Gallbladder lymphangioma: A case report and review of the literature

A comprehensive exploration of gallbladder health: from common to rare imaging findings

This comprehensive review explores a wide range of imaging findings associated with the gallbladder (GB), from anatomic variants to rare diseases. Through an in-depth review of diagnostic modalities including ultrasound, magnetic resonance cholangiopancreatography, CT, and MRI, we aim to highlight the crucial role of imaging techniques in diagnosing GB disorders, as congenital anomalies, inflammatory diseases, neoplasms, and surgical complications. Employing a detailed analysis and comparison of imaging findings across various modalities, this review seeks to improve diagnostic accuracy for GB-related pathologies, facilitating optimal patient management.

Gallbladder fossa lymphangioma encasing the common bile duct: a case report and review of the literature

Introduction

Lymphangiomas are rare low-flow lymphatic vessel malformations mostly diagnosed in childhood. Among the abdominal lymphangiomas, the gallbladder lymphangioma is a rare presentation, and only a few cases have been reported till date, of which majority were cystic lymphangiomas.

Case presentation

The authors present a case of a 48-year-old female with abdominal pain and normal physical examination and laboratory findings. On the performed imaging, a multiloculated cystic lesion, located in the gallbladder fossa, was found. The patient underwent open cholecystectomy, and surprisingly, the cyst extended to the common bile duct, which was separated cautiously. The cyst was resected, and the histopathological findings confirmed cystic lymphangioma.

Conclusion

The cystic lymphangioma of the gallbladder can be asymptomatic, although most of the literature has reported abdominal pain. The diagnosis of lymphangioma is complicated, especially when intra-cystic hemorrhage happens. Ultrasonography, computed tomography, and magnetic resonance imaging are usually performed. The surgical excision of the cyst and the gallbladder is the treatment of choice. Although bile duct involvement is extremely rare, it should be considered during the surgery.

Rare finding of duodenal lymphangioma in a patient with Helicobacter pylori associated gastritis: A case report

RATIONALE

Lymphangiomas are lymphatic malformations most commonly found in the head, neck and axilla. Their incidence in gastrointestinal tract, especially duodenum is very rare. They are mostly congenital and are usually seen in children. Owing to their asymptomatic nature, these tumors are often diagnosed incidentally. Surgical resection is the definite treatment.

PATIENT CONCERNS

We represent a case of a 30-year-old male with duodenal lymphangioma with presentation of intermittent dyspepsia for 1 year, partially relieved by a proton pump inhibitor.

DIAGNOSES

Upon physical examination, there was mild tenderness observed in the epigastrium. The rest of the physical examination was unremarkable. His complete blood count report was unremarkable. Upon a negative stool for Helicobacter pylori antigen test, the patient underwent an esophagogastroduodenoscopy which revealed H pylori gastritis and a duodenal lymphangioma.

INTERVENTIONS

Patient was put on triple therapy (clarithromycin, amoxicillin and omeprazole) for 14 days and his symptoms improved. The lymphangioma was not resected owing to small size.

OUTCOMES

Patient was followed till 1 year and his symptoms had improved.

LESSONS

The case describes a correlation between H pylori gastritis and a duodenal lymphangioma. There is likely to be an association between the two and therefore, further studies are required to find out any relationship that may exist between the 2 conditions.

Gallbladder lymphangioma simulating liver hydatid cyst: A case report

Introduction and importance

Gallbladder lymphangiomas are very-rare, yet benign tumors that start developing in early life. Those tumors often go unnoticed until adulthood as they grow into a larger size or a complication happens. Despite its rarity, suspicion for the diagnosis should be maintained by the physicians.

Case presentation

A 14-year-old female patient presented to the hospital complaining of right upper quadrant abdominal pain of one month duration. Physical examination showed mild upper quadrant tenderness. Serology testing for the patient only showed eosinophilia. Computed tomography showed a large non-enhancing cystic lesion attached to the gallbladder. Presumptive diagnosis of hydatid cyst was made, and the patient was treated accordingly. Histological analysis of mass showed dilated lymphatic vessels, hence the shift in diagnosis towards a lymphangioma was made.

Clinical discussion

Gallbladder lymphangioma are usually asymptomatic, but they can present with pain, nausea and vomiting. Multiple complications had been reported including compression of the nearby structures, intra-abdominal infection, rupture, torsion or hemorrhagic transformation. Surgical removal of the mass is the treatment of choice.

Conclusions

Right upper quadrant pain can be the presenting symptom of liver pathology. Histological assessment is needed to confirm the diagnosis which will show dilated lymphatic vessels.

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Gallbladder lymphangioma is a very-rare tumor which is often misdiagnosed by a more common pathology.

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Oral and Intravenous contrast computed tomography will show a non-enhancing cystic lesion.

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Surgery is the treatment of choice, and histological assessment will show dilated lymphatic vessels.

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To our best knowledge, this is the first reported case in Palestine, among the 10 other cases reported world-wide.

Cervical lymphangioma in adults: A report of seven cases and review of the literature

Background

Cervical lymphangioma usually occurs in children and is relatively rare in adults. The purpose of this study was to investigate the characteristics of cervical lymphangiomas in adults.

Methods

We retrospectively reviewed the medical records and analyzed clinical data obtained from seven adult patients who suffered from cervical lymphangioma from January 2008 to June 2021.

Results

Five (71.43%) of seven cases were asymptomatic and four (57.14%) lymphangiomas had a maximum diameter ≥ 10 cm. Each cervical lymphangioma was located adjacent to the carotid sheath. All the cervical lymphangiomas were completely surgically excised and were pathologically diagnosed as cystic lymphangioma. After a median 32 months follow-up period, no recurrence was observed.

Conclusion

Cervical lymphangiomas from adults are often large asymptomatic masses infiltrating or adjacent to surrounding vital structures which brings many difficulties to the surgery, requiring an experienced surgeon to remove the mass.

Disorders of the lymphatic system of the abdomen

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.

Intracystic papillary neoplasm with an associated mucinous adenocarcinoma arising in Rokitansky-Aschoff sinus of the gallbladder

Intraepithelial neoplasias are preinvasive neoplastic lesions found throughout in the digestive system, and when such lesions are discovered in the gallbladder, they are referred to as intracystic papillary neoplasm (ICPN). In the gallbladder, mucinous adenocarcinoma is a rare histologic phenotype, and adenocarcinomas involving Rokitansky–Aschoff (RA) sinuses are uncommon, which were indeed found in a case reported here. A 64-year-old male presenting with upper abdominal pain demonstrated a spherical mass protruding outward from the gallbladder fundus in imaging studies. Laparoscopic cholecystectomy was performed, and the resected specimen revealed a subserosal cystic mass with a small communication with the gallbladder lumen. The cystic mass contained a gelatinous material without solid component. Histologically, the mass was consisted of subserosal cysts lined by atypical columnar mucinous epithelium with micropapillary growth and nuclear stratification. The neoplastic transformation was more pronounced toward the serosal side of the lesion where disruption of the cyst wall, intrastromal mucin lakes, and invasion of the neoplastic cells into surrounding stroma were observed. The epithelium was of intestinal lineage, which was supported by the positive immunoreactivity against CDX2 and MUC2. The cystic spaces were communicated with surrounding RA sinuses, which indicated that the tumor arose in the sinus. The pathological diagnosis was ICPN, intestinal type, with an associated mucinous adenocarcinoma arising in RA sinus.

Adrenal Gland Lymphangiomas

Lymphangiomas of the adrenal glands (ALs) are benign vascular lesions. Approximately, 53 cases have been reported in the literature. The current study reviews and analyzes the clinical and pathologic features of all reported ALs and additionally illustrates a typical case of adrenal lymphangioma (AL). In order to perform the review analysis, a search of the international literature for ALs in adults was conducted. Thirty-eight related articles were found. Clinical and pathological information were obtained for all the reported cases and a database was created. ALs were detected more frequently in women than men. The mean age of occurrence was 39.5 years, while their mean size was 8.86 cm. Fifty-nine percent of ALs were right-sided. Size and localization were responsible for the presenting symptoms, though 30.4 % were asymptomatic. Diagnosis was made postoperatively in all cases by histological results. ALs are rare and benign lesions. They usually present as an incidental finding after abdominal imaging. The diagnosis is made after the surgical removal by histological and immunohistochemical examinations.

Extensive and invasive lymphangioma circumscriptum in a young female: A rare case report and review of the literature

Lymphatic malformations, or lymphangiomas, are benign proliferations of lymphatics, classified as superficial lymphangioma circumscriptum (LC) and deep (cavernous lymphangioma). LC, as the name suggests, is a well-circumscribed lesion but, rarely, extensive and invasive forms can also be seen. Surgical excision is the main modality of treatment. We report a case of extensive and invasive type of LC where surgical excision is difficult and recurrence is the rule.

Lymphangioma of the gallbladder in adults: review of the literature and a case report

INTRODUCTION

Lymphangiomas of the gallbladder in adults are extremely rare with only 10 cases published worldwide to date.

CASE PRESENTATION

We herein report a case of a 26-year-old male who presented with abdominal right upper quadrant pain, nausea, vomiting, and diarrhea. An ultrasound, computer tomography scan, and magnetic resonance imaging showed a cystic mass interposed between the gallbladder and the liver with characteristics identical to those of lymphangiomas in more common locations. The patient underwent an open excision of the large spongy mass en bloc with the gallbladder.

CONCLUSION

Histological findings confirmed the diagnosis of lymphangioma. Also, we provide a review of 10 cases presented in the literature, with a discussion of the clinical features, diagnosis, and surgical approach.

Is laparoscopic cholecystectomy safe for lymphangioma of the gallbladder? A complicated case mimicking subhepatic abscess

Lymphangiomas are rare benign neoplasms of the lymphatic tissue generally occurring in the childhood. Cystic lymphangioma of the gallbladder is an extremely rare tumor with only eight cases having been reported in the literature. The aspecific and potentially misleading clinical presentation of these tumors requires complex preoperative imaging in the setting of clinical suspicion to make the correct diagnosis. The treatment of choice is complete excision with negative margins to avoid local recurrence. Their tendency to locally invade the surrounding tissues requires sometimes extended resections. Laparoscopic cholecystectomy can be a questionable choice in this setting; however, the procedures can be performed safely in most cases, although complicated. We report the case of a hemorrhagic cystic lymphangioma of the gallbladder mimicking a subhepatic abscess and operated in emergency with laparoscopic approach.

Biliary cystadenocarcinoma of the gall bladder: a case report

Introduction

While biliary cystadenoma and biliary cystadenocarcinoma involving the liver are not uncommon, biliary cystadenocarcinoma of the gall bladder is an extremely rare lesion and can be very difficult to diagnose.

Case presentation

A 50-year-old Indian woman presented with pain and swelling in the right hypochondrium. An ultrasonography revealed a cystic lesion arising from the gallbladder fossa. This lesion was initially managed with aspiration and antibiotics by the treating physician. The patient was referred for surgical management because the abscess was not resolved through conservative treatment. A diagnosis of an infected nonparasitic cyst was made and deroofing of the cyst was performed. A histopathological examination of the excised cyst wall showed cystadenocarcinoma. The patient subsequently underwent a successful surgical excision of the lesion.

Conclusion

Infective lesions of the liver are common in developing countries and are usually managed through aspiration and antibiotics. Cystadenocarcinoma of the gallbladder needs to be considered in the differential diagnosis of cystic lesions arising from the gallbladder fossa. A high index of suspicion and cytological examination from the wall of such complex lesions will help in the timely management of such lesions.

[Cystic lymphangioma: an unusual cause of lower limb lymphedema]

We report an unusual cause of unilateral lymphedema of the right limb rapidly increasing in a young woman. Ultrasonography ruled out the diagnosis of iliac deep venous thrombosis or extrinsic compression: the B mode scan revealed a mass located below the aortic bifurcation and along the iliac vessels, without any compressive effect. The lesion was heterogeneous associating both tissular and cystic aspects. The lower limb lymphoscintigraphy showed an interruption of the colloid circulation at the right iliac level. Computed tomography did not give any additional information. Magnetic resonance imaging before then after gadolinium showed typical aspects of cystic lymphangioma and confirmed the ultrasonography hypothesis. Considering that this tumor is benign, that surgery would be difficult because of the anatomic situation of the mass, and that post-operative involution of the edema is uncertain, the treatment was based on compressive stockings and regular follow up.