose a diagnostic challenge to the radiologist; familiarity with characteristic imaging features, together with relevant clinical information, helps to narrow the differential diagnosis. In this article, a systematic approach to identifying and classifying primary retroperitoneal masses is described. The normal anatomy of the retroperitoneum is reviewed with an emphasis on fascial planes, retroperitoneal compartments, and their contents using cross-sectional imaging. Specific radiologic signs to accurately identify an intra-abdominal mass as primary retroperitoneal are presented, first by confirming the location as retroperitoneal and secondly by excluding an organ of origin. A differential diagnosis based on a predominantly solid or cystic appearance, including neoplastic and non-neoplastic entities, is elaborated. Finally, key diagnostic clues based on characteristic imaging findings are described, which help to narrow the differential diagnosis. This article provides a comprehensive overview of the cross-sectional imaging features of primary retroperitoneal masses, including normal retroperitoneal anatomy, radiologic signs of retroperitoneal masses and the differential diagnosis of solid and cystic, neoplastic and non-neoplastic retroperitoneal masses, with a view to assist the radiologist in narrowing the differential diagnosis.

Subserous lymphangioma of the sigmoid colon: an uncommon cause of acute abdomen in pediatric patients

Lymphangioma is a rare, benign lesion derived from a malformation of the lymphatic system, which is more frequently found in the head, neck, and axilla. However, it may be present anywhere in the body, and the diagnosis involves adults as children with some distinct clinical features among them. In pediatric patients, abdominal cystic lymphangioma occurs mostly in the mesentery presenting abdominal pain, intestinal obstruction, or, more rarely, hemorrhage. The authors report the case of a child with a short-course history of fever, abdominal pain, and constipation. The physical examination disclosed the presence of an abdominal mass and signs of peritoneal irritation. Imaging was consistent with a cystic lesion compressing the sigmoid colon and laterally displacing the remaining loops. Exploratory laparotomy was undertaken, and a sigmoidectomy, followed by Hartman’s colostomy, was performed. Histological examination revealed the nature of the lesion as a cystic lymphangioma. The authors highlight the clinical features of this entity and call attention to this disease in the differential diagnosis of acute abdomen or abdominal pain, mainly in pediatric patients.

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.

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.

A case of mesenteric cystic lymphangioma in an adult which caused duodenal stenosis after resection

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.

Huge cystic lymphangioma of the pancreas mimicking pancreatic cystic neoplasm

Lymphangiomas of the pancreas are very rare benign tumors of lymphatic origin, accounting for less than 1% of these neoplasms. We report a case of a 55-year-old woman who presented with a palpable mass in the left abdomen. Abdominal sonography and computed tomography showed a lobulated, hypodense mass extending from the left diaphragm to the pelvis, measuring 10 × 25 cm. A preoperative diagnosis of mucinous cystadenoma of the pancreas was suggested and the patient underwent laparotomy. Distal pancreatectomy with splenectomy was performed, encompassing a segment of descending colon because of close relationship to the mass. The cystic mass was histologically diagnosed as lymphangioma of the pancreas. The patient is well and free of disease 12 months after surgery. Pancreatic lymphangioma should be kept in mind when a huge, multiloculated mass is encountered in the abdomen, especially in adult women. Although lymphangioma is considered a benign tumor, involvement of adjacent organs sometimes occurs and extended resection is required to obtain a radical treatment.

Uncommon primary pelvic retroperitoneal masses in adults: a pattern-based imaging approach

There is a broad spectrum of primary pelvic retroperitoneal masses in adults that demonstrate characteristic epidemiologic and histopathologic features and natural histories. These masses may be classified into five distinct subgroups using a pattern-based approach that takes anatomic distribution and certain imaging characteristics into account, allowing greater accuracy in their detection and characterization and helping to optimize patient management. The five groups are cystic (serous and mucinous epithelial neoplasms, pelvic lymphangioma, tailgut cyst, ancient schwannoma), vascular or hypervascular (solitary fibrous tumor, paraganglioma, pelvic arteriovenous malformation, Klippel-Trénaunay-Weber syndrome, extraintestinal GIST [gastrointestinal stromal tumor]), fat-containing (lipoma, liposarcoma, myelolipoma, presacral teratoma), calcified (calcified lymphocele, calcified rejected transplant kidney, rare sarcomas), and myxoid (schwannoma, plexiform neurofibroma, myxoma).Cross-sectional imaging modalities help differentiate the more common gynecologic neoplasms from more unusual masses. In particular, the tissue-specific multiplanar capability of high-resolution magnetic resonance imaging permits better tumor localization and internal characterization, thereby serving as a road map for surgery.

An unusual cause of "appendicular pain" in a young girl: mesenteric cystic lymphangioma

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.

A giant retroperitoneal lymphangioma in a patient with neurofibromatosis type 1

Neurofibromatosis type 1 (NF-1) is a genetically inherited disorder that may cause skin abnormalities and tumors that form on nerve tissues. These tumors can be small or large and can occur anywhere in the body, including the brain, spinal cord, or other peripheral nerves. Retroperitoneal lymphangiomas are very rare benign malformations of the lymphatic system. About 95% lymphangiomas occur in the skin and the subcutaneous tissues of the head, neck and axillary region and the remaining 5% appear in other parts of the body such as lungs, pleura, pericardium, liver, gallbladder, kidney, and the mesentery. Herein, we report the case of a giant retroperitoneal lymphangioma in a patient with NF-1 with a review of the literature.

Giant cystic lymphangioma of the liver

BACKGROUND

Giant cystic lymphangiomas of the liver are rare malformations of the lymphatic system usually found in children.

CASE PRESENTATION

A 35-year-old man presenting with right upper quadrant abdominal pain for 7 months visited our clinic. Ultrasound, CT, and MRI examination demonstrated a giant cystic mass in the right trisegment of the liver. The patient underwent surgical resection and histological results of the resected specimen confirmed the diagnosis of giant cystic lymphangioma. The right upper quadrant abdominal pain subsided after the surgical resection and the patient recovered well.

CONCLUSION

Surgical resection is an effective therapy in treating giant cystic lymphangioma.

Mesenteric lymphangioma in adult: a case series with a review of the literature

Mesenteric lymphangioma is a rare benign tumor with nonspecific clinical features. A case series of three adult patients who had mesenteric lymphangioma is reported along with a review of literature. Two patients presented with painless abdominal swelling who were being managed as a case of abdominal tuberculosis and a third one had features of intestinal obstruction. In our cases, preoperative diagnosis of mesenteric lymphangioma was not suspected and all the patients had laparotomy. Peroperative findings revealed mesenteric masses, which were simulating cavitatory form of mesenteric node tuberculosis. It is stressed that mimicking of mesenteric lymphangioma with a cavitatory form of tuberculosis of mesenteric nodes in areas of high prevalence may lead to its misdiagnosis. Histopathology confirmed diagnosis of mesenteric lymphangioma in each case. Although rare and difficult to diagnose preoperatively, surgical resection is to be considered gold standard treatment for mesenteric lymphangioma.

Acquired omental cystic lymphangioma after subtotal gastrectomy: a case report

We herein describe a case of cystic lymphangioma in the greater omentum of the remnant stomach, which is thought it to be related with subtotal gastrectomy 10 yr ago for early gastric cancer. A 76-yr-old man was admitted to our department with postprandial abdominal discomfort and bowel habit change. Intraabdominal multilocular cystic mass was detected by ultrasonography and computed tomography. We performed a complete En-bloc tumor resection including spleen and distal pancreas, and histological examination confirmed cystic lymphangioma originated from the greater omentum of the remnant stomach. Although the etiology of omental lymphangioma remains largely unclear, these findings suggested strongly that obstruction of the lymphatic vessels after gastric resection for gastric carcinoma might be the most plausible cause. The surgical extirpation with resection of organs involved appears to be a treatment of choice for such unusual case.

Cystic tumors of the liver: a practical approach

Biliary cyst tumors (cystadenoma and cystadeno-carcinoma) are an indication for liver resection. They account for only 5% of all solitary cystic lesions of the liver, but differential diagnosis with multiloculated or complicated biliary cysts, atypical hemangiomas, hamartomas and lymphangiomas may be difficult. The most frequent challenge is to differentiate biliary cyst tumors from hemorrhagic cysts. Computerized tomography (CT) and magnetic resonance imaging (MRI) are often not diagnostic and in these cases fine needle aspiration (FNA) is used to confirm the presence of atypical biliary cells. FNA, however, lacks adequate sensitivity and specificity and should always be used in conjunction with imaging. Pre-operative differentiation of cystadenoma from cystadenocarcinoma is impossible and surgery must be performed if a biliary cyst tumor is suspected. When multiple cystic lesions are observed throughout the liver parenchyma, it is important to exclude liver metastasis, of which colonic cancer is the most common primary site. Multiple biliary hamartomas (von Meyenburg complex) can appear as a mixture of solid and cystic lesions and can be confused with cystic metastasis. Strong and uniform T2 hyperintensity on MRI is usually diagnostic, but occasionally a percutaneous biopsy may be required.