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Chen J, Hai Y, Li Y, Wang C. Colonic multiple polypoidal protrusions: not familial adenomatous polyposis. Gut 2024:gutjnl-2023-331670. [PMID: 38199806 DOI: 10.1136/gutjnl-2023-331670] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2023] [Accepted: 01/04/2024] [Indexed: 01/12/2024]
Affiliation(s)
- Jintong Chen
- Department of Gastroenterology, First Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian, China
- Fujian Clinical Research Center for Liver and Intestinal Diseases, Fuzhou, Fujian, China
| | - Yali Hai
- Department of Gastroenterology, People's Hospital of Yuanzhou District, Guyuan, Ningxia, China
| | - Yuyang Li
- Department of Pathology, First Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian, China
| | - Chengdang Wang
- Department of Gastroenterology, First Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian, China
- Department of Gastroenterology, National Regional Medical Center, Binhai Campus of the First Affiliated Hospital, Fujian Medical University, Fuzhou, Fujian, China
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Zeng XY, Ding Y, Lu QQ, Huang WF. A Rare Case of Colonic Lymphangioma in an Adult Woman. Indian J Surg 2022. [DOI: 10.1007/s12262-022-03461-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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3
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Liu T, Basseri S, Mussari B, DaBreo D, SenGupta S, Villalobos D, Awad S. Generalized lymphatic anomalies and review of the current management landscape: a case report and review of the literature. J Med Case Rep 2021; 15:398. [PMID: 34372919 PMCID: PMC8353871 DOI: 10.1186/s13256-021-02953-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Accepted: 06/09/2021] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Generalized lymphatic anomaly previously known as diffuse systemic lymphangiomatosis is a rare multisystem congenital disease arising from the lymphatic system, and it is characterized by abnormal proliferation of the lymphatic channels in osseous and extraosseous tissues. It typically affects children or young adults. Although it is benign, it can be misdiagnosed as malignancy because of its diffuse and debilitating nature depending on the site of involvement. Due to its rarity, diagnosis is often delayed, leading to potential significant morbidity or mortality if vital organs are involved. Furthermore, its potential for multiorgan involvement with no curative treatment makes its management challenging. CASE PRESENTATION We describe a case of a 35-year-old Caucasian female, who presented with epigastric pain and was subsequently extensively investigated at multiple tertiary centers by numerous specialists for query malignancy and metabolic bone disorder following incidental computed tomography imaging findings of multiple osteolytic lesions in the axial skeleton, and low-attenuating lesions in the axilla, spleen, and mediastinum. The diagnosis was confirmed with an axillary excisional biopsy. She was clinically stable with no end organ damage. She was monitored conservatively. CONCLUSIONS The case illustrates the importance of increased awareness among clinicians for this rare congenital disease to enable earlier diagnosis and to avoid unnecessary invasive investigations. Furthermore, this case highlights the potential need for multiple biopsies of affected sites to confirm diagnosis. We also discuss the emergence of interferon therapy, chemotherapy, immunosuppression, and immunotherapy as medical management for this condition.
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Affiliation(s)
- Tao Liu
- Department of Medicine, Queen's University, C3-008, 166 Brock Street, Kingston, ON, K7L 5G2, Canada.
| | - Sana Basseri
- Department of Radiology, Queen's University, Kingston, ON, Canada
| | - Ben Mussari
- Department of Radiology, Queen's University, Kingston, ON, Canada
| | - Dominique DaBreo
- Department of Radiology, Queen's University, Kingston, ON, Canada
| | - Sandip SenGupta
- Department of Pathology, Queen's University, Kingston, ON, Canada
| | | | - Sara Awad
- Department of Medicine, Queen's University, C3-008, 166 Brock Street, Kingston, ON, K7L 5G2, Canada
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Jin D, Sun X, Shen W, Zhao Q, Wang R. Diagnosis of Lymphangiomatosis: A Study Based on CT Lymphangiography. Acad Radiol 2020; 27:219-226. [PMID: 31076330 DOI: 10.1016/j.acra.2019.03.024] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2018] [Revised: 03/28/2019] [Accepted: 03/28/2019] [Indexed: 11/15/2022]
Abstract
RATIONALE AND OBJECTIVES Lymphangiomatosis is a rare disease characterized by the widespread presence of lymphangiomas in any part of the body. In previous studies, lymphatic vessel abnormalities in lymphangiomatosis have only rarely been mentioned. The objective of this paper is to discuss the imaging features of lymphangiomatosis, including cystic lesions and lymphatic abnormalities, on computed tomography lymphangiography (CTL). MATERIALS AND METHODS All 34 patients who were diagnosed with lymphangiomatosis underwent direct lymphangiography followed by CTL. The CTL images were independently analyzed by two experienced radiologists. The CTL image analyses included assessment of the features of cystic lesions and lymphatic vessel abnormalities. RESULTS (i) CTL revealed several cystic lesions ranging in size from 3 mm to 14 cm; the lesions were located in the neck and shoulders (61.8%), mediastinum (52.9%), retroperitoneum (70.6%), and pelvis and perineum (64.7%). (ii) Approximately 29.4% of patients showed abnormal contrast medium accumulation in cystic masses. (iii) Approximately 67.6% of patients showed lymphatic reflux. (iv) Dilated lymphatic vessels were distributed in the mediastinum (38.2%), retroperitoneum (50.0%), pelvis and lower limbs (47.1%). (v) Finally, 8.8% of patients had perineal lymphatic fistulae, and 2.9% of patients had chyluria. CONCLUSION Lymphangiomatosis is a type of systemic lymphatic abnormality that is accompanied by multiple cystic lesions. The therapeutic measures for lymphangiomatosis are determined by the size of the cystic lesions. Furthermore, the prognosis of lymphangiomatosis is affected by lymphatic abnormalities.
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Affiliation(s)
- Dan Jin
- Department of Radiology, Beijing Shijitan Hospital, Peking University Ninth School of Clinical Medicine, Capital Medical University, No. 10 Tieyi St, Haidian District, Beijing 100038, PR China
| | - Xiaoli Sun
- Department of Radiology, Beijing Shijitan Hospital, Peking University Ninth School of Clinical Medicine, Capital Medical University, No. 10 Tieyi St, Haidian District, Beijing 100038, PR China
| | - Wenbin Shen
- Department of Lymph Surgery, Beijing Shijitan Hospital, Peking University Ninth School of Clinical Medicine, Capital Medical University, Beijing, PR China
| | - Qingqing Zhao
- Department of Radiology, Beijing Shijitan Hospital, Peking University Ninth School of Clinical Medicine, Capital Medical University, No. 10 Tieyi St, Haidian District, Beijing 100038, PR China
| | - Rengui Wang
- Department of Radiology, Beijing Shijitan Hospital, Peking University Ninth School of Clinical Medicine, Capital Medical University, No. 10 Tieyi St, Haidian District, Beijing 100038, PR China.
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Giuliani A, Romano L, Coletti G, Walid A Fatayer M, Calvisi G, Maffione F, Muolo C, Vicentini V, Schietroma M, Carlei F. Lymphangiomatosis of the ileum with perforation: A case report and review of the literature. Ann Med Surg (Lond) 2019; 41:6-10. [PMID: 30992989 PMCID: PMC6449703 DOI: 10.1016/j.amsu.2019.03.010] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2019] [Accepted: 03/24/2019] [Indexed: 01/10/2023] Open
Abstract
Lymphangiomatosis is a benign proliferation of lymph vessels. Lymphatic diseases can vary from small lymphangioma to generalized lymphangiomatosis, which is a rare condition and can have several clinical manifestations. The gastrointestinal tract may be affected, but the incidence in the intestinal wall is very low. We propose in our study a case of ileal lymphangiomatosis presenting with perforation, in which the diagnosis was made after the pathological analysis of the resected intestinal tract. Although rare and not described in the literature, intestinal lymphangiomatosis could manifest itself with acute abdomen and could be a surgical urgency. This disease should be considered when intestinal perforation is observed. Lymphangiomatosis is a multisystemic disorder. The GI tract may be affected, but the incidence of lymphangioma of the intestinal wall is very low. Lymphangiomatosis of the small bowel is a rare disease, so it is easy for a clinician to make a misdiagnosis. Intestinal lymphangiomatosis could manifest itself with an acute abdomen and surgical urgency. The pathologist should keep it in mind in the differential diagnosis, when he analyses a case of perforation.
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Affiliation(s)
| | - Lucia Romano
- Department of Surgery, University of L'Aquila, Italy
- Corresponding author. University of L'Aquila, Dipartimento di Scienze Chirurgiche, Ospedale San Salvatore, 67100, Coppito, AQ, Italy.
| | - Gino Coletti
- UOC Anatomia Patologica, ASL1 Abruzzo, Ospedale San Salvatore, L'aquila, Italy
| | | | - Giuseppe Calvisi
- UOC Anatomia Patologica, ASL1 Abruzzo, Ospedale San Salvatore, L'aquila, Italy
| | | | - Chiara Muolo
- Department of Surgery, University of L'Aquila, Italy
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Lu G, Li H, Li Y. Lymphangiomatosis of the sigmoid colon - a rare cause of lower gastrointestinal bleeding: A case report and review of the literature. Oncol Lett 2016; 13:339-341. [PMID: 28123564 DOI: 10.3892/ol.2016.5399] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2015] [Accepted: 07/20/2016] [Indexed: 12/29/2022] Open
Abstract
The present study reports the case of a 79-year-old Chinese man who presented to The First Affiliated Hospital of Xi'an Jiaotong University (Xi'an, China) for the treatment of lower gastrointestinal bleeding. Multiple cystic masses in the sigmoid colon were observed with colonoscopy, and through endoscopic ultrasound (EUS), these cystic masses were confirmed to be echo-free and to exhibit septal walls in the submucosal layer; in consequence, lymphangiomatosis of the sigmoid colon was diagnosed. Considering the repeated bleeding, laparoscopy-assisted partial sigmoid colon resection was performed. The excised specimens were multiple vesicular and soft masses of ~1 cm in diameter, which were located in the submucosal layer and were surrounded by flat endothelial cells. Immunohistochemistry revealed that the specimens were positive for the specific lymphatic endothelial marker D2-40. The pathological diagnosis was consistent with the EUS findings. In the 2-year follow-up after the operation, no bleeding or other complications were noticed.
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Affiliation(s)
- Guifang Lu
- Department of Gastroenterology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi 710061, P.R. China
| | - Hongxia Li
- Department of Gastroenterology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi 710061, P.R. China
| | - Yuanyuan Li
- Department of Gastroenterology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi 710061, P.R. China
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Ilhan M, Oner G, Alibeyoglu A, Yeğen G, Gök AFK, Akyüz F, Bicen F. Primary intestinal lymphangiomatosis of the ileum in an adult-the role of surgical approach. J Surg Case Rep 2016; 2016:rjw133. [PMID: 27534888 PMCID: PMC4988297 DOI: 10.1093/jscr/rjw133] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Lymphangioma is a rare benign tumor that occurs due to abnormalities occurring during lymphatic development. It is usually seen in children and young adults. The incidence of lymphangiomas in the gastrointestinal tract is very low. Here we describe the case of 43-year-old woman with lymphangioma of the ileum with infiltrative polyposis-like appearing lesions diagnosed by capsule endoscopy and treated with segmental resection of affected intestinal part with laparotomy. Lesions involving mesentery and ileum were confirmed by pathology. After surgery, the patient's symptoms improved. No further therapy was needed because of the benign manner of the lesions. Patient had no symptoms in 10 months follow-up after surgery.
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Affiliation(s)
- Mehmet Ilhan
- Department of General Surgery, Istanbul University Istanbul Faculty of Medicine, Istanbul, Turkey
| | - Gizem Oner
- Department of General Surgery, Istanbul University Istanbul Faculty of Medicine, Istanbul, Turkey
| | - Alpay Alibeyoglu
- Department of Internal Medicine, Istanbul University Istanbul Faculty of Medicine, Istanbul, Turkey
| | - Gülçin Yeğen
- Department of Pathology, Istanbul University Istanbul Faculty of Medicine, Istanbul, Turkey
| | - Ali Fuat Kaan Gök
- Department of General Surgery, Istanbul University Istanbul Faculty of Medicine, Istanbul, Turkey
| | - Filiz Akyüz
- Department of Internal Medicine, Istanbul University Istanbul Faculty of Medicine, Istanbul, Turkey
| | - Fuat Bicen
- Department of Radiology, Istanbul University Istanbul Faculty of Medicine, Istanbul, Turkey
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Lee YS, Kim GW, Cho HJ, Shim CS. Colonic lymphangiomatosis resolved after excisional biopsy. Clin Endosc 2015; 48:81-4. [PMID: 25674533 PMCID: PMC4323441 DOI: 10.5946/ce.2015.48.1.81] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2014] [Revised: 04/02/2014] [Accepted: 05/12/2014] [Indexed: 01/27/2023] Open
Abstract
Lymphangioma is an uncommon malformation of the lymphatic system that involves a benign proliferation of the lymphatics, with no established treatment method. Multiple colonic lymphangioma, or colonic lymphangiomatosis, is an extremely rare condition. We report a case of colonic lymphangiomatosis that was detected during a colonoscopic examination conducted as part of a general health check-up. The lesion completely resolved after excisional biopsy.
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Affiliation(s)
- Young Soo Lee
- Department of Internal Medicine, Sahmyook Medical Center, Seoul, Korea
| | - Gyu Won Kim
- Department of Internal Medicine, Sahmyook Medical Center, Seoul, Korea
| | - Hye Jae Cho
- Department of Pathology, Sahmyook Medical Center, Seoul, Korea
| | - Chan Sup Shim
- Division of Gastroenterology, Department of Internal Medicine, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul, Korea
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Zhuo CH, Shi DB, Ying MG, Cheng YF, Wang YW, Zhang WM, Cai SJ, Li XX. Laparoscopic segmental colectomy for colonic lymphangiomas: A definitive, minimally invasive surgical option. World J Gastroenterol 2014; 20:8745-8750. [PMID: 25024636 PMCID: PMC4093731 DOI: 10.3748/wjg.v20.i26.8745] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2013] [Revised: 01/29/2014] [Accepted: 03/10/2014] [Indexed: 02/06/2023] Open
Abstract
Colonic lymphangioma is an unusual benign malformation. We herein describe two cases. A 36-year-old woman was admitted with one year of intermittent abdominal pain; colonoscopy, abdominopelvic computed tomography and endoscopic ultrasonography (EUS) revealed enlarged cystic masses at the ascending colon. In another 40-year-old man, colonoscopy and EUS revealed an asymptomatic lobulated cystic mass with four small sessile polyps at the sigmoid colon. Both patients underwent laparoscopic segmental colectomy. Both masses were histologically confirmed as cystic lymphangiomas, and the patients were discharged without complications. The management of colonic lymphangioma depends on the individual situation; close surveillance or endoscopic therapy may be appropriate for asymptomatic lesions smaller than 2.5 cm in diameter. Surgical intervention can be considered for larger lesions or in patients who develop complication risks. Laparoscopic segmental colon resection may be recommended to excise relatively large submucosal lesions because it is a definitive, minimally invasive intervention with a fast postoperative recovery.
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Lin RY, Zou H, Chen TZ, Wu W, Wang JH, Chen XL, Han QX. Abdominal lymphangiomatosis in a 38-year-old female: Case report and literature review. World J Gastroenterol 2014; 20:8320-8324. [PMID: 25009412 PMCID: PMC4081712 DOI: 10.3748/wjg.v20.i25.8320] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2013] [Revised: 02/09/2014] [Accepted: 04/09/2014] [Indexed: 02/06/2023] Open
Abstract
Lymphangioma is an uncommon benign tumor that develops in the lymphatic system. Abdominal lymphangiomatosis is extremely rare in adult patients, and the clinical symptoms of this condition are complicated and atypical. We report a case of abdominal lymphangiomatosis in a 38-year-old female who presented with intestinal bleeding and protein-losing enteropathy, as well as lesions in the lung and bones. A computed tomography scan revealed multiple small cystic lesions without enhancement. Histological examination revealed microscopic cysts were submucosal, with walls composed of thin fibrous tissue, and D2-40 stained highlight the lining of the lymphatic channels by immunohistochemical method. We make a comparison with the cases reported before, and also discuss the diagnose of diffuse pulmonary lymphangiomatosis and Gorham’s disease.
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11
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Hynes SO, McLaughlin R, Kerin M, Rowaiye B, Connolly CE. A unique cause of a rare disorder, unilateral macromastia due to lymphangiomatosis of the breast: a case report. Breast J 2012; 18:367-70. [PMID: 22730958 DOI: 10.1111/j.1524-4741.2012.01256.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Macromastia and in particular unilateral macromastia is a rare clinical entity. It relates to massive enlargement of the breast in non-obese women. This case report describes an initially mild unilateral asymmetry occurring nine months postpartum in a 33-year-old female. However, following her second pregnancy within 12 months, her left breast became severely enlarged. This did not improve on delivery. No discrete lesion was seen on imaging and no significant abnormalities were seen in her blood chemistry. Surgical treatment was a mammoplasty and 580 g of mammary tissue was removed. Grossly, there was spongiform subcutaneous tissue with diffuse extension. On histology, this consisted of a highly complex and diffuse pattern of infiltration and of cavernous empty channels lined by a delicate attenuated endothelium which was CD34 and D2-40 positive. The appearances were consistent with lymphangiomatosis, more commonly encountered in the limbs, heretofore. Lymphangiomatosis has not been previously described in breast tissue and only a single case report exists for such a lesion in axillary tissue. Treatment of such lesions in the periphery by surgical excision is very difficult and excision without being radical can be impossible. Follow up of our patient, shows no evidence of recurrence in this patient. Our case report describes the clinicopathological features, differential diagnosis to be considered and treatment, in addition to reviewing the relevant literature.
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Affiliation(s)
- Sean O Hynes
- Departments of Histopathology Department of Surgery, Galway University Hospitals, Galway, Ireland
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Case report - An acute presentation of lymphangiomatosis. Int J Surg Case Rep 2012; 3:158-60. [PMID: 22377502 DOI: 10.1016/j.ijscr.2011.08.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2011] [Accepted: 08/30/2011] [Indexed: 11/21/2022] Open
Abstract
INTRODUCTION Lymphangioma is an uncommon malformation of lymphatic system. Multiple colonic lymphangioma named as lymphangiomatosis is considered an extremely rare disease. PRESENTATION OF CASE We report a case of colonic lymphangiomatosis presenting as recurrent right iliac fossa pain in a young female treated surgically. DISCUSSION Lymphangiomatosis is a rare but benign disease with a variety of presentations. There are few reported cases in the literature at present and no guidelines regarding the diagnosis or treatment of the same. CONCLUSION Our case demonstrates an unusual presentation of lymphangiomatosis treated surgically. Debate will remain on this rare condition.
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