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Yang M, Wang J, Zhu L, Zhang D. Spontaneous regression of suspected lymphangiomas of the small-bowel mesentery in a three-month-old infant. Asian J Surg 2024; 47:3274-3275. [PMID: 38519314 DOI: 10.1016/j.asjsur.2024.03.082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2024] [Accepted: 03/14/2024] [Indexed: 03/24/2024] Open
Affiliation(s)
- Meng Yang
- Department of Geriatrics, Xiangyang No. 1 People's Hospital, Hubei University of Medicine, Xiangyang, Hubei, 441000, China
| | - Jinghui Wang
- Department of Gastroenterology, Xiangyang No. 1 People's Hospital, Hubei University of Medicine, China
| | - Lei Zhu
- Department of Laboratory, Xiangyang No. 1 People's Hospital, Hubei University of Medicine, Xiangyang, 441000, China.
| | - Dongdong Zhang
- Department of Oncology, Xiangyang No. 1 People's Hospital, Hubei University of Medicine, Jiefang Road No.15, Xiangyang, Hubei, 441000, China.
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Yan J, Fu Y, Liu S, Bai Y, Chen Y. Mesenteric and omental lymphatic malformations in children: seven-year surgical experience from two centers in China. BMC Pediatr 2024; 24:360. [PMID: 38783260 PMCID: PMC11112925 DOI: 10.1186/s12887-024-04808-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Accepted: 05/02/2024] [Indexed: 05/25/2024] Open
Abstract
PURPOSE To compare the clinical characteristics, surgical management and prognosis of mesenteric lymphatic malformations (ML) and omental lymphatic malformations (OL) in children. METHODS This retrospective study included 148 ML patients and 53 OL patients who underwent surgical treatment at two centers between January 2016 and December 2022. Details about the patients' clinical characteristics, cyst characteristics, preoperative complications, surgical methods, and prognosis were retrieved and compared. RESULTS No significant differences in sex ratio, prenatal diagnosis, or age of diagnosis were noted between ML and OL patients. Vomiting was more common in ML patients than in OL patients (46.6% vs. 22.6%, P = 0.002), but OL patients were more likely to be misdiagnosed (35.8% vs. 18.9%, P = 0.012). The size of the cysts in OL patients was significantly larger than that in ML patients (14.0 [4.0-30.0] vs. 10.0 [2.0-50.0] cm, P<0.001), and cysts with turbid fluid were more common in OL patients (38.0% vs. 20.6%, P<0.001). More OL patients than ML patients had preoperative hemorrhage or infection of cysts (41.5% vs. 31.8%, P<0.016). Cyst excision was performed in 137 (92.6%) ML patients and 51 (96.2%) OL patients, and the incidence of postoperative complications was lower (12.6% vs. 4.2%, P = 0.165) among OL patients. The main postoperative complications included adhesive ileus and recurrence of cysts. Additionally, more OL patients than ML patients were treated with laparoscopic surgery (69.8% vs. 39.2%, P<0.001). CONCLUSIONS There were differences in clinical characteristics, cyst characteristics and preoperative complications between ML and OL patients. Cyst excision was the most common surgical method that was used to treat both ML and OL patients, and laparoscopic surgery could be a feasible surgical approach for treating OL patients with a good prognosis. TRIAL REGISTRATION Retrospectively registered.
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Affiliation(s)
- Jiayu Yan
- Department of General Surgery, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, 100045, China
| | - Yao Fu
- School of Public Health, China Medical University, Shenyang, 110122, China
| | - Shuting Liu
- Department of Pediatric Surgery, Shengjing Hospital of China Medical University, Shenyang, 110004, China
| | - Yuzuo Bai
- Department of Pediatric Surgery, Shengjing Hospital of China Medical University, Shenyang, 110004, China.
| | - Yajun Chen
- Department of General Surgery, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, 100045, China.
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Backen T, Hatch M, Kurian A. Adult Mesenteric Lymphangioma Resulting in Small Bowel Obstruction. Cureus 2024; 16:e55090. [PMID: 38558578 PMCID: PMC10978151 DOI: 10.7759/cureus.55090] [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: 02/26/2024] [Indexed: 04/04/2024] Open
Abstract
A mesenteric cystic lymphangioma (MCL) is a rare condition that primarily manifests in children. This case report illustrates an unusual presentation of an MCL causing a small bowel obstruction with volvulus in an adult. We present a 31-year-old male who presented to our hospital with a small bowel obstruction. He underwent laparotomy, and a lymphatic mass acting as a lead point and causing small bowel volvulus was discovered intra-operatively. The patient underwent a small bowel with associated mass resection and primary anastomosis; he recovered well. The final pathology demonstrated an MCL. Despite the MCL being a rare entity in adults, it must be considered as the differential for various abdominal pathologies. Although the majority of these masses lack malignant potential, they should be resected, as they pose a risk of mechanical obstruction, torsion, and perforation. Prior descriptions include individual case reports of symptomatic lesions, proposed non-operative management, and follow-up imaging.
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Affiliation(s)
- Timbre Backen
- General Surgery, Hospital Corporation of America (HCA) Swedish Medical Center, Englewood, USA
| | - Matthew Hatch
- General Surgery, Hospital Corporation of America (HCA) Swedish Medical Center, Englewood, USA
| | - Ashwin Kurian
- Minimally Invasive Surgery, Denver Esophageal and Stomach Center, Denver, USA
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Bhusal A, Habibullah Q, Rahman M, Bandh B, Islam S, Dola T, Bista S. Mesenteric cystic lymphangioma in an adolescent male; a diagnostic dilemma: A case report. Int J Surg Case Rep 2023; 113:109042. [PMID: 37984261 PMCID: PMC10694645 DOI: 10.1016/j.ijscr.2023.109042] [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: 10/08/2023] [Revised: 11/05/2023] [Accepted: 11/09/2023] [Indexed: 11/22/2023] Open
Abstract
INTRODUCTION AND IMPORTANCE Hemolymphangioma, a rare type of lymphangioma, is a benign hamartoma of the blood vessels and lymphatic system. Considered to be extremely rare among adults with infrequent occurrence in abdominal regions, lymphangioma involving mesentery accounts for <1 % of cases and only 0.05 % involve the GI tract. Due to the absence of typical clinical presentation, making a confirmatory preoperative diagnosis is challenging. CASE PRESENTATION An 18-year-old Bangladeshi man visited the hospital with the complaints of epigastric and umbilical pain for 15 days which was insidious in onset. Physical examination revealed an ill defined lump that was palpable on the right side of the abdomen. Ultrasonography showed multiloculated cystic mass having septation approximately 13 × 6 cm in size. An abdominal CT scan showed cystic lesion with septations measuring about 14.5 × 12.3 cm, compressing the bowel loops towards left, that was suggestive of mesenteric lymphangioma. The patient underwent partial surgical resection. The excised mass was sent for histopathology. Histopathology disclosed a benign tumor composed of proliferation of blood vessels of different sizes lined by endothelium in a fibromuscular stroma. CLINICAL DISCUSSION Mesenteric lymphangiomas are infrequent malformations and very few cases of mesenteric hemolymphangioma have been reported in adults. Histopathology is required for confirmatory diagnosis and immunohistochemistry is required to differentiate the tumor subtype. Surgical resection is deemed a standard treatment modality. CONCLUSION We report an extremely rare case of mesenteric hemolymphangioma to bring it to concern that even with the vague clinical presentations and involvement of age groups beyond the status quo, surgeons must be vigilant about abdominal MCL/hemolymphangioma and proceed accordingly.
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Affiliation(s)
- Asmita Bhusal
- Sir Salimullah Medical College and Mitford Hospital, Dhaka, Bangladesh.
| | - Quazi Habibullah
- Department of Surgery, Sir Salimullah Medical College and Mitford Hospital, Dhaka, Bangladesh
| | - Mashiur Rahman
- Department of Surgery, Sir Salimullah Medical College and Mitford Hospital, Dhaka, Bangladesh
| | - Biplob Bandh
- Department of Surgery, Sir Salimullah Medical College and Mitford Hospital, Dhaka, Bangladesh
| | - Saiful Islam
- Department of Surgery, Sir Salimullah Medical College and Mitford Hospital, Dhaka, Bangladesh
| | - Tanvin Dola
- Sir Salimullah Medical College, Dhaka, Bangladesh
| | - Saugat Bista
- Sir Salimullah Medical College and Mitford Hospital, Dhaka, Bangladesh
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Yan J, Xie C, Chen Y. Surgical Treatment of Mesenteric Lymphatic Malformations in Children: An Observational Cohort study. J Pediatr Surg 2023; 58:1762-1769. [PMID: 36931944 DOI: 10.1016/j.jpedsurg.2023.02.041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Revised: 01/17/2023] [Accepted: 02/03/2023] [Indexed: 02/23/2023]
Abstract
BACKGROUND Few studies have analyzed the cyst characteristics and complications of mesenteric lymphatic malformations (ML). This study aimed to compare ML's cyst characteristics and preoperative complications at different locations and suggest a modified ML classification for patients requiring surgery. METHODS In total, 157 ML patients underwent surgery at Beijing Children's Hospital between January 2010 and December 2021. The cyst characteristics and preoperative complications were reviewed. The surgical methods for ML were analyzed according to the modified ML classification (Type I, n = 87, involving the intestinal wall; Type II, n = 45, located in the mesenteric boundaries; Type III, n = 16, involving the root of the mesentery; Type IV, n = 7, multicentric ML; Type V, n = 2, involving the upper rectum). RESULTS Overall, 111 (70.7%) ML were located at the intestinal mesentery and 44 (28.0%) at the mesocolon. Type I and type II ML mainly involved intestinal mesentery (64.9%) and mesocolon (56.8%), respectively (P < 0.001). Microcystic-type ML and ML with chylous fluid were only located in the intestinal mesentery. Intestinal volvulus was only found in patients with ML in the intestinal mesentery (P < 0.001), whereas ML in the mesocolon were more prone to hemorrhage (P = 0.002) and infection (P = 0.005). ML in the jejunal mesentery was an independent risk factor for intestinal volvulus (OR = 3.5, 95% CI 1.5-8.3, P = 0.003). The surgical methods significantly differed between Type I and type II ML (P < 0.001). CONCLUSIONS ML at different locations have different characteristics. For patients requiring surgery, the new ML classification can be used to select an appropriate surgical method. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
- Jiayu Yan
- Department of General Surgery, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
| | - Chuanping Xie
- Department of General Surgery, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
| | - Yajun Chen
- Department of General Surgery, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China.
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Satheakeerthy S, Sharma V, Huynh F. Cystic lymphangioma presenting as an acute abdomen in an adult male with congenital aortic stenosis. Radiol Case Rep 2023; 18:2176-2179. [PMID: 37101888 PMCID: PMC10123318 DOI: 10.1016/j.radcr.2023.03.033] [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: 02/08/2023] [Revised: 03/12/2023] [Accepted: 03/16/2023] [Indexed: 04/28/2023] Open
Abstract
Abdominal cystic lymphangioma rarely presents as an acute abdomen. In this article, we describe a young adult male with congenital aortic stenosis who initially presented with abdominal pain and raised inflammatory markers. The imaging in the form of a computed tomography scan was unfortunately inconclusive. In the evolution of this diagnostic dilemma, we describe the importance of early operative management as well as explore the link between cardiac and lymphatic malformations.
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Affiliation(s)
| | - Varsha Sharma
- Department of General Surgery, Western Health, Footscray Hospital, Footscray, VIC 3011, Australia
| | - Frederick Huynh
- Department of General Surgery, Western Health, Footscray Hospital, Footscray, VIC 3011, Australia
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Hakimi T, Seyar F, Halimi SA, Jawed MA. Childhood mesenteric cyst: A rare intra-abdominal entity with literature review. Int J Surg Case Rep 2023; 106:108216. [PMID: 37068457 PMCID: PMC10130205 DOI: 10.1016/j.ijscr.2023.108216] [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: 02/20/2023] [Revised: 03/28/2023] [Accepted: 03/29/2023] [Indexed: 04/19/2023] Open
Abstract
INTRODUCTION AND IMPORTANCE Mesenteric cysts are uncommon intra-abdominal benign masses that appear in childhood with varying degrees of clinical manifestations, ranging from being asymptomatic to presenting as an acute abdomen. The diagnosis is made incidentally during the work-up for other abdominal pathologies such as acute appendicitis, bowel obstruction, etc. The treatment is mostly surgical and varies depending on the clinical type of the lesion. CASE PRESENTATION A 26-month-old child was referred to our teaching hospital's pediatric surgery department with an abdominal mass. The patient had previously complained of constipation and been treated symptomatically with laxatives. Ultrasonography reported ovarian cysts confirmed by computerized tomography scanning (as a misdiagnosis report of an ovarian cyst instead of a mesenteric cyst), done outside the hospital in a private diagnostic center. CLINICAL DISCUSSION The patient was prepared for operation and during the surgical procedure, she was found to have a duplex cyst, which was mostly incorporated in the mesentery of the distal 1/3 of the transverse mesocolon. The cyst was enucleated through a lower midline laparotomy incision without bowel resection and anastomosis. The histopathological analysis of the specimen confirmed a mesenteric cyst. CONCLUSION Mesenteric cysts are rare lesions in children and should be considered when approaching any intra-abdominal mass. Except for the rare cases where intestinal resection and/or partial cyst excision are required, all mesenteric cysts can be excised while preserving intestinal integrity and vascular supply.
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Affiliation(s)
- Turyalai Hakimi
- Department of Pediatric Surgery, Kabul University of medical science, Maiwand Teaching Hospital, Kabul, Afghanistan.
| | - Farukh Seyar
- Department of Abdominal Surgery, Kabul University of medical science, Ali Abad Teaching Hospital, Kabul, Afghanistan
| | - Sultan Ahmad Halimi
- Department of Pathology, Kabul University of medical science, Kabul, Afghanistan
| | - Mohammad Anwar Jawed
- Department of Pediatric Surgery, Kabul University of medical science, Maiwand Teaching Hospital, Kabul, Afghanistan
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Rajendran S, Hui TCH, Lin NS. Torsed mesenteric lymphangioma causing closed-loop small bowel obstruction in an adult patient. ANZ J Surg 2023; 93:779-781. [PMID: 36086886 DOI: 10.1111/ans.18034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2022] [Revised: 08/24/2022] [Accepted: 08/26/2022] [Indexed: 11/30/2022]
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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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10
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Wang L, Feng H, Chen B, Luan F. Case Report: Endoscopic manifestations and clinical features of small intestinal lymphangioma-A report of two cases. Front Oncol 2022; 12:916295. [PMID: 36568194 PMCID: PMC9773366 DOI: 10.3389/fonc.2022.916295] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2022] [Accepted: 11/17/2022] [Indexed: 12/14/2022] Open
Abstract
Objective The aims of this study were to analyze the clinical characteristics, auxiliary examinations, and treatment measures of small intestinal lymphangioma and to improve the clinical diagnostic ability of clinicians. Methods This paper reports two cases of small intestinal lymphangioma in the Department of Gastroenterology, the First Affiliated Hospital of Soochow University, and makes a comprehensive analysis. Results A 31-year-old woman went to the hospital with complaints of dizziness, fatigue, and anemia. A 52-year-old woman complained of upper abdominal pain and went to the hospital with abdominal pain awaiting investigation. Both patients were subjected to three major routine examinations, tumor complete set, CT, capsule endoscopy, and deep enteroscopy, and both of them underwent complete resection of the affected intestinal segment. Pathology showed that both patients had small intestinal lymphangioma. Conclusions The clinical manifestations of small intestinal lymphangioma lack specificity. Capsule endoscopy and deep enteroscopy are helpful for clinical diagnosis, and pathological examination is still the gold standard. Surgical treatment can achieve better results.
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Trifoliate mesenteric lymphatic malformation. Dig Liver Dis 2022; 54:1723-1724. [PMID: 35840486 DOI: 10.1016/j.dld.2022.06.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Revised: 04/22/2022] [Accepted: 06/27/2022] [Indexed: 12/30/2022]
Abstract
Mesenteric lymphatic malformations are rare lesions and its diagnosis can cause dilemma in spite of imaging studies. A laparotomy revealed this diagnosis in a five-year-old child who presented with abdominal pain.
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Feng X, Chen X, Feng Q, Liu X, Li H, Chen H, Cai Z, Li J. Case report: A mesocolic lymphangioma in a 14-year-old child resected by laparoscopic surgery. Front Oncol 2022; 12:1034563. [PMID: 36439409 PMCID: PMC9681893 DOI: 10.3389/fonc.2022.1034563] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Accepted: 10/19/2022] [Indexed: 11/11/2022] Open
Abstract
Introduction Cystic lymphangioma is a benign malformation tumor of the lymphatic system. Its location is variable, and mesocolic localization remains extremely rare. Case presentation We report a case of right mesocolon giant cystic lymphangioma in a previously healthy 14-year-old boy who was successfully managed through a minimally invasive laparoscopic excision. The patient presented with 8 months of dull abdominal pain, sporadic, located on the peri-umbilicus, exacerbated for a month. An abdominal computed tomography (CT) revealed a large, multiseptated cystic mass on the right mesocolon. Right mesocolic excision using a laparoscope was performed on this patient. He was discharged on the fifth day without complications. Recurrence was not detected in three months of follow-up. Conclusion Cystic lymphangiomas in the mesocolon are rare benign neoplasms that pose diagnostic challenges. Complete resection is the optimal option for diagnostic confirmation and recurrence prevention. Laparoscopic surgery is feasible for children with mesocolic lymphangioma.
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Affiliation(s)
- Xuping Feng
- Department of Liver Surgery & Liver Transplantation, State Key Laboratory of Biotherapy and Cancer Center, West China Hospital, Sichuan University and Collaborative Innovation Center of Biotherapy, Chengdu, Sichuan, China
- Laboratory of Liver Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Xinyang Chen
- West China School of Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Qingbo Feng
- Department of Liver Surgery & Liver Transplantation, State Key Laboratory of Biotherapy and Cancer Center, West China Hospital, Sichuan University and Collaborative Innovation Center of Biotherapy, Chengdu, Sichuan, China
- Laboratory of Liver Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Xiaoyin Liu
- Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Hancong Li
- West China School of Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Hao Chen
- Department of Liver Surgery & Liver Transplantation, State Key Laboratory of Biotherapy and Cancer Center, West China Hospital, Sichuan University and Collaborative Innovation Center of Biotherapy, Chengdu, Sichuan, China
- Laboratory of Liver Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Zhaolun Cai
- Gastric Cancer Center, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Jiaxin Li
- Department of Liver Surgery & Liver Transplantation, State Key Laboratory of Biotherapy and Cancer Center, West China Hospital, Sichuan University and Collaborative Innovation Center of Biotherapy, Chengdu, Sichuan, China
- Laboratory of Liver Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan, China
- DaFang County People's Hospital, Bijie, Guizhou, China
- *Correspondence: Jiaxin Li,
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Shater W, Maree G, Hemi F, Issa A, Hammad F, Salloum R, Ali W. A large mesenteric lymphangioma in a 2-year-old child. JOURNAL OF PEDIATRIC SURGERY CASE REPORTS 2022. [DOI: 10.1016/j.epsc.2022.102418] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/15/2022] Open
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Bai K, Dai Y, Jiang C, Lin S, Wang G. Gastric lymphangioma: a case report and review of literature. BMC Gastroenterol 2022; 22:407. [PMID: 36058923 PMCID: PMC9441034 DOI: 10.1186/s12876-022-02431-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2022] [Accepted: 07/19/2022] [Indexed: 11/21/2022] Open
Abstract
Background Gastric lymphangioma is one of the highly rare benign tumors characterized by multilocular or unilocular lymphatic spaces. Herein, we report a case of lymphangioma in the gastric antrum. Case presentation A 77-year-old male patient who had been experiencing epigastric discomfort for a year was presented to our hospital. A gastric subepithelial lesion was diagnosed by upper endoscopy and was entirely excised via diatal subtotal gastrectomy. Endoscopic ultrasonography revealed an echoless homogenous echo pattern in the third wall layer. A lymphangioma was diagnosed by pathologic investigation of the resected specimen. The PubMed, Embase and Web of Science databases were reviewed for literature in English while using the keywords of “gastric lymphangioma” or “lymphangioma of stomach” or “gastric lymphatic cyst” or “lymphatic cyst of stomach” and the results were discussed. Conclusion Gastric lymphangioma is a rarely occurring submucosal tumor that should be considered when diagnosing subepithelial lesions in the stomach.
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Affiliation(s)
- Kunhao Bai
- Department of Endoscopy, Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, 651 Dongfengdong Street, Yuexiu District, Guangzhou, 510060, Guangdong, China.,Department of Epidemiology, School of Public Health, Sun Yat-Sen University, Guangzhou, Guangdong, China
| | - Yujun Dai
- Department of Hematology, Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, Guangdong, China
| | - Chen Jiang
- Department of Pathology, Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, Guangdong, China
| | - Shiyong Lin
- Department of Endoscopy, Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, 651 Dongfengdong Street, Yuexiu District, Guangzhou, 510060, Guangdong, China.
| | - Guobao Wang
- Department of Endoscopy, Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, 651 Dongfengdong Street, Yuexiu District, Guangzhou, 510060, Guangdong, China.
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Gkalonaki I, Anastasakis M, Patoulias I. Atypical locations for cystic lymphangiomas. JOURNAL OF PEDIATRIC SURGERY CASE REPORTS 2022. [DOI: 10.1016/j.epsc.2022.102323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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16
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Aguilar-Espinosa F, Salcedo-Vargas R, Galván-Bizarro HA, Rodríguez-Ramos CR, Barba-Jaramillo ED. Mesenteric cyst manifested as obesity, gastroesophageal reflux, urinary incontinence, and abdominal mass during pregnancy-Case report and literature review. Int J Surg Case Rep 2022; 97:107366. [PMID: 35841759 PMCID: PMC9403017 DOI: 10.1016/j.ijscr.2022.107366] [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: 05/10/2022] [Revised: 06/24/2022] [Accepted: 06/25/2022] [Indexed: 02/07/2023] Open
Abstract
INTRODUCTION AND IMPORTANCE The mesenteric cyst (MC) is a rare entity, a benign lesion that causes the growth of an abdominal mass and other clinical presentations. The presentation of MC during pregnancy is even less frequent. CASE PRESENTATION A 34-year-old Mexican woman presented with a mesenteric cyst treated with laparotomy aspiration during the 16th week of pregnancy; the pregnancy was resolved by cesarean section without problems. Nevertheless, 17 months later, the lesion recurred. New assessment and surgical treatment with complete excision are performed without evidence of further recurrence. CLINICAL DISCUSSION This case is essential due to the low frequency of association between pregnancy and mesenteric cyst. Incomplete resection, aspiration, and marsupialization of the lesion carry a high risk of recurrence. Therefore, the opportune moment to perform a complete resection of the lesion and avoid complications should be evaluated during pregnancy. CONCLUSION MC should be considered a differential diagnosis in cystic lesions during pregnancy. Imaging studies, complete surgical resection, histological evaluation, and follow-up are necessary for adequate treatment.
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Affiliation(s)
- Francisco Aguilar-Espinosa
- General Surgery, General Hospital of Zone 21, Mexican Institute of Social Security, Tepatitlan de Morelos, Jalisco, Mexico.
| | - Rodolfo Salcedo-Vargas
- Pathological Anatomy, Santa Fe Memorial Hospital, Tepatitlan de Morelos, Jalisco, Mexico
| | - Hiram Alfonso Galván-Bizarro
- Medical Student, General Hospital of Zone 21, Mexican Institute of Social Security, Tepatitlan de Morelos, Jalisco, Mexico
| | - Carlos Rubén Rodríguez-Ramos
- Anesthesiology, General Hospital of Zone 21, Mexican Institute of Social Security, Tepatitlán de Morelos, Jalisco, Mexico
| | - Erika Diana Barba-Jaramillo
- General Surgery, General Hospital of Zone 21, Mexican Institute of Social Security, Tepatitlan de Morelos, Jalisco, Mexico
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17
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Gatti M, Maino C, Tore D, Carisio A, Darvizeh F, Tricarico E, Inchingolo R, Ippolito D, Faletti R. Benign focal liver lesions: The role of magnetic resonance imaging. World J Hepatol 2022; 14:923-943. [PMID: 35721295 PMCID: PMC9157713 DOI: 10.4254/wjh.v14.i5.923] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2021] [Revised: 08/07/2021] [Accepted: 04/09/2022] [Indexed: 02/06/2023] Open
Abstract
Liver lesions are common findings in radiologists’ daily routine. They are a complex category of pathology that range from solitary benign lesions to primary liver cancer and liver metastases. Benign focal liver lesions can arise from different liver cell types: Epithelial (hepatocytes and biliary cells) and nonepithelial (mesenchymal cells). Liver magnetic resonance imaging (MRI) is a fundamental radiological method in these patients as it allows with its multiparametric approach optimal non-invasive tissue characterization. Furthermore, advanced liver MRI techniques such as diffusion-weighted imaging and hepatobiliary contrast agents have improved the detection of focal liver lesions and can be highly effective in differentiating pseudotumor from tumors, as well as benign from malignant lesions, and can also be used for differential diagnosis. Although histological examination can be useful in making a definitive diagnosis, MRI is an important modality in the diagnosis of liver lesions with a significant impact on patient care. This aim of this review is to provide a comprehensive overview of benign liver lesions on MRI.
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Affiliation(s)
- Marco Gatti
- Department of Surgical Sciences, University of Turin, Turin 10126, Italy
| | - Cesare Maino
- Department of Diagnostic Radiology, Ospedale San Gerardo, Monza 20900, Italy
| | - Davide Tore
- Department of Surgical Sciences, University of Turin, Turin 10126, Italy
| | - Andrea Carisio
- Department of Surgical Sciences, University of Turin, Turin 10126, Italy
| | - Fatemeh Darvizeh
- School of Medicine, Vita-Salute San Raffaele University, Milan 20121, Japan
| | | | - Riccardo Inchingolo
- Interventional Radiology Unit, “F. Miulli” Regional General Hospital, Acquaviva delle Fonti 70021, Italy
| | - Davide Ippolito
- Department of Diagnostic Radiology, School of Medicine, University of Milano-Bicocca, Monza 20900, Italy
- Department of Diagnostic Radiology, Ospedale San Gerardo, Monza 20900, Italy
| | - Riccardo Faletti
- Department of Surgical Sciences, University of Turin, Turin 10126, Italy
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18
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Thapa S, Sharma A, Upreti D, Karki OB, Regmi S, Ghartimagar D, Ghosh A. A Huge Mesenteric Lymphangioma Presenting as a Small Bowel Volvulus in a Paediatric Patient: A Case Report. Case Rep Pathol 2022; 2022:3033705. [PMID: 35620582 PMCID: PMC9130006 DOI: 10.1155/2022/3033705] [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: 02/11/2022] [Accepted: 05/04/2022] [Indexed: 11/29/2022] Open
Abstract
Lymphangioma is a benign tumor characterized by proliferation of thin-walled lymphatic spaces. Lymphangioma of the small-bowel mesentery is rare, with an incidence of 1 : 250,000, representing less than 1% of all lymphangiomas. The predilection of the tumor is in the head and neck (70%), axillary (20%), and internal organs (10%). They are usually asymptomatic but can cause acute abdominal symptoms due to complications such as volvulus, bleeding, or lymphangioma rupture that require emergent surgery. Here, we report a case of mesenteric lymphangioma (ML) of a small bowel in a paediatric patient who presented with pain abdomen on and off which increased in severity and later had features of subacute intestinal obstruction. He underwent explorative laparotomy, and the mass was excised completely along with the part of small intestine. Pathological analysis of the surgical specimen confirmed the diagnosis of ML of the small intestine. The postoperative recovery was uneventful, and the patient was discharged after ten days of hospital stay. Though benign in nature, ML may cause acute abdominal symptoms that require emergent surgery. Therefore, it has to be kept in differential diagnosis of the acute abdominal condition.
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Affiliation(s)
- Sushma Thapa
- Department of Pathology, Manipal College of Medical Sciences, Pokhara, Nepal
| | - Abhinav Sharma
- Department of Surgery, Adesh Medical College and Hospital, Ambala, Haryana, India
| | - Dipesh Upreti
- Department of Surgery, Manipal College of Medical Sciences, Pokhara, Nepal
| | - Om Bahadur Karki
- Department of Surgery, Manipal College of Medical Sciences, Pokhara, Nepal
| | - Sudeep Regmi
- Department of Pathology, Manipal College of Medical Sciences, Pokhara, Nepal
| | - Dilasma Ghartimagar
- Department of Pathology, Manipal College of Medical Sciences, Pokhara, Nepal
| | - Arnab Ghosh
- Department of Pathology, Manipal College of Medical Sciences, Pokhara, Nepal
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19
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Lymphangioma Cavernosum with a Rare Location. J Clin Med 2022; 11:jcm11061643. [PMID: 35329968 PMCID: PMC8955802 DOI: 10.3390/jcm11061643] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Revised: 03/10/2022] [Accepted: 03/14/2022] [Indexed: 02/05/2023] Open
Abstract
Lympangioma cavernosum in the abdominal cavity is a rare benign tumour. In most cases, such tumours are diagnosed in the oral cavity and neck. The aim of this paper is to present our clinical observations and review of existing literature to draw attention to this disease. A 25-year-old woman was admitted to our department for a symptomatic tumour in the lesser curvature of the stomach. The patient was first operated on as a three-year-old child because the tumour extended from the back wall of the stomach to the gastro-colonic ligament. The medical records showed that it was a benign tumour; however, no diagnosis was specified. No symptoms were observed for 22 years. Currently, the patient is admitted for epigastric pain. Abdominal computed tomography revealed an extensive mass located between the left segments of the liver and the lesser curvature of the stomach. The patient was operated on, and the tumour was completely removed. The patient’s postoperative course was uneventful. Histopathological examination of the lymphangioma cavernosum was performed. Two months after the operation, the patient did not report any complaints.
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20
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Gagliardi F, Lauro A, Tripodi D, Amabile MI, Palumbo P, Di Matteo FM, Palazzini G, Forte F, Frattaroli S, Khouzam S, Marino IR, D'Andrea V, Sorrenti S, Pironi D. Mesenteric Cyst with GI Symptoms: A Fluid Approach to Treatment-Case Report and Literature Review. Dig Dis Sci 2022; 67:786-798. [PMID: 35059952 DOI: 10.1007/s10620-021-07352-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/17/2021] [Indexed: 12/09/2022]
Abstract
Mesenteric cysts are defined as a heterogeneous group of intra-abdominal cystic lesions of the mesentery or omentum that may be found in any portion of the gastrointestinal tract from the duodenum to the rectum. The clinical condition is entirely asymptomatic in many patients, particularly with small cysts. The diagnosis is typically incidental and secondary to imaging performed for other purposes. In symptomatic patients, the clinical picture is characterized by nonspecific gastrointestinal signs and symptoms. Treatment may be surgical or via interventional radiology. We report the case of a 55-year-old female patient complaining of left-sided abdominal discomfort and constipation lasting three months. An abdominal ultrasound showed the presence of a 10 × 14 × 16 cm anechoic cystic mass filling the whole anterior and left abdominal cavity, confirmed by CT and MRI. The cyst, removed laparoscopically, was histologically a simple mesothelial cyst. We reviewed the international literature over the last 10 years of all cases with mesenteric cysts > 10 cm in evaluating gastrointestinal symptoms at diagnosis, histology, performed treatment, and outcome.
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Affiliation(s)
- Federica Gagliardi
- Department of Surgical Sciences, Sapienza University of Rome, Viale Regina Elena 324, 00161, Rome, Italy
| | - Augusto Lauro
- Department of Surgical Sciences, Sapienza University of Rome, Viale Regina Elena 324, 00161, Rome, Italy
| | - Domenico Tripodi
- Department of Surgical Sciences, Sapienza University of Rome, Viale Regina Elena 324, 00161, Rome, Italy.
| | - Maria Ida Amabile
- Department of Surgical Sciences, Sapienza University of Rome, Viale Regina Elena 324, 00161, Rome, Italy
| | - Piergaspare Palumbo
- Department of Surgical Sciences, Sapienza University of Rome, Viale Regina Elena 324, 00161, Rome, Italy
| | - Filippo Maria Di Matteo
- Department of Surgical Sciences, Sapienza University of Rome, Viale Regina Elena 324, 00161, Rome, Italy
| | - Giorgio Palazzini
- Department of Surgical Sciences, Sapienza University of Rome, Viale Regina Elena 324, 00161, Rome, Italy
| | - Flavio Forte
- Urology Department, M.G. Vannini Hospital, Rome, Italy
| | - Stefano Frattaroli
- Department of Surgical Sciences, Sapienza University of Rome, Viale Regina Elena 324, 00161, Rome, Italy
| | - Simone Khouzam
- Department of Surgery, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, USA
| | - Ignazio R Marino
- Department of Surgery, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, USA
| | - Vito D'Andrea
- Department of Surgical Sciences, Sapienza University of Rome, Viale Regina Elena 324, 00161, Rome, Italy
| | - Salvatore Sorrenti
- Department of Surgical Sciences, Sapienza University of Rome, Viale Regina Elena 324, 00161, Rome, Italy
| | - Daniele Pironi
- Department of Surgical Sciences, Sapienza University of Rome, Viale Regina Elena 324, 00161, Rome, Italy
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21
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Yu H, Mao Q, Zhou L, Li J, Xu X. Rare Case of Cystic Lymphangioma Transforming Into Lymphangiosarcoma: A Case Report. Front Oncol 2022; 12:814023. [PMID: 35251984 PMCID: PMC8894725 DOI: 10.3389/fonc.2022.814023] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Accepted: 01/26/2022] [Indexed: 12/15/2022] Open
Abstract
Cystic lymphangioma (CL) is a rare benign tumor that mainly occurs in the neck and axilla and usually occurs in children, whereas lymphangiosarcoma (LAS) is a rare invasive tumor, usually secondary to chronic lymphedema caused by various causes, with a rare malignant transformation from CL. We presented the case of a 63-year-old woman who underwent four surgical excisions for multiple recurrence of CL in the right groin. The changes of imaging and pathological examination revealed the unusual process of its gradual malignant transformation into LAS. We followed up the patient for 16 years, and she eventually died of LAS complications.
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Affiliation(s)
- Huili Yu
- Department of Radiology, China Resources & WISCO General Hospital, Wuhan University of Science and Technology, Wuhan, China
| | - Qinxiang Mao
- Department of Radiology, Liuzhou People’s Hospital, Liuzhou, China
| | - Lingyan Zhou
- Department of Radiology, The Second Hospital of Wuhan Iron and Steel Company, Wuhan, China
| | - Jiawei Li
- Department of Radiology, China Resources & WISCO General Hospital, Wuhan University of Science and Technology, Wuhan, China
| | - Xunhua Xu
- Department of Radiology, China Resources & WISCO General Hospital, Wuhan University of Science and Technology, Wuhan, China
- *Correspondence: Xunhua Xu,
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22
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Yan J, Wang L, Xie C, Peng C, Pang W, Chen Y. Preoperative complications in children with mesenteric lymphatic malformations: Incidence, risk factors and outcomes. Front Pediatr 2022; 10:1033897. [PMID: 36245723 PMCID: PMC9557770 DOI: 10.3389/fped.2022.1033897] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Accepted: 09/16/2022] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Preoperative complications of mesenteric lymphatic malformations (ML) in children are various and complex. We aim to analyze the incidences and risk factors of three major preoperative complications (hemorrhage of the cyst, infection of the cyst and intestinal volvulus) in ML patients, and explore their influence on the outcomes. METHODS This retrospective cohort study enrolled ML patients undergoing surgery at Beijing Children's Hospital between June 2016 and June 2022 and classified them according to different preoperative complications, preoperative hemorrhage or infection, and preoperative intestinal volvulus. The groups were examined and compared according to sex, age at admission, presenting symptoms, laboratory examinations, imaging examinations, preoperative treatments, cyst characteristics, surgical details, perioperative clinical data, and follow-up. Logistic regression analysis was performed to identify the independent risk factors for preoperative hemorrhage or infection, and preoperative intestinal volvulus. RESULTS Of the 104 enrolled ML patients, 27 (26.0%) had preoperative hemorrhage or infection, and 22 (21.2%) had preoperative intestinal volvulus. Univariate analysis showed that patients with preoperative hemorrhage or infection had a higher rate of ML in the mesocolon (44.4 vs. 23.4%, p < 0.038) and larger cysts (10 vs. 8 cm, p = 0.042) than patients without preoperative hemorrhage or infection. Multivariable logistic regression analysis found that the location (OR, 3.1; 95% CI, 1.1-8.6; p = 0.026) and size of the cyst (≥7.5 cm) (OR, 6.2; 95% CI, 1.6-23.4; p = 0.007) were independent risk factors for preoperative hemorrhage or infection. Preoperative intestinal volvulus was only found in ML at the intestinal mesentery. Further analysis showed that ML in the jejunal mesentery was an independent risk factor for preoperative intestinal volvulus (OR, 3.3; 95% CI, 1.1-10.0; p = 0.027). Patients with preoperative hemorrhage or infection spent more on hospitalization costs than patients without preoperative hemorrhage or infection (3,000 vs. 2,674 dollars, p = 0.038). CONCLUSIONS ML patients should be treated as soon as possible after diagnosis. The location and size of the cyst were independent risk factors for preoperative hemorrhage or infection. ML in the jejunal mesentery was an independent risk factor for preoperative intestinal volvulus.
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Affiliation(s)
- Jiayu Yan
- Department of General Surgery, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
| | - Li Wang
- Department of Emergency Surgery, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
| | - Chuanping Xie
- Department of General Surgery, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
| | - Chunhui Peng
- Department of General Surgery, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
| | - Wenbo Pang
- Department of General Surgery, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
| | - Yajun Chen
- Department of General Surgery, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
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23
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Jose M, Chandanwale S, Singh M, Raj A, Gore C. Mesenteric cystic lymphangioma – A rare entity with unusual presentation. MEDICAL JOURNAL OF DR. D.Y. PATIL VIDYAPEETH 2022. [DOI: 10.4103/mjdrdypu.mjdrdypu_427_20] [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
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24
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Broderick M, Burgwardt N, Weinberg G. Infected mesenteric cystic lymphangioma as a cause of pediatric acute abdomen. JOURNAL OF PEDIATRIC SURGERY CASE REPORTS 2022. [DOI: 10.1016/j.epsc.2021.102144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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25
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Umino R, Urabe M, Ohkura Y, Haruta S, Ueno M, Udagawa H. Successful laparoscopic resection of gastric lymphangioma under the intraoperative guidance of indocyanine green fluorescence imaging: A case report. Asian J Endosc Surg 2022; 15:176-179. [PMID: 33908176 DOI: 10.1111/ases.12946] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2021] [Revised: 03/15/2021] [Accepted: 04/17/2021] [Indexed: 11/28/2022]
Abstract
Gastric lymphangioma (GLA) is an extremely rare tumor without an established therapeutic strategy. Surgical resection is considered the mainstay of treatment, although there is a high risk of local recurrence if negative margins are not achieved. A 51-year-old man underwent routine abdominal ultrasonography, which incidentally detected a 20-mm tumor adjacent to the lesser curvature of the stomach. GLA was suspected based on its polycystic appearance. After a 16-month monitoring period, laparoscopic resection was performed because of tumor growth and involvement of the left gastric artery. Intraoperative indocyanine green (ICG) navigation system revealed lymphatic drainage from the tumor, which we used to help determine the optimal excision line and minimize the loss of gastric volume. Pathological examination confirmed complete resection with negative margins and supported a diagnosis of lymphangioma. We performed laparoscopic radical resection of GLA under guidance from intraoperative ICG fluorescence imaging, which allowed us to maximize residual gastric volume.
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Affiliation(s)
- Ryosuke Umino
- Department of Gastroenterological Surgery, Toranomon Hospital, Tokyo, Japan
| | - Masayuki Urabe
- Department of Gastroenterological Surgery, Toranomon Hospital, Tokyo, Japan
| | - Yu Ohkura
- Department of Gastroenterological Surgery, Toranomon Hospital, Tokyo, Japan.,Okinaka Memorial Institute for Medical Research, Tokyo, Japan
| | - Shusuke Haruta
- Department of Gastroenterological Surgery, Toranomon Hospital, Tokyo, Japan
| | - Masaki Ueno
- Department of Gastroenterological Surgery, Toranomon Hospital, Tokyo, Japan.,Okinaka Memorial Institute for Medical Research, Tokyo, Japan
| | - Harushi Udagawa
- Department of Gastroenterological Surgery, Toranomon Hospital, Tokyo, Japan.,Okinaka Memorial Institute for Medical Research, Tokyo, Japan
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26
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Wu CH, Lu CH. Case report: Omental lymphangioma mimicking gastric cystic tumor. Radiol Case Rep 2021; 17:212-215. [PMID: 34824652 PMCID: PMC8605189 DOI: 10.1016/j.radcr.2021.10.027] [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: 09/26/2021] [Revised: 10/10/2021] [Accepted: 10/11/2021] [Indexed: 11/25/2022] Open
Abstract
Omental lymphangioma is a rare pathology presented in the abdomen, and it can mimic several clinical conditions. Owing to its variable signs and symptoms, making a correct diagnosis by clinicians may be difficult. Surgical excision is the gold standard treatment. In this article, we report a case who presented with nonspecific abdominal complaints, and underwent surgery. Final pathologic diagnosis revealed omental cystic lymphangioma.
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Affiliation(s)
- Chia-Hui Wu
- Department of Medical Imaging, Kaohsiung Medical University Hospital, No.100, Tzyou 1st Rd., Sanmin Dist., Kaohsiung City, 80756, Taiwan.,Department of Radiology, School of Medicine, College of Medicine, Kaohsiung Medical University, No.100, Shih-Chuan 1st Road, Sanmin Dist., Kaohsiung City, 80708, Taiwan
| | - Chia-Hsin Lu
- Department of Medical Imaging, Kaohsiung Medical University Hospital, No.100, Tzyou 1st Rd., Sanmin Dist., Kaohsiung City, 80756, Taiwan.,Department of Radiology, School of Medicine, College of Medicine, Kaohsiung Medical University, No.100, Shih-Chuan 1st Road, Sanmin Dist., Kaohsiung City, 80708, Taiwan.,Department of Medical Imaging, Kaohsiung Municipal Ta-Tung Hospital, No.68, Jhonghua 3rd Rd, Cianjin District, Kaohsiung City 80145, Taiwan
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27
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Avila A, Rojas C, Lao OB. Rare mesenteric cystic lymphangioma presenting as acute intestinal obstruction in a 10-year-old boy. JOURNAL OF PEDIATRIC SURGERY CASE REPORTS 2021. [DOI: 10.1016/j.epsc.2021.102038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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28
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Chylous content might determine the optimal surgical approach for mesenteric lymphatic malformations in childhood. J Vasc Surg Venous Lymphat Disord 2021; 10:430-435. [PMID: 34171533 DOI: 10.1016/j.jvsv.2021.06.008] [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: 03/16/2021] [Accepted: 06/04/2021] [Indexed: 11/21/2022]
Abstract
BACKGROUND Mesenteric lymphatic malformations (LMs) represent rare congenital anomalies that can include chylous or nonchylous content. The pathologic mechanisms explaining this phenomenon are poorly understood and not yet described. Furthermore, the current management approach does not consider the contents of the mesenteric LMs. In the present study, we have defined the relationship between the lymphatic mesenteric cyst content and the histologic evidence of LMs within the bowel wall. METHODS We retrospectively investigated all patients with mesenteric LMs treated surgically at our department from 1999 to 2018. RESULTS A total of 11 patients (6 girls and 5 boys) were included in our analysis. Seven patients had presented with LMs located in the jejunal mesentery, three in the ileocecal region, and only one in the mesocolon transversum and omentum. Of the 11 children, 7 had had LMs with nonchylous content and 4 had presented with chylous content LMs. Intestinal resection was performed in all 4 patients with chylous content LMs and 4 patients with nonchylous content LMs. Histopathologic evaluation of the surgical specimens determined that only the LMs with chylous content displayed malformed lymphatic channels throughout the bowel wall. The resected small bowel of four patients with nonchylous content showed no LM extension throughout the intestinal wall. CONCLUSIONS LMs with chylous content seem to develop from malformed lymphatic channels within the bowel wall. In such cases, segmental intestinal resection is mandatory. In contrast, mesenteric LMs with nonchylous content can potentially be treated without bowel resection if the blood supply can be preserved. This finding is, to the best of our knowledge, reported in the present study for the first time.
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29
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Kusuma P, Putra MDP, Suwardi S. Mesenteric Cystic Lymphangioma in Pediatric Patient: A Rare Intra-Abdominal Tumor Management in Rural Country Case Report. Open Access Maced J Med Sci 2021. [DOI: 10.3889/oamjms.2021.6134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Introduction: Mesenteric Cystic Lymphangioma (MCL) is a benign malformation of the lymphatic system. MCL seldomly occurs with a very rare incidence of around 1: 250,000. This neoplasm is more common in pediatric patients. Symptoms can appear with various clinical features ranging from asymptomatic abdominal mass to acute abdomen.
Case description: Here we report a patient with MCL: that presented with bilious vomiting, abdominal pain, and abdominal mass. The patient underwent explorative laparotomy, mass excision, and jejunal resection.
Discussion: Although benign, MCL can cause other symptoms such as bleeding, torsion, or lymphangioma rupture. Therefore, MCL should be considered as one of the differential diagnoses in acute abdominal and abdominal mass cases in children.
Conclusion: In conclusion, although sometimes asymptomatic and found incidentally, the MCL should be resected because it has the potential to grow and invade vital organs and cause life-threatening complications.
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30
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Namikawa T, Shimizu S, Yokota K, Tanioka N, Munekage M, Uemura S, Maeda H, Kitagawa H, Kobayashi M, Hanazaki K. Cystic lymphangioma of the greater omentum treated by laparoscopic resection. Clin J Gastroenterol 2021; 14:1004-1007. [PMID: 33782862 DOI: 10.1007/s12328-021-01404-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Accepted: 03/23/2021] [Indexed: 02/05/2023]
Abstract
We report a rare case of cystic lymphangioma of the greater omentum, which was treated by laparoscopic resection. A 61-year-old man was referred to our hospital for the treatment of a perigastric cystic lesion. Esophagogastroduodenoscopy revealed neither a mucosal lesion nor a submucosal tumor in the stomach. Abdominal contrast-enhanced computed tomography imaging showed a cystic lesion in the ventral side of the lower part of the stomach and no mass lesions in the liver. The patient underwent laparoscopic resection of the cystic lesion. The intraoperative observation confirmed that a well-defined cystic lesion was present wrapped in the greater omentum and located predominantly in the right side. Although the cystic lesion was located directly beside the right gastroepiploic artery and vein, excision of the cystic lesion along with the cuff of the omentum was performed without sacrificing the vessels. Macroscopic examination of the resected specimen showed an ovoid, cystic mass measuring 7.5 × 4.3 cm within the omentum. The pathological diagnosis was "cystic lymphangioma without malignant signs." Following surgery, the patient remained symptom-free without evidence of recurrence for 6 months. The laparoscopic approach, being minimally invasive, can be considered the most feasible approach for the resection of an abdominal cystic lymphangioma.
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Affiliation(s)
- Tsutomu Namikawa
- Department of Surgery, Kochi Medical School, Oko-cho, Nankoku, Kochi, 783-8505, Japan.
| | - Shigeto Shimizu
- Department of Surgery, Kochi Medical School, Oko-cho, Nankoku, Kochi, 783-8505, Japan
| | - Keiichiro Yokota
- Department of Surgery, Kochi Medical School, Oko-cho, Nankoku, Kochi, 783-8505, Japan
| | - Nobuhisa Tanioka
- Department of Surgery, Kochi Medical School, Oko-cho, Nankoku, Kochi, 783-8505, Japan
| | - Masaya Munekage
- Department of Surgery, Kochi Medical School, Oko-cho, Nankoku, Kochi, 783-8505, Japan
| | - Sunao Uemura
- Department of Surgery, Kochi Medical School, Oko-cho, Nankoku, Kochi, 783-8505, Japan
| | - Hiromichi Maeda
- Department of Surgery, Kochi Medical School, Oko-cho, Nankoku, Kochi, 783-8505, Japan
| | - Hiroyuki Kitagawa
- Department of Surgery, Kochi Medical School, Oko-cho, Nankoku, Kochi, 783-8505, Japan
| | - Michiya Kobayashi
- Department of Human Health and Medical Sciences, Kochi Medical School, Kochi, Japan
| | - Kazuhiro Hanazaki
- Department of Surgery, Kochi Medical School, Oko-cho, Nankoku, Kochi, 783-8505, Japan
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31
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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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Abdulraheem AK, Al Sharie AH, Al Shalakhti MH, Alayoub SY, Al-Domaidat HM, El-Qawasmeh AE. Mesenteric cystic lymphangioma: A case report. Int J Surg Case Rep 2021; 80:105659. [PMID: 33636409 PMCID: PMC7918257 DOI: 10.1016/j.ijscr.2021.105659] [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: 01/15/2021] [Revised: 02/09/2021] [Accepted: 02/13/2021] [Indexed: 11/17/2022] Open
Abstract
Mesenteric cystic lymphangiomas are rare benign lesions characterized by lymphatic vessels malformation with an unknown etiology. Although, mesenteric cystic lymphangiomas are rare but should be included in the differential diagnosis of abdominal pain. Surgical resection of mesenteric lymphangiomas should be performed as fast as possible to avoid many serios complications.
Introduction and importance Mesenteric cystic lymphangiomas are rare benign lesions of the abdominal cavity characterized by lymphatic vessels malformation with an unknown etiology. Despite the silent clinical course of mesenteric cystic lymphangiomas, they are considered as clinically tricky lesions with an immense spectrum of presentations. Case presentation We present a case of abdominal mesenteric cystic lymphangioma in a 1-year 9-month-old female patient, who complained of fever and abdominal pain for 10 days duration. Laboratory investigations, abdominal X-ray, ultrasonography, computed tomography and histopathological examination were all used to establish the diagnosis. Clinical discussion A trial of true-cut biopsies performed by an interventional radiologist was not informative, so a multidisciplinary team decision was made to excise the mass. Intraoperative findings include multiloculated fused cystic lesion (8.0 × 5.0 × 4.0 cm) on the descending mesocolon. Histopathological examination revealed the diagnosis of a mesenteric cystic lymphangioma. The postoperative period was not complicated. Conclusion Mesenteric cystic lymphangiomas are mostly asymptomatic in nature, yet predisposed to life threating events. Surgical excision is the modality of treatment characterized by low recurrence rate and a non-complicated postoperative period.
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Affiliation(s)
- Ahmad K Abdulraheem
- Department of General Surgery and Urology, Faculty of Medicine, Jordan University of Science & Technology, Irbid, 22110, Jordan.
| | - Ahmed H Al Sharie
- Faculty of Medicine, Jordan University of Science & Technology, Irbid, 22110, Jordan
| | - Majd H Al Shalakhti
- Department of General Surgery and Urology, Faculty of Medicine, Jordan University of Science & Technology, Irbid, 22110, Jordan
| | - Saleh Y Alayoub
- Department of General Surgery and Urology, Faculty of Medicine, Jordan University of Science & Technology, Irbid, 22110, Jordan.
| | - Hamzeh M Al-Domaidat
- Department of General Surgery and Urology, Faculty of Medicine, Jordan University of Science & Technology, Irbid, 22110, Jordan
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Ajmera P, Jadhav V. Painful Abdominal Lump in the Pediatric Age Group: A Diagnostic Dilemma. Cureus 2021; 13:e13202. [PMID: 33728165 PMCID: PMC7946611 DOI: 10.7759/cureus.13202] [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] [Indexed: 11/17/2022] Open
Abstract
Any cystic lesion occurring in the mesentery which may or may not extend into the retroperitoneum is referred to as a mesenteric cyst; they have an infrequent incidence rate in the pediatric age group. Definitive etiology of the cystic lymphatic malformations is still not known but there are multiple hypotheses. A young male child presented with acute onset abdominal pain and palpable intra-abdominal mass and ultrasonography revealed presence of two lesions, one of them as an encysted turbid fluid collection in the right lumbar region and the other as a dilated, tortuous, intercalated structure. On CT, the first one was identified definitively as a mesenteric cyst while the other as a possible neoplastic mass in close proximity to the first one. Histopathology confirmed the diagnosis as a cystic lymphatic malformation of the mesenteric cyst. The limited awareness of its existence along with its usually asymptomatic nature, are the likely reasons that it still remains an elusive diagnosis. Based on our case we discuss, the use of a multi-modality approach towards diagnosing cystic malformation disorders and how the use of MRI is under-utilised when it could prove decisive.
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Affiliation(s)
- Pranav Ajmera
- Radiology, Dr. D.Y. Patil Medical College, Hospital and Research Center, Pune, IND
| | - Vikas Jadhav
- Radiology, Dr. D.Y. Patil Medical College, Hospital and Research Center, Pune, IND
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Tympa A, Grigoriadis C, Theodoraki K, Vassiliou I. Abdominal cystic lymphangioma mimicking ovarian mass: A case report and literature review. Mol Clin Oncol 2020; 14:43. [PMID: 33437481 PMCID: PMC7788561 DOI: 10.3892/mco.2020.2202] [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: 08/30/2020] [Accepted: 12/17/2020] [Indexed: 11/11/2022] Open
Abstract
Cystic lymphangiomas are uncommon benign lesions extremely rare in the adult population. Most cases are found in the neck and axillary regions; while <1% of patients present with cystic lymphangiomas in the mesentery, greater omentum and retroperitoneum. The present report describes a rare case of large omental lymphangioma mimicking ovarian mass. A 40-year-old G2P2 female patient presented without symptoms for routine gynecological examination. Transvaginal ultrasound examination revealed a cystic mass with a maximum diameter of 10 cm localized at the right parametrium space, suggestive of large cystic lesion of the right ovary. Further preoperative evaluation by magnetic resonance imaging indicated that the mass was either cystic lymphangioma or mesenteric cyst. Complete excision of the cyst without need for gastrectomy was performed via laparotomy under general anaesthesia. Histology revealed omental lymphangioma. Most abdominal lymphangiomas are initially asymptomatic. The role of synchronous imaging examinations, such as ultrasonography and magnetic resonance imaging, in diagnosis of these lesions is crucial. Full preoperative differential diagnosis evaluation in cases of large intraabdominal lesions is required in order to decide the appropriate surgical approach and management.
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Affiliation(s)
- Aliki Tympa
- First Department of Anesthesiology, Aretaieion Hospital, Medical School, University of Athens, Athens 11528, Greece
| | | | - Kassiani Theodoraki
- First Department of Anesthesiology, Aretaieion Hospital, Medical School, University of Athens, Athens 11528, Greece
| | - Ioannis Vassiliou
- Second Department of Surgery, Aretaieion Hospital, Medical School, University of Athens, Athens 11528, Greece
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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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Ong D, Cribb B, Marshall-Webb M, Yong J. Rare cystic mesenteric mass of the small bowel: mesenteric lymphangioma. ANZ J Surg 2020; 91:E417-E418. [PMID: 33170998 DOI: 10.1111/ans.16434] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2020] [Revised: 10/28/2020] [Accepted: 10/29/2020] [Indexed: 11/26/2022]
Affiliation(s)
- Daniel Ong
- Department of General Surgery, Queen Elizabeth Hospital, Adelaide, South Australia, Australia
| | - Benjamin Cribb
- Department of General Surgery, Queen Elizabeth Hospital, Adelaide, South Australia, Australia
| | - Matthew Marshall-Webb
- Department of General Surgery, Queen Elizabeth Hospital, Adelaide, South Australia, Australia
| | - Jonathan Yong
- Department of General Surgery, Queen Elizabeth Hospital, Adelaide, South Australia, Australia
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38
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Diffuse mesenteric microcystic lymphatic malformation in a 12-year-old girl. JOURNAL OF PEDIATRIC SURGERY CASE REPORTS 2020. [DOI: 10.1016/j.epsc.2020.101639] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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Raufaste Tistet M, Ernst O, Lanchou M, Vermersch M, Lebert P. Imaging features, complications and differential diagnoses of abdominal cystic lymphangiomas. Abdom Radiol (NY) 2020; 45:3589-3607. [PMID: 32296900 DOI: 10.1007/s00261-020-02525-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
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.
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Affiliation(s)
- M Raufaste Tistet
- Department of Digestive Diagnostic and Interventional Radiology, University Hospital Claude Huriez - Regional University Hospital Center, rue Michel Polonoski, 59037, Lille Cedex, France.
| | - O Ernst
- Department of Digestive Diagnostic and Interventional Radiology, University Hospital Claude Huriez - Regional University Hospital Center, rue Michel Polonoski, 59037, Lille Cedex, France
| | - M Lanchou
- Department of Digestive Diagnostic and Interventional Radiology, University Hospital Claude Huriez - Regional University Hospital Center, rue Michel Polonoski, 59037, Lille Cedex, France
| | - M Vermersch
- Department of Digestive Diagnostic and Interventional Radiology, University Hospital Claude Huriez - Regional University Hospital Center, rue Michel Polonoski, 59037, Lille Cedex, France
| | - P Lebert
- Department of Digestive Diagnostic and Interventional Radiology, University Hospital Claude Huriez - Regional University Hospital Center, rue Michel Polonoski, 59037, Lille Cedex, France
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40
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Long X, Zhang L, Cheng Q, Chen Q, Chen XP. Solitary hepatic lymphangioma mimicking liver malignancy: A case report and literature review. World J Clin Cases 2020; 8:4633-4643. [PMID: 33083428 PMCID: PMC7559670 DOI: 10.12998/wjcc.v8.i19.4633] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Revised: 08/03/2020] [Accepted: 08/26/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Hepatic lymphangioma, a malformation of the liver lymphatic system, is a rare benign neoplasm and usually coexists with other visceral lymphangiomas. Solitary hepatic lymphangioma is much more rarely seen and could cause a clinical misinterpretation as malignancy.
CASE SUMMARY A 50-year-old woman with a liver mass of approximately 3.5 cm was initially diagnosed with hepatocellular carcinoma given the risk factors for liver cancer that she presented with, including Schistosome japonicum infection and jaundice, and also together with imaging results, which showed the mass enhanced quickly in the arterial phase and faded fast in the venous phase. The patient did not have the surgery first but received three rounds of transarterial chemoembolization because of her anxiety and fears for operation. Finally, the patient underwent laparoscopic liver segment 4b resection and cholecystectomy and was discharged from the hospital only 10 d after the operation. The pathological examination indicated the mass as hepatic lymphangioma. The patient has been followed up for 30 mo without recurrence. To raise the awareness of this misdiagnosed case and to better diagnose and treat this rare disease in future, we reviewed the published literature of solitary hepatic lymphangioma for its clinical symptoms, imaging presentation, operative techniques, histology features and prognosis.
CONCLUSION Solitary hepatic lymphangioma mimicking malignancy makes diagnosis difficult. Complete surgical resection is the first choice to treat solitary hepatic lymphangioma.
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Affiliation(s)
- Xin Long
- Hepatic Surgery Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, Hubei Province, China
| | - Lei Zhang
- Hepatic Surgery Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, Hubei Province, China
| | - Qi Cheng
- Hepatic Surgery Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, Hubei Province, China
| | - Qian Chen
- Endoscopic Unit, Department of Gastroenterology and Hepatology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, Hubei Province, China
| | - Xiao-Ping Chen
- Hepatic Surgery Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, Hubei Province, China
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Hou G, Jiang Y, Jing H, Xu W, Xu KF, Chen L, Li F, Cheng W. Usefulness of 99mTc-ASC lymphoscintigraphy and SPECT/CT in the evaluation of rare lymphatic disorders: Gorham-Stout disease, lymphangioma, and lymphangioleiomyomatosis. Medicine (Baltimore) 2020; 99:e22414. [PMID: 32991473 PMCID: PMC7523828 DOI: 10.1097/md.0000000000022414] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
The purpose of this study was to investigate the role of Tc-antimony sulfide colloid (ASC) lymphoscintigraphy and single photon emission computed tomography/computed tomography (SPECT/CT) in the evaluation of rare lymphatic disorders, including Gorham--Stout disease (GSD), lymphangioma, and lymphangioleiomyomatosis (LAM).Nine patients suspected to have rare lymphatic disorders were included in this retrospective study. All patients underwent Tc-ASC lymphoscintigraphy and SPECT/CT to evaluate the lesions. The lymphoscintigraphy results were compared with the clinical and immunopathological findings.Tc-ASC lymphoscintigraphy and SPECT/CT could provide lymphatic draining and anatomical information for rare lymphatic disorders. Among the 9 patients, 3 were diagnosed with GSD (1 female, 2 males; aged 15-34 years, range 27.0 ± 10.4 years), 3 with lymphangioma (1 female, 2 males; aged 17-42 years, range 32.0 ± 13.2 years), and 3 patients were diagnosed with LAM (3 females; aged 33-50 years, range 43.7 ± 9.3 years]. GSD is characterized by multiple bone destruction, including spine, ribs, ilium, pubis, ischium, and femur. The tracer uptake of involved bones and soft tissue around bone is increased, accompanied by chylothorax, chylopericardium, and chylous leakage in abdominal and pelvic cavity. Lymphangiomas present as multiple cystic lesions with increased tracer uptake in the peripancreatic, retroperitoneal, and iliac areas, and in the abdominopelvic cavity. LAM presents as multiple thin-walled cysts in the bilateral lungs and multiple retroperitoneal enlarged lymph nodes with increased tracer uptake.Tc-ASC lymphoscintigraphy and SPECT/CT could comprehensively and specifically detect some rare lymphatic disorders, namely, GSD, lymphangioma, and LAM. This technique is useful for the evaluation of GSD, lymphangioma, and LAM.
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Affiliation(s)
- Guozhu Hou
- Department of Nuclear Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
- Beijing Key Laboratory of Molecular Targeted Diagnosis and Therapy in Nuclear Medicine, Beijing, China
| | - Yuanyuan Jiang
- Department of Nuclear Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
- Beijing Key Laboratory of Molecular Targeted Diagnosis and Therapy in Nuclear Medicine, Beijing, China
| | - Hongli Jing
- Department of Nuclear Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
- Beijing Key Laboratory of Molecular Targeted Diagnosis and Therapy in Nuclear Medicine, Beijing, China
| | - Wenshuai Xu
- Department of Pulmonary and Critical Care Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Kai-Feng Xu
- Department of Pulmonary and Critical Care Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Libo Chen
- Department of Nuclear Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
- Beijing Key Laboratory of Molecular Targeted Diagnosis and Therapy in Nuclear Medicine, Beijing, China
| | - Fang Li
- Department of Nuclear Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
- Beijing Key Laboratory of Molecular Targeted Diagnosis and Therapy in Nuclear Medicine, Beijing, China
| | - Wuying Cheng
- Department of Nuclear Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
- Beijing Key Laboratory of Molecular Targeted Diagnosis and Therapy in Nuclear Medicine, Beijing, China
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Liu L, Ke G, Shen WM, Jia CK. Giant cystic lymphangioma in the mesoileum: A case report and literature review. TURKISH JOURNAL OF GASTROENTEROLOGY 2020; 31:603-606. [PMID: 32915149 DOI: 10.5152/tjg.2020.19256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Affiliation(s)
- Ling Liu
- Department of General Surgery, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang Province, China
| | - Ge Ke
- Department of General Surgery, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang Province, China
| | - Wei-Min Shen
- Department of General Surgery, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang Province, China
| | - Chang-Ku Jia
- Department of General Surgery, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang Province, China
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Fukuta A, Inoue T, Kawakubo N, Kondo T, Matsuura T. Congenital intestinal atresia associated with a mesenteric cystic lymphangioma in a low birth weight neonate: A case report. Int J Surg Case Rep 2020; 75:136-139. [PMID: 32949911 PMCID: PMC7502782 DOI: 10.1016/j.ijscr.2020.09.021] [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: 08/08/2020] [Revised: 09/06/2020] [Accepted: 09/06/2020] [Indexed: 12/03/2022] Open
Abstract
Reperfusion injury or disturbed blood flow may cause congenital intestinal atresia. Premature baby had congenital intestinal atresia/mesenteric cystic lymphangioma. Small bowel atresia and stenosis may be due to accidentally disturbed blood flow.
Introduction Congenital intestinal atresia requires emergency surgery soon after birth. Lymphangioma, a benign tumor, is caused by an anomalous lymphatic system. We report a case of congenital intestinal atresia associated with a mesenteric cystic lymphangioma in a low birth weight neonate. Presentation of case At 21 weeks of pregnancy, ultrasonography revealed a cystic lesion in the fetal abdominal cavity. At 31 weeks, magnetic resonance imaging showed dilatation of the small intestine. This low birth weight (1752 g) male infant was born by vaginal delivery at 32 weeks 3 days’ gestation. Laparotomy on day 2 of life revealed jejunal atresia and a mesenteric cyst. The cyst was removed and intestinal anastomosis was performed. Histologically, the cyst proved to be a mesenteric lymphangioma. Discussion The most popular theories regarding the mechanism of congenital intestinal atresia include reperfusion injury and intestinal tract blood flow disturbance. In this fetus, intestinal torsion had occurred around the mesenteric cystic lymphangioma, which apparently disturbed the mesenteric blood flow and caused intestinal atresia. Conclusion There have been few reports of the combination of a mesenteric cystic lymphangioma and congenital intestinal atresia. This case supports the theory that small bowel atresia and stenosis are caused by accidental blood flow disturbance.
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Affiliation(s)
- Atsuhisa Fukuta
- Department of Pediatric Surgery, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan; Department of Pediatric Surgery, Saga-Ken Medical Center Koseikan, Saga, Japan.
| | - Takayuki Inoue
- Department of Pediatric Surgery, Saga-Ken Medical Center Koseikan, Saga, Japan
| | - Naonori Kawakubo
- Department of Pediatric Surgery, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Takaya Kondo
- Department of Pediatric Surgery, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Toshiharu Matsuura
- Department of Pediatric Surgery, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
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Swenson pull-through procedure with total mesorectal excision for a rectosigmoid mesenteric lymphatic malformation. JOURNAL OF PEDIATRIC SURGERY CASE REPORTS 2020. [DOI: 10.1016/j.epsc.2020.101563] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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45
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Mina E, Fusi G, Angotti R, Nardi N, Vincenti M, Messina M, Molinaro F, Bertozzi M. Mesenteric cystic lymphangioma mimicking an ileo-colic intussusception. JOURNAL OF PEDIATRIC SURGERY CASE REPORTS 2020. [DOI: 10.1016/j.epsc.2020.101461] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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46
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César Ernesto LC, Diana Lizbeth RO, Uriel CG, Rebeca AR, Daniel CR, Paloma AV, González Jazmín DA, Armando GD. ADRENAL cystic lymphangioma PRESENTING as a nonfunctioning adrenal carcinoma in a 45-year-old male: Case report. JOURNAL OF CLINICAL AND TRANSLATIONAL ENDOCRINOLOGY CASE REPORTS 2020. [DOI: 10.1016/j.jecr.2020.100062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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47
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Isolated hepatic lymphangiomas in children: Two case reports. JOURNAL OF PEDIATRIC SURGERY CASE REPORTS 2020. [DOI: 10.1016/j.epsc.2020.101430] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
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Hamaguchi Y, Arita S, Sugimoto N, Inamoto O, Takagi H, Kogire M, Kitai T. Laparoscopic resection of abdominal cystic lymphangioma derived from lesser omentum: Case report. Medicine (Baltimore) 2020; 99:e18641. [PMID: 31895826 PMCID: PMC6946562 DOI: 10.1097/md.0000000000018641] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
RATIONALE Cystic lymphangiomas are uncommon congenital malformations that originate from lymphatic channels. Lymphangiomas frequently appear in the head, neck, and axillary regions of children. Abdominal cystic lymphangiomas are extremely rare, having a reported incidence of 1 in 20,000 to 250,000. PATIENT CONCERNS A 50-year-old female patient was admitted to our hospital with a cough that had persisted for several weeks. Abdominal ultrasonography incidentally revealed a multilocular cystic lesion in the lesser curvature of the stomach. DIAGNOSIS Preoperative findings indicated that the lesion was cystic lymphangioma. However, the possibility of a pancreatic tumor could not be completely excluded. INTERVENTIONS Laparoscopy revealed a multilocular cyst in the lesser curvature of the stomach. The gastrocolic ligament was divided, and the body and tail of the pancreas was exposed in the omental bursa, showing that the cystic lesion was not derived from the pancreas but from the lesser omentum. Although it was located directly beside the left gastric artery, the cyst was enucleated and totally resected laparoscopically without sacrificing the artery. OUTCOMES The cystic lesion was histopathologically diagnosed as an abdominal cystic lymphangioma originating from the lesser omentum. The patient was discharged on the postoperative day 4 without complications. LESSONS Preoperative imaging cannot completely distinguish abdominal cystic lymphangiomas from other types of cystic tumors. Because cystic lymphangiomas have the potential to grow, invade vital structures, and develop life-threatening complications, laparoscopic assessment followed by total resection is considered a useful treatment strategy for peripancreatic cystic lesions.
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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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Nagano H, Kimura T, Iida A, Togawa T, Goi T, Sato Y. Cystic lymphangioma in the peripheral jejunal mesentery in an adult and excision with laparoscopic-assisted surgery: a case report. World J Surg Oncol 2019; 17:170. [PMID: 31651341 PMCID: PMC6814111 DOI: 10.1186/s12957-019-1713-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2019] [Accepted: 09/20/2019] [Indexed: 12/14/2022] Open
Abstract
Background Lymphangiomas are uncommon congenital malformations that present mainly in the head, neck, and axillar regions in pediatric patients. Mesenteric cystic lymphangiomas (MCLs), which occasionally present with substantial growth and the invasion of adjacent vital structures, are rarely reported in adults. We report a case of MCL in an adult who was treated with laparoscopic-assisted excision. Case presentation A 40-year-old Japanese man visited his family physician for prolonged periumbilical pain. Plain computed tomography (CT) showed a low-density mass in his left abdomen, and he was referred to our hospital 2 weeks later. His abdomen was flat and soft, and no mass was felt upon palpation. Routine laboratory data showed no abnormalities in the blood cell counts. The levels of tumor markers, such as carcinoembryonic antigen (CEA), carbohydrate antigen 19-9 (CA19-9), and cancer antigen 125 (CA125), were within normal ranges. Contrast-enhanced CT was performed, and a low-density mass was observed with an irregular outline and poor contrast, as well as involvement of the peripheral mesenteric artery and partial compression of the adjacent jejunum without dilatation of the oral side of the bowel. The patient was diagnosed with lymphatic cysts and observed for 1 month without symptom exacerbation. Follow-up CT showed no increase in the size of the mass but showed apparent invasion of the jejunal wall without bowel obstruction. Magnetic resonance imaging (MRI) showed intermediate intensity on T1-weighted imaging (T1WI) and high intensity on T2-weighted imaging (T2WI). The coronal view on T2WI clearly showed an accumulation of cystic lesions. We performed tumor excision with partial resection of the jejunum in a laparoscopic-assisted manner. Pathological examination showed multicystic lesions with an attenuated endothelial lining, surrounding rich adipose tissue and scattered smooth muscle fibers; the patient was diagnosed with MCL. Immunohistochemical assays supported this diagnosis. Conclusions This is rare case of MCL presenting in an adult who underwent successful laparoscopic-assisted resection. Mesenteric lymphangioma (ML) should be considered in the differential diagnosis of patients with intraabdominal cysts. Radical excision is optimal, even when the patient is asymptomatic. Laparoscopic-assisted tumor resection is a suitable surgical method for treating MLs located in the peripheral mesentery.
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Affiliation(s)
- Hideki Nagano
- Department of Surgery, National Hospital Organization Tsuruga Medical Center, 33-1, Sakuragaoka, Tsuruga, Fukui, 914-0195, Japan.
| | - Toshihisa Kimura
- Department of Surgery, National Hospital Organization Tsuruga Medical Center, 33-1, Sakuragaoka, Tsuruga, Fukui, 914-0195, Japan
| | - Atsushi Iida
- Department of Surgery, National Hospital Organization Tsuruga Medical Center, 33-1, Sakuragaoka, Tsuruga, Fukui, 914-0195, Japan
| | - Tamotsu Togawa
- Department of Surgery, National Hospital Organization Tsuruga Medical Center, 33-1, Sakuragaoka, Tsuruga, Fukui, 914-0195, Japan
| | - Takanori Goi
- First Department of Surgery, Faculty of Medicine, University of Fukui, 23-3, Matsuokashimoaizuki, Eiheiji-cho, Yoshida-gun, Fukui, 910-1193, Japan
| | - Yasunori Sato
- Department of Human Pathology Kanazawa University Graduate School of Medicine, 13-1, Takara-machi, Kanazawa, Ishikawa, 920-8640, Japan
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