Retroperitoneal cystic lymphangioma

A clinicopathologic and immunohistochemical study of ten pancreatic lymphangiomas and a review of the literature

BACKGROUND

Pancreatic lymphangiomas are rare benign tumors, of which only a few cases have been reported in the literature. In this study, the authors present a series of primary pancreatic lymphangiomas.

METHODS

Cases of nonepithelial pancreatic cystic tumors (lymphangiomas) diagnosed between 1966 and 1994 were retrieved from the Endocrine Pathology Registry of the Armed Forces Institute of Pathology. Histologic features (in 10 cases) as well as histochemical and immunohistochemical studies (in 6 cases) were reviewed. Long term patient follow-up data were obtained in 9 cases.

RESULTS

The patients included 8 females and 2 males ages 2-61 years (mean age, 28.9 years) at initial presentation. The tumors were circumscribed and occurred predominantly (in 6 of 10 cases) in the tail of the pancreas. The multicystic, serous, or chylous fluid-filled cystic tumors ranged from 3 to 20 cm (average, 12.7 cm) in greatest dimension. Histologically, the tumors consisted of multilocular cystic spaces of various sizes, lined by endothelial cells. The stroma contained smooth muscle and mature lymphocytes. Immunohistochemistry determined the endothelial lining cells to be factor VIII-R antigen and CD31 positive (in all cases tested) but usually CD34 negative. All patients for whom follow-up data were obtained (n=9) were alive without evidence of disease an average of 7.2 years after initial diagnosis.

CONCLUSIONS

Pancreatic lymphangiomas occur predominantly in females within a wide age range. Multilocular, fluid-filled cysts, with endothelial immunoreactivity for factor VIII-R antigen and CD31, are characteristic of these tumors. Complete surgical excision of these benign tumors resulted in excellent long term prognoses for all patients studied.

Cystic retroperitoneal lymphangiomas in adults

Lymphangioma (LA) is a rare benign tumour of the lymphatic tissue, most common in the neck and head, and clinically manifests itself mostly in childhood. Within this group, intra-abdominal and retroperitonal LA are the rarest tumours, especially when occurring in adults. We report four LAs localized in the retroperitoneum of patients aged between 28 and 72 years. One of these tumours infiltrated the transverse mesocolon and greater omentum, others were situated in the left retroperitoneum and retroperitoneally at the duodeno-jejunal flexure, and in the retrosplenal and retropancreatic area. Diagnosis was made by light microscopy supported by immunohistochemistry. In three cases the tumour could be removed by radical surgery and none of these patients had a recurrence (median follow-up time: 4 years). The tumour could not be removed completely from one patient with pre-operative chylascos. Six months after diagnosis of LA this patient died of cardiopulmonary failure due to progressive tumour chylascos. Isolation and ligation of the cystic LA's peduncle as well as ligation of lymph channels can prevent recurrences and chylascos.

Cystic lymphangioma of the pancreas

Cystic lymphangioma of the pancreas is a rare condition. A 14-year-old girl presented with a cystic abdominal mass and abdominal pain. She was initially treated by biopsy and cyst drainage, and subsequently with partial excision of the cystic mass. The mass, which was a cystic lymphangioma involving the pancreas, recurred after each operation. Persisting symptoms led to a pylorus-preserving pancreatectomy and hepaticojejunostomy. Total excision is the only effective method of treating this benign tumour. The patient remains symptom free 2 1/2 years after pancreatectomy.

Identification and surgical management of cystic retroperitoneal lymphangioma in children

Retroperitoneal lymphangiomas are rare, benign cystic structures that are best evaluated with computed tomography and ultrasound. Preoperative diagnosis is often difficult, in part because there is little to distinguish them from other cystic masses and because the lesion is often not considered on the differential diagnosis. Surgery may be required as both a diagnostic and therapeutic measure. The cysts may be asymptomatic for years and then present because of compression of surrounding structures or pain. The treatment is as complete surgical excision as is possible. Bowel cleansing should be done preoperatively. The long-term results are excellent when total excision or near-total excision with marsupialization is accomplished.

Retroperitoneal cystic lymphangioma

Two cases of retroperitoneal cystic lymphangioma (CL) are presented; the current literature on this rare, benign neoplasm of the lymphatic system is reviewed. This tumor consists of various numbers of cyst-like cavities filled with a serous, serosanguineous or chylous fluid. The histogenesis of CL is still uncertain. Most commonly CL occurs in the neck and in the axillary region, whereas it is rare in the retroperitoneum. Although retroperitoneal CL is a benign lesion, it may cause significant morbidity due to its large size, and its often invasive character with a strong tendency to secondary infection. The treatment of choice is surgical excision.

Retroperitoneal cystic lymphangioma diagnosed by computerized tomography, magnetic resonance imaging and thin needle aspiration

We report a case of retroperitoneal cystic lymphangioma presenting with right pack pain. Although preoperative diagnosis is usually difficult in such a rare condition, we could make the preoperative diagnosis on grounds of the peculiar findings obtained by computerized tomography (CT), magnetic resonance imaging (MRI) and needle aspiration.

Retroperitoneal cystic lymphangioma section imaging in two cases, and review of the literature

Two patients with retroperitoneal cystic lymphangioma are reported with a review of the medical literature. In one, the patient was asymptomatic from the lesion but had a computed tomography (CT) and an ultrasound to evaluate the extent of disease with a known carcinoma of the colon. The second patient presented with an acute abdominal pain requiring surgical management. CT on this patient showed multiple cystlike cavities filled with fluid, in a retroperitoneal location. The preoperative diagnosis of retroperitoneal cystic lymphangioma was confirmed at surgery. Magnetic resonance (MR) performed on the second patient gave better delineation of craniocaudal extent and showed one of the cysts to have probable hemorrhage.

Intra-abdominal lymphangioma

The historical background, aetiology, clinical features, radiographic findings and treatment of abdominal lymphangiomas are reviewed. The condition may give rise to the acute surgical abdomen.

Urethral obstruction owing to retroperitoneal cystic lymphangioma

We report a case of cystic lymphangioma arising from retroperitoneal tissues of the pelvis, which caused urethral obstruction and eventual urinary retention. Sonography and computerized tomography demonstrated a retroperitoneal cystic mass in the pelvis. A preoperative diagnosis of retroperitoneal cystic lymphangioma was suggested by typical computerized and sonographic features.