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Alrasheed SM, Alluqmani MF, Almoallem SH, Alshibely AY, Alharthi HE, Alkhalifah BS, Almutairi RM, Alnefaie SA, Alnahdi RK, Alshehri AY, Al Dossary MO, Ergsous RF, Bukhamsin MT, Alsalam AA, Al-Hawaj F. Lymphangioma: A Rare Benign Cystic Pancreatic Lesion. Cureus 2022; 14:e21056. [PMID: 35155021 PMCID: PMC8825325 DOI: 10.7759/cureus.21056] [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] [Accepted: 01/09/2022] [Indexed: 11/08/2022] Open
Abstract
Pancreatic lesions are more commonly identified nowadays with the widespread use of imaging investigations. Pancreatic lesions are heterogeneous groups of pathologies with different behavior and prognosis. It is quite difficult to differentiate these lesions because of the shared clinical manifestation and the overlapping imaging features of these lesions. We report the case of a 38-year-old woman who presented with a complaint of a 3-month history of epigastric abdominal pain radiating to her back. She reported a gradual increase in the severity of the pain. She described it as sharp in quality and was exacerbated with food intake and was alleviated by oral paracetamol. There was no history of abdominal distension, weight loss, or change in appetite. Apart from asthma, she had no other comorbid conditions or previous surgeries. She was referred to have an abdominal computed tomography scan which showed a large lesion that appears to arise from the head of the pancreas and was cystic with no soft tissue component. The radiological impression was a lymphoepithelial cyst, duplication cyst, pseudocyst from previous acute pancreatitis, lymphangioma, or intraductal papillary mucinous neoplasm. The decision for open surgical removal was decided. The patient underwent laparotomy and the cystic lesion was identified as arising from the pancreatic head. Complete resection of the mass was carried out with no complications. Histopathological examination revealed cystic lesions with the presence of lymphoid cells aggregates peripherally. The lining of the channels was positive for CD31 and was negative for CD34. Such findings conferred the diagnosis of lymphangioma. Lymphangioma is a very rare tumor of the pancreas with non-specific clinical and imaging features. Complete surgical resection of the lesion is the treatment of choice and the prognosis of the tumor is favorable if the tumor was resected completely.
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Affiliation(s)
- Salman M Alrasheed
- Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, SAU
| | - Maha F Alluqmani
- Medicine, Ibn Sina National College For Medical Studies, Jeddah, SAU
| | | | - Anmar Y Alshibely
- Medicine, King Saud bin Abdulaziz University for Health Sciences, Jeddah, SAU
| | | | - Bodour S Alkhalifah
- Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, SAU
| | - Reem M Almutairi
- Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, SAU
| | | | | | | | | | | | | | | | - Faisal Al-Hawaj
- Medicine, Imam Abdulrahman Bin Faisal University, Dammam, SAU
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Viscosi F, Fleres F, Mazzeo C, Vulcano I, Cucinotta E. Cystic lymphangioma of the pancreas: a hard diagnostic challenge between pancreatic cystic lesions-review of recent literature. Gland Surg 2018; 7:487-492. [PMID: 30505770 DOI: 10.21037/gs.2018.04.02] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Lymphangiomas are rare congenital benign tumors arising from the lymphatic system. The incidence of this disease in the pancreas is extremely rare, accounting for less than 1% of these tumors. Before introducing the review we reported a case of a 67-year-old woman with cystic lymphangioma of the pancreas. We reported the radiological investigations carried out preoperatively and the treatment performed. The review tries to identify the features described in literature of the pancreatic lymphangioma. We have performed a PubMed research of the world literature between January 1st 2000, to November 31st 2017, using the keywords [Lymphangioma pancreas], [diagnosis], [CT lymphangioma] and [MRI lymphangioma]. We have found 158 articles, of which about 100 were case reports. Based on our search criteria, we have identified 31 pancreatic lymphangioma in literature reporting their imaging characteristics. According to our report and to several authors in literature the diagnosis of cystic pancreatic lymphangioma should be considered as a differential diagnosis of pancreatic cystic lesions (PCLs). The role of imaging exams (CT and MRI) can help to identify and suspect this possibility of diagnosis. The endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) can have a potential role to reach the correct diagnosis.
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Affiliation(s)
- Francesca Viscosi
- Department of Human Pathology of the Adult and Evolutive Age "Gaetano Barresi", Section of General Surgery, University of Messina, Messina, Italy
| | - Francesco Fleres
- Department of Human Pathology of the Adult and Evolutive Age "Gaetano Barresi", Section of General Surgery, University of Messina, Messina, Italy
| | - Carmelo Mazzeo
- Department of Human Pathology of the Adult and Evolutive Age "Gaetano Barresi", Section of General Surgery, University of Messina, Messina, Italy
| | - Ignazio Vulcano
- Department of Human Pathology of the Adult and Evolutive Age "Gaetano Barresi", Section of General Surgery, University of Messina, Messina, Italy
| | - Eugenio Cucinotta
- Department of Human Pathology of the Adult and Evolutive Age "Gaetano Barresi", Section of General Surgery, University of Messina, Messina, Italy
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Abstract
Pancreatic cystic lymphangioma is an extremely rare tumor. The characteristic imaging findings are poorly defined, and distinguishing between this disease and other pancreatic cyst-related tumors is very difficult. We herein report a case of a Japanese woman in her 50s with this lesion, located in the tail of the pancreas. Pancreatic cystic lymphangioma should therefore be considered in the differential diagnosis of pancreatic cystic lesions. Laparoscopic resection can be a useful, minimally invasive surgical approach for treating these cysts as well as for the treatment of benign or low-grade malignant tumors located in the pancreatic body or tail.
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Affiliation(s)
- Masakuni Fujii
- Department of Internal Medicine, Okayama Saiseikai General Hospital, Japan
| | - Hiroaki Saito
- Department of Internal Medicine, Okayama Saiseikai General Hospital, Japan
| | - Masao Yoshioka
- Department of Internal Medicine, Okayama Saiseikai General Hospital, Japan
| | - Junji Shiode
- Department of Internal Medicine, Okayama Saiseikai General Hospital, Japan
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