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Shi R, Yang P, Guo Y, Tang Y, Luo H, Qin C, Jiang T, Huang Y, Gao Z, Zeng X, Wang J. Laparoscopic anatomical partial splenectomy for extremely rare isolated splenic lymphangioma in an adult: a case report and literature review. Front Oncol 2024; 14:1460566. [PMID: 39296983 PMCID: PMC11408321 DOI: 10.3389/fonc.2024.1460566] [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: 07/06/2024] [Accepted: 08/21/2024] [Indexed: 09/21/2024] Open
Abstract
Background Benign tumors of the spleen are rare compared to those of other parenchymal organs, accounting for less than 0.007% of all tumors, and are often found incidentally. Splenolymphangiomas are much rarer, commonly occur in children, and tend to have multiple foci. Splenic lymphangiomas are rare in adults, and fewer than 20 adult patients with isolated splenic lymphangiomas have been reported. In this article, we report the case of a middle-aged female patient with isolated splenic lymphangioma who underwent laparoscopic anatomical hypophysectomy of the lower pole of the spleen. We also summarize the existing literature on splenic lymphangioma diagnosis and available treatment options. Case presentation A 58-year-old middle-aged woman was found to have a mass approximately 60 mm in diameter at the lower pole of the spleen during a health checkup that was not accompanied by other symptoms or examination abnormalities. After completing a preoperative examination with no contraindications to surgery, the patient underwent laparoscopic anatomical splenectomy of the lower extremity of the spleen. The patient recovered well without complications and was discharged from the hospital on the 7th postoperative day. Histopathological and immunohistochemical results confirmed the diagnosis of splenic lymphangioma. Prompt surgical intervention is safe and necessary when splenic lymphangiomas are large or associated with a risk of bleeding. Conclusion Splenic lymphangiomas are rare and require early surgical intervention in patients with large tumor diameters or those at risk of rupture and bleeding. After rigorous preoperative evaluation and preparation, laparoscopic anatomical partial splenectomy is safe and feasible for surgeons with experience in laparoscopic surgery.
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Affiliation(s)
- Ruizi Shi
- Department of Hepatobiliary Surgery, Mianyang Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Mianyang, China
| | - Pei Yang
- Department of Hepatobiliary Surgery, Mianyang Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Mianyang, China
| | - Yangjie Guo
- Department of Hepatobiliary Surgery, Mianyang Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Mianyang, China
| | - Yiping Tang
- Department of Hepatobiliary Surgery, Mianyang Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Mianyang, China
| | - Hua Luo
- Department of Hepatobiliary Surgery, Mianyang Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Mianyang, China
| | - Chuan Qin
- Department of Hepatobiliary Surgery, Mianyang Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Mianyang, China
| | - Ting Jiang
- Department of Hepatobiliary Surgery, Mianyang Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Mianyang, China
| | - Yu Huang
- Department of Hepatobiliary Surgery, Mianyang Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Mianyang, China
| | - Ziqing Gao
- Department of Pathology, Mianyang Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Mianyang, China
| | - Xintao Zeng
- Department of Hepatobiliary Surgery, Mianyang Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Mianyang, China
| | - Jianjun Wang
- Department of Hepatobiliary Surgery, Mianyang Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Mianyang, China
- NHC Key Laboratory of Nuclear Technology Medical Transformation, Mianyang Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Mianyang, China
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2
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Soleimani N, Pouraminaee F, Anbardar MH, Bahador A, Rahimi B, Mohammadzadeh S, Aghakhaninejad F, Farahmand M, Hasani M. Splenic Lymphangioma Mimicking Lymphomatous Involvement: A Case Report with Review of the Literature. Case Rep Med 2023; 2023:9969213. [PMID: 37383046 PMCID: PMC10299890 DOI: 10.1155/2023/9969213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Revised: 06/08/2023] [Accepted: 06/14/2023] [Indexed: 06/30/2023] Open
Abstract
Lymphangioma is a benign malformation of lymphatic vessels usually found in the head and neck areas or axilla. They may involve visceral organs with a lower percentage. Splenic lymphangioma is a rare tumor. This disease is often seen in children but may be diagnosed incidentally in adults. Most patients are asymptomatic, but in large and multifocal lesions, the patient may have some nonspecific symptoms such as abdominal pain, abdominal distention, nausea, vomiting, and loss of appetite. Physical examination may show no specific findings or detect palpable masses. The preoperative diagnosis of splenic lymphangioma is challenging. Histopathological evaluation and sometimes immunohistochemistry tests can result in a definitive diagnosis. In this study, we present an 18-year-old man, with Burkitt's lymphoma who underwent laparotomy and total splenectomy as a result of cystic lesions discovered accidentally during imaging with the final diagnosis of splenic lymphangioma after histopathological evaluation.
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Affiliation(s)
- Neda Soleimani
- Department of Pathology, Shiraz Medical School, Shiraz University of Medical Sciences, Shiraz, Iran
- Shiraz Transplant Center, Abu Ali Sina Hospital, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Fatemeh Pouraminaee
- Pathology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mohammad Hossein Anbardar
- Department of Pathology, Shiraz Medical School, Shiraz University of Medical Sciences, Shiraz, Iran
- Shiraz Transplant Center, Abu Ali Sina Hospital, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Ali Bahador
- Shiraz Transplant Center, Abu Ali Sina Hospital, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Benyamin Rahimi
- Department of Pathology, Shiraz Medical School, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Sahand Mohammadzadeh
- Department of Pathology, Shiraz Medical School, Shiraz University of Medical Sciences, Shiraz, Iran
- Shiraz Transplant Center, Abu Ali Sina Hospital, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Fatemeh Aghakhaninejad
- Department of Pathology, Shiraz Medical School, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mohammad Farahmand
- Shiraz Transplant Center, Abu Ali Sina Hospital, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mahsa Hasani
- Department of Pathology, Shiraz Medical School, Shiraz University of Medical Sciences, Shiraz, Iran
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3
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Su T, Li C, Song B, Song D, Feng Y. Case report and literature review: Giant retroperitoneal cystic lymphangioma. Front Surg 2023; 10:1074067. [PMID: 36733888 PMCID: PMC9887134 DOI: 10.3389/fsurg.2023.1074067] [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: 10/19/2022] [Accepted: 01/02/2023] [Indexed: 01/18/2023] Open
Abstract
Background Cystic lymphangioma is a rare benign tumor of the lymphatic system, which is most commonly observed in the neck, head and armpit.Less than 5% of lymphangiomas occur in the abdominal cavity and even less in the retroperitoneum. Case description A 65-year-old male patient was diagnosed with an "abdominal mass that had persisted for 1 year, accompanied by abdominal pain, abdominal distension and dyspnea for 7 days". After abdominal computerd tomography, a giant multilobed abdominal lymphangioma was suspected, which squeezed the intestinal canal and was closely related to the inferior vena cava. The patient underwent an exploratory laparotomy, during which, it was found that the tumor formed extensive adhesions to the transverse colon, small intestine and pelvic wall, and enveloped the abdominal aorta, superior mesenteric artery, inferior mesenteric artery and inferior vena cava to varying degrees. It was diffcult to remove the cyst completely. Postoperative pathology confirmed the diagnosis of retroperitoneal cystic lymphangioma. The patient recovered well after the operation, was eating normally by 5 days postoperatively,and was discharged 10 days postoperatively.The patient was followed up 1 month after postoperatively and no evidence of recurrence was observed. Conclusion In this case, we report a patient with giant retroperitoneal cystic lymphangioma who underwent exploratory laparotomy combined with preoperative abdominal computerd tomography and acute abdominal pain, abdominal distension and dyspnea. Because of the large volume of the tumor and its close relationship with the superior mesenteric artery and other blood vessels, the surgeon used scissors to separate the tumor sharply and removed the whole tumor completely.
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Affiliation(s)
- Tieshan Su
- Departments of Gastrointestinal Colorectal Anus Surgery, China-Japan Union Hospital, Jilin University, Changchun, China
| | - Chaoyuan Li
- Departments of Orthopedics Surgery, China-Japan Union Hospital, Jilin University, Changchun, China
| | - Bin Song
- Departments of Gastrointestinal Colorectal Anus Surgery, China-Japan Union Hospital, Jilin University, Changchun, China
| | - Defeng Song
- Departments of Gastrointestinal Colorectal Anus Surgery, China-Japan Union Hospital, Jilin University, Changchun, China,Correspondence: Defeng Song Ye Feng
| | - Ye Feng
- Departments of Gastrointestinal Colorectal Anus Surgery, China-Japan Union Hospital, Jilin University, Changchun, China,Correspondence: Defeng Song Ye Feng
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4
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Pham MD, Nguyen MT, Vo MTT, Hoang VT, Pham NTT. Splenic lymphangioma in adult patient treated with laparoscopic splenectomy: A rare case report. SAGE Open Med Case Rep 2023; 11:2050313X221147196. [PMID: 36636099 PMCID: PMC9829880 DOI: 10.1177/2050313x221147196] [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: 09/12/2022] [Accepted: 12/07/2022] [Indexed: 01/05/2023] Open
Abstract
Splenic lymphangioma is a benign cystic tumor that develops as a result of lymphatic vessels' congenital abnormalities. It is a rare condition that mostly occurs in children and young adults. Due to the lack of typical symptoms and signs, splenic lymphangioma is difficult to diagnose and often incidentally revealed during radiological examinations. We report a case of a 55-year-old Asian female, who presented with left upper quadrant abdominal pain in the past 3 days. She had mild upper abdominal tenderness, with no other specific findings. Abdominal contrast material-enhanced computed tomography revealed three hypodense lesions arising from a normal-sized spleen. The histologic findings after laparoscopic splenectomy demonstrated a 3-cm-diameter yellowish-white tumor made up of multiple cystic structures. Primary benign splenic tumors are exceedingly rare, especially in adults over 20. While small lesions are mostly asymptomatic, bigger lesions can cause organ compression or even rupture. Therefore, even in adults with pain in the left upper quadrant abdomen or enlarged spleen, splenic lymphangioma should be taken into account in the differential diagnosis. The case serves as an example of a rare congenital splenic tumor. Treatment of this benign splenic abnormality with laparoscopic splenectomy is a good, safe approach.
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Affiliation(s)
- Minh Duc Pham
- Department of Surgery, Hue University of Medicine and Pharmacy, Hue University, Hue, Vietnam,Department of Abdominal Emergency and Pediatric Surgery, Hue Central Hospital, Hue, Vietnam
| | - Minh Thao Nguyen
- Anatomy and Surgical training Department, Hue University of Medicine and Pharmacy, Hue University, Hue, Vietnam
| | - Minh Tri Thi Vo
- School of Medicine and Pharmacy, The University of Da Nang, Da Nang, Vietnam
| | - Van Trung Hoang
- Department of Radiology, Thien Hanh Hospital, Buon Ma Thuot, Vietnam
| | - Ngoc Trinh Thi Pham
- School of Medicine and Pharmacy, The University of Da Nang, Da Nang, Vietnam,Ngoc Trinh Thi Pham, School of Medicine and Pharmacy, The University of Da Nang, 41 Le Duan Street, Da Nang 550000, Vietnam.
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5
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Malgras B, Najah H, Dohan A, Barat M, Soyer P. Diagnosis and treatment of focal splenic lesions. J Visc Surg 2022; 159:121-135. [DOI: 10.1016/j.jviscsurg.2021.11.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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6
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Barat M, Hoeffel C, Aissaoui M, Dohan A, Oudjit A, Dautry R, Paisant A, Malgras B, Cottereau AS, Soyer P. Focal splenic lesions: Imaging spectrum of diseases on CT, MRI and PET/CT. Diagn Interv Imaging 2021; 102:501-513. [PMID: 33965354 DOI: 10.1016/j.diii.2021.03.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Revised: 03/29/2021] [Accepted: 03/31/2021] [Indexed: 12/12/2022]
Abstract
The spleen can be affected by a variety of diseases. Some of them are readily identified as variations of normal or benign diseases on imaging. However, for a substantial number of focal splenic abnormalities, the diagnosis can be difficult so that histopathologic analysis may be required for a definite diagnosis. In this review, the typical splenic abnormalities that can be diagnosed with imaging with a high degree of confidence are illustrated. The complementary role of computed tomography (CT), magnetic resonance imaging and positron emission tomography/CT that helps make a diagnostic approach is discussed. Finally, current applications and future trends of radiomics and artificial intelligence for the diagnosis of splenic diseases are addressed.
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Affiliation(s)
- Maxime Barat
- Department of Radiology, Hôpital Cochin, AP-HP, 75014 Paris, France; Université de Paris, 75006 Paris, France.
| | - Christine Hoeffel
- Department of Radiology, Reims University Hospital, 51092 Reims, France; CRESTIC, University of Reims Champagne-Ardenne, 51100 Reims, France
| | | | - Anthony Dohan
- Department of Radiology, Hôpital Cochin, AP-HP, 75014 Paris, France; Université de Paris, 75006 Paris, France
| | - Amar Oudjit
- Department of Radiology, Hôpital Cochin, AP-HP, 75014 Paris, France
| | - Raphael Dautry
- Department of Radiology, Hôpital Cochin, AP-HP, 75014 Paris, France
| | - Anita Paisant
- Department of Radiology, University Hospital of Angers, 49100 Angers, France; Faculté de Médecine, Université d'Angers, 49045 Angers, France
| | - Brice Malgras
- Department of Digestive and Endocrine Surgery, Bégin Army Training hospital, 94160 Saint-Mandé, France; École du Val-de-Grâce, 75005 Paris, France
| | - Anne-Ségolène Cottereau
- Université de Paris, 75006 Paris, France; Department of Nuclear Medicine, Hôpital Cochin, AP-HP, 75014 Paris, France
| | - Philippe Soyer
- Department of Radiology, Hôpital Cochin, AP-HP, 75014 Paris, France; Université de Paris, 75006 Paris, France
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7
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Evola G, Mazzone G, Corsaro A, Brancato G, Evola FR, Basile G. Hemorrhagic shock from post-traumatic rupture of microcystic splenic lymphangioma: A case report and review of the literature. Int J Surg Case Rep 2020; 75:376-379. [PMID: 32987290 PMCID: PMC7522038 DOI: 10.1016/j.ijscr.2020.09.045] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2020] [Revised: 09/06/2020] [Accepted: 09/06/2020] [Indexed: 11/23/2022] Open
Abstract
INTRODUCTION Lymphangioma is an abnormal proliferation of lymphatic vessels. Isolated splenic lymphangioma (SL) is rare; in the last 30 years only 22 cases were reported in the literature. Diagnosis is difficult by the absence of typical symptoms and signs. SL is often asymptomatic and occasionally detected through radiological exams or, after the onset of a life-threatening complication, at surgery or pathological examination. Surgery represents the treatment of choice. PRESENTATION OF CASE A 22-year-old Caucasian male was admitted to the Emergency Department after a car accident, complaining of sudden onset, severe, left upper quadrant abdominal pain. Abdominal examination revealed mild abdominal distention and a severe abdominal pain on superficial and deep palpation of left upper abdominal quadrant with obvious muscle guarding and rebound tenderness. Abdominal computed tomography scan showed splenic rupture with hemoperitoneum. Laboratory tests reported severe anemia. The patient received blood transfusions and was taken emergently to the operating room for exploratory laparotomy, evacuation of hemoperitoneum and splenectomy. The postoperative course was uneventful, the patient was discharged on the 7th post-operative day. Diagnosis of microcystic SL was made at pathological examination. DISCUSSION Post-traumatic splenic rupture may be favored by the presence of a unknown and asymptomatic isolated SL. Although different types of treatment of SL are reported in the literature, splenectomy represents the treatment of choice to avoid complications. CONCLUSION Isolated SL is difficult to diagnose and suspect because of lack of pathognomonic symptoms and specific diagnostic signs. It can be diagnosed after the onset of a life-threatening complication. Splenectomy is the preferable definitive treatment.
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Affiliation(s)
- Giuseppe Evola
- General and Emergency Surgery Department, Garibaldi Hospital, Piazza Santa Maria di Gesù 5, 95100, Catania, Italy.
| | - Giovanni Mazzone
- First Department of Surgery, Azienda Ospedaliero-Universitaria "Policlinico-V. Emanuele-San Marco", P.O. San Marco, Viale C.A. Ciampi, 95121, Catania, Italy
| | - Antonino Corsaro
- Department of General Surgery and Medical-Surgical Specialties, University of Catania, Via S. Sofia 78, 95123, Catania, Italy
| | - Giovanna Brancato
- Department of General Surgery and Medical-Surgical Specialties, University of Catania, Via S. Sofia 78, 95123, Catania, Italy
| | - Francesco Roberto Evola
- Department of Orthopedic and Traumatology, Cannizzaro Hospital, Via Messina 829, 95126, Catania, Italy
| | - Guido Basile
- Department of General Surgery and Medical-Surgical Specialties, University of Catania, Via S. Sofia 78, 95123, Catania, Italy
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8
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Perez A, Perez MEC, Yuga AC, Viray BAG. Splenic lymphangioma in adulthood: A case report. Int J Surg Case Rep 2020; 67:250-253. [PMID: 32086147 PMCID: PMC7029340 DOI: 10.1016/j.ijscr.2020.01.061] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2020] [Accepted: 01/29/2020] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION Splenic disease are uncommon and primary tumors of the spleen are very rare. These are classified as splenic cyst, benign and malignant tumors. Splenic lymphangioma is a rare, slow-growing benign tumor of the spleen. More often seen in children, it is a congenital malformation of the lymphatic system and is rarely seen in adulthood. When present in adults, it is usually asymptomatic and would be incidentally detected through imaging studies. Infrequently, some patients would present with abdominal pain, distension, nausea, and may have palpable abdominal mass. It may be solitary or may have multiple splenic lesions. PRESENTATION OF CASE We present of a case of splenic mass in a 56-year old female, which remained undetected until incidentally discovered on work-up for chronic back pain. Laparoscopic splenectomy was eventually performed with eventual resolution of the chronic back pain. Histopathologic examination revealed splenic lymphangioma. DISCUSSION Splenic tumors are uncommon. Splenic lymphangiomas presenting in adulthood are extremely rare, and preoperative diagnosis may be difficult in asymptomatic patients. CONCLUSION Surgical removal of splenic lymphangiomas may be necessary to relieve symptoms, prevent complications and confirm diagnosis.
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Affiliation(s)
- Anthony Perez
- Department of Surgery, University of the Philippines-Philippine General Hospital, Philippines; Division of Hepatopancreaticobiliary Surgery, Department of Surgery, University of the Philippines-Philippine General Hospital, Philippines.
| | - Mary Ellen C Perez
- Department of Anesthesiology, University of the Philippines-Philippine General Hospital, Philippines
| | - Ann Camille Yuga
- Department of Surgery, University of the Philippines-Philippine General Hospital, Philippines
| | - Brent Andrew G Viray
- Department of Surgery, University of the Philippines-Philippine General Hospital, Philippines
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9
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Castro-Poças FM, Bernardo S, Lima OMG, Santos MD. Miniprobe endoscopic ultrasonography for the diagnosis of colon hemangiolymphangioma. REVISTA ESPANOLA DE ENFERMEDADES DIGESTIVAS 2019; 111:488-490. [PMID: 31140287 DOI: 10.17235/reed.2019.6144/2018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Hemangiolymphangioma is a very rare benign vascular tumor that affects the gastrointestinal tract in less than 1% of cases. We present the case of an asymptomatic 52-year-old female referred for endoscopic colorectal cancer screening. A sub-epithelial pediculated polypoid lesion in the splenic angle of the colon was identified. An endoscopic ultrasonography with a miniprobe was performed, which identified an anechoic lesion in the submucosal layer. Surgery was performed and the histologic findings were compatible with two hemangiolymphangioma lesions. This is one of the few cases reported in the literature of hemangiolymphangioma diagnosed by miniprobe endoscopic ultrasonography and the first to describe two lesions in the same patient.
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Affiliation(s)
- Fernando M Castro-Poças
- Gastroenterology, Santo António Hospital. Institute of Biomedical Sciences Abel Salazar, Portugal
| | | | | | - Marisa D Santos
- Surgery, Santo António Hospital. Institute of Biomedical Sciences Abel Salazar, Portugal
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10
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Kumar P, Kumar S, Husain N, Chandra A. Isolated cystic lymphangiomatosis of spleen in an adult: a diagnostic conundrum. BMJ Case Rep 2018; 2018:bcr-2017-223856. [PMID: 29622712 DOI: 10.1136/bcr-2017-223856] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Lymphangiomatosis is a rare developmental disorder characterised by diffuse proliferation of anastomosing lymphatic channels (lymphangiomas). It is believed to result from anomalous lymphatic development and usually presents in childhood. It typically occurs as a part of systemic lymphangiomatosis and isolated organ involvement is rare. Only nine cases of isolated cystic lymphangiomatosis of spleen have been reported between 1990 and 2010. Tuberculosis is a significant health problem in India and varied forms of this disease are seen in clinical practice. Isolated splenic tuberculosis, though a rare entity, has been described in the Indian population. We present a case of isolated splenic lymphangiomatosis in a 42-year-old woman that was initially misdiagnosed as splenic tuberculosis and was treated accordingly. Unresponsive to medical treatment, the patient underwent splenectomy and on histopathological examination, cystic lymphangiomatosis was diagnosed. The patient's symptoms resolved after surgery and she is doing well at a follow-up of 3 months.
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Affiliation(s)
- Pavan Kumar
- Department of Surgical Gastroenterology, King George's Medical University, Lucknow, Uttar Pradesh, India
| | - Saket Kumar
- Department of Surgical Gastroenterology, King George's Medical University, Lucknow, Uttar Pradesh, India
| | - Nuzhat Husain
- Department of Pathology, Dr Ram Manohar Lohia Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Abhijit Chandra
- Department of Surgical Gastroenterology, King George's Medical University, Lucknow, Uttar Pradesh, India
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11
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Alsubaie HM, Alsubaie KM, Mahfouz ME. Giant pulmonary teratoma with huge splenic lymphangiomatosis: a very rare case. J Surg Case Rep 2017; 2017:rjx117. [PMID: 28928924 PMCID: PMC5597874 DOI: 10.1093/jscr/rjx117] [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: 05/08/2017] [Accepted: 08/05/2017] [Indexed: 11/14/2022] Open
Abstract
Teratomas are tumors composed of tissues derived from more than one germ cell line. They manifested with a great variety of clinical and radiological features. We report a case of a giant left hemithorax teratoma in a female with huge spleen tumor and review the relevant literature. A 38-year-old female with progressively aggravating dyspnea at rest from a mild trauma. Absent breath sounds on the left side. There was splenomegaly. Computed tomography scan revealed a huge mass (20 × 15 × 18 cm), containing elements of heterogeneous density in the left hemithorax. The spleen tumor was occupying most of the spleen without any other abdominal manifestations. The patient underwent left thoracotomy and laparoscopic splenectomy. Histopathological examination revealed a benign mature teratoma and cystic lymphangiomatosis of the spleen. To the best of our knowledge and after reviewing the available literature this is the first case of huge mature pulmonary teratoma with large cystic spleen lymphangiomatosis.
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Affiliation(s)
| | | | - Mohammed Eid Mahfouz
- Department of Surgery, College of Medicine, Taif University, Taif, Saudi Arabia.,Surgical Departments, King Abdul Aziz Specialist Hospital, Taif, Saudi Arabia
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12
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Duvvada S, Senapati D, Challa SR, Kalluri T. Cystic lymphangioma of spleen in adults. BMJ Case Rep 2017; 2017:bcr2016216267. [PMID: 28122799 PMCID: PMC5278320 DOI: 10.1136/bcr-2016-216267] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/12/2016] [Indexed: 11/03/2022] Open
Abstract
Splenic diseases are rare. Tumours of the spleen are classified as either benign or malignant. Primary benign tumours of the spleen are extremely rare, identified on surgery and autopsy, accounting for <0.007% of all splenic tumours. Splenic lymphangiomas are benign cystic tumours resulting from congenital malformations of the lymphatic system that appear as a single or multiple lesions of the spleen. It mainly affects children and is rarely manifested after the age of 20 years of age. We report a case of cystic lymphangioma of spleen in a 40-year-old woman admitted with a huge mass in the abdomen, which on imaging found to be a cystic mass arising from spleen. On laparotomy the spleen was found occupying a major part of the abdomen. Splenectomy was performed and histopathological examination revealed it to be a cystic lymphangioma of spleen. This case report emphasises on the rarity of the case at this age and the sheer size of the tumour, being largest until as per our knowledge.
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Affiliation(s)
- Shalini Duvvada
- Department of General Surgery, Konaseema Institute of Medical Sciences and Research Foundation Hospital, Amalapuram, Andhra Pradesh, India
| | - Debadutta Senapati
- Department of General Surgery, S.C.B. Medical College & Hospital, Cuttack, Odisha, India
| | - Sreenivas Rao Challa
- Department of General Surgery, Konaseema Institute of Medical Sciences & Research Foundation, Amalapuram, Andhra Pradesh, India
| | - Tejokrishna Kalluri
- Department of General Surgery, Konaseema Institute of Medical Sciences and Research Foundation Hospital, Amalapuram, Andhra Pradesh, India
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13
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14
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Patil AR, Nandikoor S, De Marco J, Bhat R, Shivakumar S, Mallrajapatna G. Disorders of the lymphatic system of the abdomen. Clin Radiol 2016; 71:941-952. [PMID: 27450410 DOI: 10.1016/j.crad.2016.06.116] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2016] [Revised: 06/22/2016] [Accepted: 06/27/2016] [Indexed: 12/31/2022]
Abstract
The lymphatic system of the abdomen comprises of the cisterna chyli, its major and minor lymphatic tributaries, and lymph nodes. Disorders of the lymphatic system of the abdomen are rarely encountered and consist of primary and secondary types. Abdominal lymphangiomas constitute the majority and have characteristic imaging features. Complicated lymphangiomas may pose a diagnostic dilemma. Generalised systemic lymphangiomatosis is a rare condition and affects major organs with a poor prognosis. Retroperitoneal lymphangiectasia in the appropriate setting might predict underlying infection, such as filariasis. Other acquired conditions include iatrogenic or treatment-induced chylocoele. Chylous ascites can be secondary to multiple causes and can be confirmed by biochemical testing and lymphangiogram in appropriate settings.
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Affiliation(s)
- A R Patil
- Departments of Radiology, Apollo Hospitals, Bannerghatta Road, Bangalore, India.
| | - S Nandikoor
- Departments of Radiology, Apollo Hospitals, Bannerghatta Road, Bangalore, India
| | - J De Marco
- Department of Radiology, Morristown Medical Center, Morristown, NJ, USA
| | - R Bhat
- Surgical Gastroenterology, Apollo Hospitals, Bannerghatta Road, Bangalore, India
| | - S Shivakumar
- Pathology, Apollo Hospitals, Bannerghatta Road, Bangalore, India
| | - G Mallrajapatna
- Departments of Radiology, Apollo Hospitals, Bannerghatta Road, Bangalore, India
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15
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Abstract
A 16-year-old girl with abdominal pain for 3 years underwent FDG PET/CT scan for evaluating identifiable origin. The images showed multifocal, subcapsular thin-walled low-attenuation masses on CT and focal, slight increased ¹⁸F-FDG uptake on PET with an SUV(max) of 3.0. Based on the findings, malignancy cannot be excluded. Then, pathologic examination was performed, and it was identified to be splenic lymphangioma. We herein presented the FDG PET/CT findings of this splenic lymphangioma, which is a rare benign vascular tumor and commonly caused by congenital malformation of the lymphatic vessels.
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Jang WY, Do MY, Ahn BC, Park MS, Kim HA, Ryu SY, Kim SP, Park KU. Lymphangioma involving whole mesentery confirmed by core needle biopsy. Yeungnam Univ J Med 2016. [DOI: 10.12701/yujm.2016.33.2.130] [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
Affiliation(s)
- Won Young Jang
- Department of Internal Medicine, Keimyung University Dongsan Hospital, Keimyung University College of Medicine, Daegu, Korea
| | - Min Young Do
- Department of Internal Medicine, Keimyung University Dongsan Hospital, Keimyung University College of Medicine, Daegu, Korea
| | - Byung Chan Ahn
- Department of Internal Medicine, Keimyung University Dongsan Hospital, Keimyung University College of Medicine, Daegu, Korea
| | - Myeong Soon Park
- Department of Internal Medicine, Keimyung University Dongsan Hospital, Keimyung University College of Medicine, Daegu, Korea
| | - Hyun Ah Kim
- Department of Internal Medicine, Keimyung University Dongsan Hospital, Keimyung University College of Medicine, Daegu, Korea
| | - Seong-Yeol Ryu
- Department of Internal Medicine, Keimyung University Dongsan Hospital, Keimyung University College of Medicine, Daegu, Korea
| | - Sang Pyo Kim
- Department of Pathology, Keimyung University Dongsan Hospital, Keimyung University College of Medicine, Daegu, Korea
| | - Keon Uk Park
- Department of Internal Medicine, Keimyung University Dongsan Hospital, Keimyung University College of Medicine, Daegu, Korea
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17
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Roman A, Iancu C, Andreica V, Socaciu M, Anton O, Sechel R, Badea R. Splenic cystic lymphangioma with atypical ultrasound findings. J Med Ultrason (2001) 2015; 43:99-105. [PMID: 26703174 DOI: 10.1007/s10396-015-0659-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2015] [Accepted: 07/12/2015] [Indexed: 10/23/2022]
Abstract
Splenic lymphangiomas are rare benign tumors occurring more frequently in children. Because of their asymptomatic growth, splenic lymphangiomas are usually suspected based on incidental findings, the diagnosis relying on different imaging techniques and requiring histological confirmation. The rarity of the disease and its atypical imaging findings make the diagnosis of splenic lymphangiomas challenging. We describe the case of an isolated splenic cystic lymphangioma affecting an elderly female patient. The patient was asymptomatic and the blood tests were normal. The tumor appeared on gray-scale ultrasound as an inhomogeneous, mostly hyperechoic septated mass, which is atypical for a cystic lymphangioma. Contrast-enhanced ultrasound and contrast-enhanced computed tomography suggested the benign nature of the tumor and narrowed the diagnosis. The tumor received histopathological confirmation after splenectomy. Various CT and MRI findings in splenic lymphangiomas have been described, but very few reports regarding CEUS exist to this point.
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Affiliation(s)
- Andrei Roman
- Department of Ultrasonography, "Octavian Fodor" Institute of Gastroenterology and Hepatology, "Iuliu Hatieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Cornel Iancu
- Department of Surgery, "Octavian Fodor" Institute of Gastroenterology and Hepatology, "Iuliu Hatieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Vasile Andreica
- Department of Gastroenterology, "Octavian Fodor" Institute of Gastroenterology and Hepatology, "Iuliu Hatieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Mihai Socaciu
- Department of Ultrasonography, "Octavian Fodor" Institute of Gastroenterology and Hepatology, "Iuliu Hatieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Ofelia Anton
- Department of Radiology and Computed Tomography, "Octavian Fodor" Institute of Gastroenterology and Hepatology, Cluj-Napoca, Romania
| | - Roxana Sechel
- Department of Pathology, "Octavian Fodor" Institute of Gastroenterology and Hepatology, Cluj-Napoca, Romania
| | - Radu Badea
- Department of Ultrasonography, "Octavian Fodor" Institute of Gastroenterology and Hepatology, "Iuliu Hatieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania.
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18
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Abstract
Splenic lymphangioma is a rare malformation of the splenic lymphatic channels, mostly seen in children. It is characterized by the presence of cysts, resulting from increases in the size and number of thin-walled lymphatic vessels that are abnormally interconnected and dilated. The condition may be restricted to the spleen, but in most cases it involves multiple organs (systemic lymphangiomatosis). The clinical picture is variable; small lesions are often incidentally detected through imaging studies, while larger lesions can result in compression of organs, causing pain or rupture even after minor trauma. Therefore, splenic lymphangiomas should be considered in the differential diagnosis of splenomegaly or left upper quadrant pain even among adults and should be immediately treated with splenectomy; delay in the therapeutic intervention can lead to life-threatening complications.
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Affiliation(s)
- Ioannis Ioannidis
- From the Department of Pathology, University of South Alabama, Mobile
| | - Andrea G. Kahn
- From the Department of Pathology, University of South Alabama, Mobile
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19
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Gigantic lymphangioma with marked extraluminal progression of the ascending colon: report of a case. Surg Today 2014; 45:919-23. [PMID: 25344823 DOI: 10.1007/s00595-014-1055-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2014] [Accepted: 04/30/2014] [Indexed: 10/24/2022]
Abstract
We report a case of gigantic cystic lymphangioma of the ascending colon excised through an open laparotomy. A 34-year-old woman consulted a gynecologist for treatment of infertility. Transvaginal ultrasonography revealed a cystic mass in the pelvis, and she was transferred to our hospital for further investigation. Abdominal enhanced computed tomography (CT) showed a bulky cystic mass, 25 cm or larger, in the abdominal and pelvic cavity. Colonoscopy revealed a cystic submucosal tumor with a cushion sign. Cystic lymphangioma was diagnosed and excised via open surgery as we could not exclude its malignant potential. Pathological examination confirmed lymphangioma. To our knowledge, this is the most gigantic lymphangioma of the colon documented in the literature. About 3 months after surgery, the patient discovered that she was pregnant and her first baby was delivered at term, uneventfully.
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20
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Crema E, Etchebehere RM, Gonzaga MN, Lima RS, Bertulucci PA, da Silva AA. Splenic lymphangioma: a rare benign tumor of the spleen treated by laparoscopic surgery. ABCD-ARQUIVOS BRASILEIROS DE CIRURGIA DIGESTIVA 2013; 25:178-9. [PMID: 23411808 DOI: 10.1590/s0102-67202012000300009] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
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21
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George Verghese B, Kalvehalli Kashinath S, Kanth RR. Lymphangioma of the Spleen—A Rare Tumor Rarely seen
in an Adult: A Case Report and a Comprehensive
Literature Review. Euroasian J Hepatogastroenterol 2013. [DOI: 10.5005/jp-journals-10018-1066] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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22
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Gureş N, Gurluler E, Alim A, Berber I, Gurkan A. Cystic pancreatic lymphangioma. Rare Tumors 2012; 4:e27. [PMID: 22826784 PMCID: PMC3401155 DOI: 10.4081/rt.2012.e27] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2012] [Revised: 03/16/2012] [Accepted: 04/22/2012] [Indexed: 12/16/2022] Open
Abstract
Lymphangioma of the pancreas is a rare benign tumor of lymphatic origin. Retroperitoneal lymphangiomas account for 1% of all lymphangiomas. Herein, we report a case of cystic pancreatic lymphangioma diagnosed in 34 year-old female patient who was hospitalized for a slight pain in the epigastrium and vomiting. Radiological imaging revealed a large multiloculated cystic abdominal mass with enhancing septations involving the upper retroperitoneum. During the laparoscopic surgery, a well circumscribed polycystic tumor was completely excised preserving the pancreatic duct. The patient made a complete recovery and is disease-free 12 months postoperatively.
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Affiliation(s)
- Nazim Gureş
- Acibadem University, International Hospital General Surgery Department, Istanbul, Turkey
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23
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Wang XY, Zhao MF, Ma G, Long J, Guo KJ. Diagnosis and treatment of retroperitoneal lymphangioma: an analysis of 15 cases. Shijie Huaren Xiaohua Zazhi 2011; 19:1968-1970. [DOI: 10.11569/wcjd.v19.i18.1968] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
AIM: To summarize the clinical and imaging characteristics, operative methods and curative effect of retroperitoneal lymphangioma.
METHODS: The clinical and radiological data for 15 patients with retroperitoneal lymphangioma were analyzed retrospectively.
RESULTS: All the patients were diagnosed with retroperitoneal lymphangioma by imaging examination and underwent surgical resection. Pathological examination of resected specimens confirmed the initial diagnosis. The follow-up period ranges from 1 month to 17 years. Relapse occurred in one patient, who subsequently underwent a complete resection and showed no recurrence during one-year follow-up.
CONCLUSION: Retroperitoneal lymphangioma has non-specific clinical manifestations and is easily misdiagnosed. Ultrasound is useful for screening retroperitoneal lymphangioma, while CT can help make a definite diagnosis. Patients with retroperitoneal lymphangioma need to undergo complete resection and often have good prognosis.
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24
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Moyle PL, Kataoka MY, Nakai A, Takahata A, Reinhold C, Sala E. Nonovarian Cystic Lesions of the Pelvis. Radiographics 2010; 30:921-38. [DOI: 10.1148/rg.304095706] [Citation(s) in RCA: 85] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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