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

A case report of a mesenteric cystic lymphangioma in a young adult woman presenting to the emergency room

BACKGROUND

Mesenteric cystic lymphangiomas (MCLs) are rare benign tumours seen in adults. The clinical presentation may vary from asymptomatic to acute abdominal pain with inexplicable abdominal pain, nausea and vomiting.

CASE PRESENTATION

In the current case report, a 22-year old, healthy women presented to the emergency room with acute abdominal pain in need of urgent surgical exploration. Histopathological examination revealed an mesenteric cystic lymphangioma.

CONCLUSION

In patients with inexplicable abdominal pain, the suspicion of MCLs and proper diagnostic strategies are important. The primary treatment of MCLs consists of radical surgical resection to prevent invasion in surrounding tissue. Tertiary referral centres should be consulted to support in the diagnosis, treatment and follow-up of MCLs.

Cystic Lymphangioma of the Mesentery in an Adult: A Case Report and Literature Review

Lymphangiomas are rare benign cystic tumors. Surgical excision is the primary treatment, aiming for complete removal. Diagnosis relies on imaging and histological confirmation. Malignant transformation is exceptionally rare. We report a 25-year-old man admitted for peri-umbilical abdominal pain and an abdominal mass. Imaging revealed multilocular peritoneal cystic formations with infiltration of adjacent mesenteric fat. Laboratory findings were unremarkable, and exploratory laparotomy was performed. A voluminous cystic mass originating from the mesentery was discovered, requiring intestinal sacrifice for complete resection. Immediate postoperative recovery was smooth. Pathological analysis confirmed the diagnosis of mesenteric cystic lymphangioma. The patient had a favorable outcome with no tumor recurrence at a three-year follow-up. We emphasize the significance of complete surgical removal to prevent complications associated with cystic lymphangioma and reduce the risk of recurrence.

Diffuse abdominal lymphangiomatosis without tumoral masses: a case report

Diffuse abdominal lymphangiomatosis is a rare and complex disease. It typically presents with non-specific gastrointestinal symptoms and characteristic cystic lesions or tumoral masses on imaging based on the literature to date. This report presents the rare case of a young man with an atypical form of diffuse abdominal lymphangiomatosis in the complete absence of cystic lesions or lymphangioma tumoral masses, thus presenting a unique diagnostic challenge. It was successively treated by surgery, gastric electrical stimulator, sirolimus, and imatinib.

Mesenteric Cystic Lymphangioma, an acute presentation in a 9-year-old child

Mesenteric lymphangioma is a rare malformation of the lymphatic system. Misdiagnosis of mesenteric cystic lymphangioma can occur due to its rarity and resemblance to other cystic lesions and ascites. The authors report an acute presentation of a mesenteric lymphangioma in a 9-year-old child. Clinical, radiological, and surgical findings are illustrated accordingly. As authors, we aim to add to the limited data of acute presentations of mesenteric lymphangiomas.

Unusual acute right abdominal pain. Distal ileum mesenteric cystic lymphangioma in adult, a rare case and literature review

Lymphangiomas in the peritoneal cavity are rare in adults, with most cases occurring in children. We present the case of a 49-year-old woman who was admitted with severe lower abdominal pain. The diagnostic assessment revealed a multiloculated cystic structure in the mesentery of the distal ileum, suggesting a lymphangioma. The patient underwent laparotomy and resection, with successful removal of the mass. Histopathological examination confirmed the diagnosis of intestinal lymphangioma, a rare benign vascular neoplasm of the small bowel. Postoperatively, the patient experienced resolution of postoperative ileus and mild back and abdominal pain, with no complaints during follow-up. Awareness of this uncommon condition is crucial for accurate diagnosis and appropriate treatment. Surgical resection, supported by radiological and histopathological investigations, is the primary treatment modality for symptomatic lymphangioma. Regular follow-up with imaging may be necessary to monitor recurrence.

Mesenteric cystic lymphangioma in adults: a rare entity presenting as acute abdomen - a report of two cases

Lymphangiomas are rare benign tumors that mainly involve the head and neck region in pediatric patients. Lymphangiomas of the small bowel mesentery in adults are rarer. We present two cases of mesenteric lymphangioma with acute abdominal pain on presentation. Case 1: A 38-year-old female presented with abdominal pain, vomiting, fever, and difficult evacuation. On abdominal examination, she had an ill-defined, tender lump, and radiological findings raised a possibility of perforation peritonitis. Thus, exploratory laparotomy was planned. Per-operatively, a mesenteric mass was found, which, on histopathological evaluation, was found to be a mesenteric lymphangioma involving the bowel. Case 2: A 27-year-old male presented with abdominal pain and difficult evacuation. Radiological evaluation revealed a multilobulated lesion involving the mesentery and with differential diagnoses of mesenteric fibromatoses and inflammatory pseudotumor. Histopathological assessment of the resected mass revealed a lymphangioma that was limited to the mesentery. Owing to their rarity and non-specific presentation, mesenteric lymphangiomas are often misdiagnosed on clinical examination and imaging. Thus, histopathological examination is the gold standard to reach a definitive diagnosis.

A rare incidence of retroperitoneal Cystic Lymphangioma in a 45-year-old female - A Case Report

Introduction and importance

Cystic lymphangioma is an extremely rare benign vascular neoplasm of mesodermal origin, arising from lymphatic vessels and occurring principally in male children. The retroperitoneum is the rarest site, accounting for <1 % of all types of lymphangioma. The incidence of cystic lymphangioma is unknown due to the scarcity of published data.

Case presentation

A 45-year-old female presented to our hospital complaining of vague abdominal pain and intermittent episodes of vomiting over four months. Preoperative imaging via ultrasound and Computed Tomography revealed a well-demarcated retroperitoneal cystic mass between the right kidney and the liver.

Clinical discussion

The mass was excised laparoscopically. Histopathological examination confirmed a cystic hygroma (a subtype of cystic lymphangioma).

Conclusion

Cystic lymphangioma is rare, often misdiagnosed and may present with vague symptoms. Complete resection may be feasible and can be curative.

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Cystic lymphangioma is a rare benign lymphatic neoplasm presenting almost exclusively in children.

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Retroperitoneal lymphangiomas comprise <1 % of all lymphangiomas.

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Presenting symptoms may be non-specific, as in our case.

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The mass could become infected, bleed or rupture.

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Complete surgical resection is the treatment of choice for such lesions.

Extensive abdominal lymphangiomatosis involving the small bowel mesentery: A case report

BACKGROUND

Abdominal lymphangiomatosis is a rare benign condition accounting for less than 1% of all the cases of lymphangiomatosis. Management usually involves radical surgical excision; however, depending upon the extent of involvement, patient condition, and absence of complications, conservative management can be also considered.

CASE SUMMARY

We present the case of a 32-year-old male who presented with short onset abdominal pain and melena. Physical examination findings were within normal limits, except for left lower abdominal tenderness. Upper gastrointestinal endoscopy was within normal limits. Abdominal and pelvic ultrasound and computed tomography (CT) scan revealed numerous, variably-sized cystic lesions within the abdominal cavity, exclusively and extensively affecting the small bowel mesentery with sparing of the retroperitoneum. The diagnosis was confirmed by CT and cytological examination. Radical surgical excision was technically impossible in this patient because of the extensive involvement of the mesentery; therefore, the patient was managed conservatively.

CONCLUSION

Extensive and exclusive small bowel mesentery involvement in abdominal lymphangiomatosis is rare. Imaging modalities play an important role in establishing the diagnosis and conservative management can be considered when surgery is technically impossible.

Mesenteric Lymphangioma Presenting With Small Bowel Volvulus in an Adult

Benign tumours of vascular and lymphatic origin are known as lymphangiomas. In this report, we present a case of a 26-year-old lady admitted with symptoms of small bowel obstruction. Her computed tomography (CT) scan showed a well-defined mass in the small bowel mesentery associated with small bowel volvulus. Segmental resection of the bowel, including the mass, was performed. Microscopic examination and immunohistochemistry of the specimen were consistent with lymphangioma of the small bowel mesentery.

The Effectiveness of Abdominal Lymphangioma Laparoscopic Removal in Children: A Single Center Experience

Background: Lymphangiomas represent 5% of all benign pediatric tumors. Abdominal lymphangiomas (ALs) are extremely rare. Therapy includes surgery, sclerotherapy, or pharmacological treatment. Laparoscopic resection (LR) has been already described, but mainly as case reports. The aim of this study is to present our series of ALs LR. Materials and Methods: From 2007 to 2020, 10 cases of ALs were electively treated by LR. Patients' age ranged from 4 months to 14 years. Preoperative diagnosis was achieved by ultrasonography and magnetic resonance images. In all cases LR was performed with four trocars: a 10 mm transumbilical trocar for camera and extraction and three 3-5 mm operative trocars. Results: Lymphangiomas arise from mesocolon in 5 giant cases, ileal mesentery in 3 and right adrenal gland in 2. LR was achieved without intraoperative complications and need of conversion in all cases. Two giant cases needed a percutaneous puncture under laparoscopic view to gain working space. A minimal ileal resection by video-assisted procedure was carried out in 2. Median hospital length was 4 days; no recurrence of disease at serial ultrasound examinations was seen at median follow-up of 5.9 years. Discussion: Several approaches have been proposed for AL treatment. The main challenges are the huge dimensions, the difficulty to achieve a complete resection, and the risk of recurrence. In this series, elective LR of ALs resulted as feasible and effective, and we consider it the standard surgical therapy.

[Minimally invasive approach for the treatment of Giant retroperitoneal cystic tumors: Presentation of two cases and literature review]

The primary retroperitoneal tumors are malignant or no malignant neoplasias, which the mesenteric cyst has an uncommon presentation. They have a great histological variety that includes the simple lymphatic cysts or the lymphangiomas which are congenital or acquired tumors whose intra-abdominal localization is unusual. There are three clinical features: incidental, unspecific and acute; and their therapeutic management is determinate by their radiological profile and it involves the preoperative percutaneous drainage in case of huge cysts for decreasing the size of the tumor and getting the radical cystectomy without relapse. This review presents two cases of acute abdominal pain related to huge retroperitoneal cysts resolved by minimally invasive approach and bibliographic review.

Resection of an Asymptomatic Lymphangioma in a 76-Year-Old Male

Lymphangiomas are benign congenital malformation comprised of the lymphatic system. They typically present in the head, neck, and axillary regions of children with <1% being described in the small bowel mesentery. We report a case of a 76-year-old man who presented with incidental large (9x6 cm) multiloculated cystic mass in the right upper quadrant (RUQ) on a CT scan performed for nephrolithiasis. He was asymptomatic at the presentation. We performed a diagnostic laparoscopy which was converted to an open procedure due to the mesenteric mass extending deeply toward the mesenteric root. The depth of invasion required small bowel resection with primary side-to-side anastomosis. Pathology confirmed a lymphangioma of the small bowel mesentery with histopathological analysis and cytology negative for malignant cells. Lymphangiomas are benign masses, however, their complete resection, including the resection of the involved organs is necessary. Incomplete resection or drainage is no longer used in management due to high rates of recurrence. Mesenteric lymphangiomas, while typically benign congenital malformations, can progress and impact surrounding structures via mass effect. Definitive treatment of lymphangiomas, even when asymptomatic, should be complete resection.

Jejunal mesenteric lymphangioma treated by pancreaticoduodenectomy: A case report

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Small bowel mesenteric lymphangiomas in adults are rare.

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A huge lymphangioma infiltrated the pancreas and duodenum.

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A pancreaticoduodenectomy was required to remove it completely.

Introduction

A lymphangioma is a benign congenital malformation of the lymphatic system that generally appears in the head, neck, and axillary regions. Small bowel mesenteric lymphangiomas have been described in less than 1% of lymphangiomas.

Presentation of case

We report the case of a 20-year-old woman who presented with abdominal pain. Computed tomography revealed a large (22 cm in diameter) multi-cystic lesion inferior to the processus uncinatus of the pancreas. As the presumptive diagnosis was a lymphangioma of the jejunal mesentery, we decided to perform a laparotomy. Intraoperatively, the peritoneal cavity was found to be fully occupied by a multi-cystic lesion that arose from the root of the jejunal mesentery and the processus uncinatus of the pancreas. It was adherent to the duodenum and inseparable from the duodenum and the processus uncinatus. A subtotal stomach-preserving pancreaticoduodenectomy was performed. The tumor was diagnosed as a lymphangioma of the jejunal mesentery after histopathological analysis.

Discussion

Although lymphangioma is benign, complete resection, including resection of the involved organs, is necessary. Incomplete resection has a 10% postoperative recurrence rate and may also be associated with complications. To the best of our knowledge, this is the first reported case of a mesenteric lymphangioma treated by pancreaticoduodenectomy.

Conclusion

Although the lymphangioma was pathologically benign, a pancreaticoduodenectomy was required to remove it completely. When a tumor’s location and size cause impingement on surrounding structures, surgeons should consider performing a pancreaticoduodenectomy to treat similar cases.

Morison's pouch: anatomical review and evaluation of pathologies and disease spread on cross-sectional imaging

The peritoneum is a complex structure. Having a better understanding of this complex anatomy will enable the radiologist to accurately assess and diagnose the wide range of intra-abdominal pathologies. In this article, we review the anatomy, boundaries, and connections of Morison's pouch. In addition, we discuss the incidence and development of common pathological conditions within Morison's pouch and the role of multiple imaging modalities in assessment and diagnosis of these conditions.

Complete resection of a massive mesenteric lymphangioma in an adult

Mesenteric lymphangioma is a benign cystic tumour of the lymphatic vessels that occurs rarely in adults. Due to the infrequency of cases and the insidious presentation, these tumours can be diagnosed late and become massive. Resection of mesenteric lymphangioma in its entirety is the recommended management in order to prevent recurrence. This case report describes the finding of a massive mesenteric lymphangioma (dimensions 420×470×100 mm) in a young man, the investigations leading to diagnosis, and the subsequent surgical management. The substantial size of this tumour produced considerable challenges for the surgical team, including involvement of adjacent small bowel and mesenteric vasculature. Preoperative diagnosis and assessment of the anatomy was pivotal in achieving a complete resection and a good patient outcome.

A rare case of retroperitoneal and mesenteric lymphangiomatosis

Lymphagiomatosis are rare benign malformations of the lymphatic system. They are more commonly seen during childhood and are frequently asymptomatic and incidentally found in the adult patient. We report a case of a 31-year-old male who presented initially with melena. Computer tomography scan revealed multiple confluent, fluid-density lesions encasing the retroperitoneum and mesentery. A laparotomy and incisional biopsy of the mesenteric lesion was performed. Histologic examination demonstrated fibrofatty tissue with prominent, thick-walled endothelial-lined vessels. The histologic and computer tomography findings were consistent with a diagnosis of retroperitoneal and mesenteric lymphangiomatosis. The patient was subsequently discharged home well.

Pediatric patients with mesenteric cystic lymphangioma: A case series

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.

PRESENTATION OF CASES

Here we report four pediatric patients with MCL: two males presented with bilious vomiting and ileus, one female with abdominal pain, and one female with asymptomatic abdominal mass. All patients underwent explorative laparotomy and mass excision was done and/or marsupialization. All patients were discharged at the third - fourth postoperative day uneventfully.

DISCUSSION

Although benign, lymphangioma 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.

New Approach to Rare Pediatric Multicystic Mesenteric Lymphangioma; Would It Guide the Development of Targeted Therapy?

In children, lymphangiomas are extremely rare pathologic entities that are characterized by unusual locations. The mesenteric localization is extremely rare in children, and the clinical signs usually mimic an acute abdominal syndrome. For most of the cases, their diagnosis is established by the radiologist, and the main therapeutic option is represented by surgery for lesion removal. We hereby describe the case of a 4 year old girl admitted to the pediatric emergency department for continuous abdominal pain, more intense in the orthostatic position, associated with abdominal distension, nausea, and vomiting. These symptoms raised the clinical suspicion of acute abdominal syndrome. The patient had no previous clinically significant events. Radiologic examination suggested a mesenteric multicystic lymphangioma certified by surgical and histopathological evaluation. No specific targeted therapy is currently available; moreover, no specific criteria for recurrences have been stated. A new approach of infantile lymphangiomas following surgery, regarding the use of specific lymphatic markers panel including D2-40, Prox-1, VEGFR-3, PDGFs, and Ki67 may improve the characterization of such lesions regarding their prognosis, recurrence rate and targeted therapy implementation especially for those with a more aggressive or recurrent behavior.

A Huge Cystic Retroperitoneal Lymphangioma Presenting with Back Pain

Retroperitoneal lymphangioma is a rare location and type of benign abdominal tumors. The clinical presentation of this rare disease is nonspecific, ranging from abdominal distention to sepsis. Here we present a 73-year-old female patient with 3-month history of back pain. USG and CT revealed a huge cystic mass which was surgically excised and appeared to be lymphangioma on histopathology.

Giant primary cystic mediastinal lymphangioma: A case report

Cystic lymphangioma mainly occurs in children. Cystic mediastinal lymphangioma (CML) originates from mediastinal tissues and is an extremely uncommon cystic lymphangioma that develops from the lymphatic vessels. The present study reports the case of 46-year-old male patient with a giant CML that was surgically resected by video-assisted thoracoscopy. The largest diameter of the CML was 18.0 cm, and ~400 ml of pale yellow fluid was removed from the cystic cavity during surgery. The postoperative pathological reports on the cystic wall showed that the neoplasm was a CML. At present, at the one-year postoperative follow-up, there are no signs of recurrence. In conclusion, complete surgical resection may prevent recurrence.