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Kothandaraman V, Wisener J, Helgerson PW. Complex lymphatic anomalies: Challenging diagnostic considerations. Clin Case Rep 2024; 12:e8370. [PMID: 38161630 PMCID: PMC10756942 DOI: 10.1002/ccr3.8370] [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: 09/13/2023] [Revised: 11/14/2023] [Accepted: 12/14/2023] [Indexed: 01/03/2024] Open
Abstract
Diagnosis of complex lymphatic anomalies can be difficult, and biopsies can be associated with significant morbidity. Mediastinal masses with features such as osseous involvement warrant thorough noninvasive evaluation prior to biopsy.
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Affiliation(s)
| | - John Wisener
- University of Virginia Medical CenterCharlottesvilleVirginiaUSA
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Lal A, Gupta P, Singhal M, Sinha SK, Lal S, Rana S, Khandelwal N. Abdominal lymphatic malformation: Spectrum of imaging findings. Indian J Radiol Imaging 2021; 26:423-428. [PMID: 28104932 PMCID: PMC5201068 DOI: 10.4103/0971-3026.195777] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Lymphatic malformations are congenital vascular malformations with lymphatic differentiation. Although the most common locations for lymphatic malformation are the neck and axilla, they can occur at several locations in the body including the abdomen. The abdominal location is rather rare and accounts for approximately 5% of all lymphatic malformation. Abdominal lymphatic malformation can arise from mesentery, omentum, gastrointestinal tract, and retroperitoneum. Clinical presentation includes an abdominal lump, vague abdominal discomfort, and secondary complications including intestinal obstruction, volvulus, ischemia, and bleeding. There is a broad spectrum of radiological manifestation. In the present review, we discuss the imaging appearance of abdominal lymphatic malformation. The diagnosis of lymphatic malformation in our series was based on the histopathological examination (in cases who underwent surgery) and fine needle aspiration cytology.
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Affiliation(s)
- Anupam Lal
- Department of Radiodiagnosis and Imaging, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Pankaj Gupta
- Department of Radiodiagnosis and Imaging, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Manphool Singhal
- Department of Radiodiagnosis and Imaging, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Saroj K Sinha
- Department of Gastroenterology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Sadhana Lal
- Department of Gastroenterology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Surinder Rana
- Department of Gastroenterology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Niranjan Khandelwal
- Department of Radiodiagnosis and Imaging, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
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Abstract
The liver normally produces a large amount of lymph. It is estimated that between 25% and 50% of the lymph received by the thoracic duct comes from the liver. In normal conditions, hepatic lymphatics are not depicted on cross-sectional imaging. They are divided in lymphatics of deep system (lymphatics following the hepatic veins and the portal tract) and those of superficial system (convex surface and inferior surface). A variety of diseases may affect hepatic lymphatics and in general they manifest as lymphedema, lymphatic mass, or cystic lesions. Abnormal distended lymphatics are especially seen in periportal spaces as linear hypoattenuations on CT or strong linear hyperintensities on heavily T2-weighted MR imaging. Lymphatic tumor spread as in lymphoma and lymphangitic carcinomatosis manifests as periportal masses and regional lymph node enlargement. Lymphatic disruption after trauma or surgery is depicted as perihepatic fluid collections of lymph (lymphocele). Lymphatic malformation such as lymphangioma is seen on imaging as cystic spaces of variable size.
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Ak SJ, Park SK, Park HU. [A case of isolated hepatic lymphangioma]. THE KOREAN JOURNAL OF GASTROENTEROLOGY 2012; 59:189-92. [PMID: 22387840 DOI: 10.4166/kjg.2012.59.2.189] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Hepatic lymphangioma is a rare benign neoplasm. It usually occurs as a part of systemic lymphangiomatosis. Isolated hepatic lymphangioma is extremely rare. A 58-year-old woman with weight loss was referred for the evaluation of chronic renal insufficiency and hepatic mass. Abdominal computed tomography showed 3 cm sized multilobulated cystic lesion with calcification and thick septal enhancing focus in the segment V of the liver. On abdominal magnetic resonance imaging, the masses exhibited low signal intensity on the T1-weighted images and high signal intensity on the T2-weighted images. Malignant tumor could not be ruled out, and therefore, the patient underwent right anterior segmentectomy of the liver. Gross pathology reveraled a 3.0×2.2×1.5 cm mass with multichamber cyst, which was filled with mucoid material. Histologically the mass was composed of irregularly shaped vascular channels filled acellular homogeneous lymph fluids. The final diagnosis was hepatic isolated cavernous lymphangioma. Herein, we report a case of isolated hepatic lymphangioma and also review the existing literature.
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Affiliation(s)
- Seol Jung Ak
- Department of Internal Medicine, Maryknoll Medical Center, Busan, Korea.
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Plard L, Guedin P, Le Pennec V, Chiche L. [Hepatic cysts: diagnosis and management]. JOURNAL DE CHIRURGIE 2008; 145:217-225. [PMID: 18772728 DOI: 10.1016/s0021-7697(08)73749-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
Cystic lesions of the liver are common and usually benign. The most frequent lesion is simple hepatic cyst: typical imaging findings make their diagnosis easy and they require no treatment. Complicated hepatic cysts (i.e., compression, hemorrhage, infection) have more variable imaging findings making diagnosis more difficult; they may evoke other diagnoses. Asymptomatic hepatic cysts do not require any treatment or follow-up. Symptomatic cysts may benefit from simple follow-up or may be treated by laparoscopic fenestration or alcohol sclerotherapy. The differential diagnosis of complicated hepatic cysts includes cystadenoma, cystadenocarcinoma, hydatid cyst, or cystic metastasis; surgical resection is usually indicated for these lesions.
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Affiliation(s)
- L Plard
- Département de chirurgie digestive, CHU, Caen
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Ra SH, Bradley RF, Fishbein MC, Busuttil RW, Lu DSK, Lassman CR. Recurrent hepatic lymphangiomatosis after orthotopic liver transplantation. Liver Transpl 2007; 13:1593-7. [PMID: 17969190 DOI: 10.1002/lt.21306] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Hepatic lymphangiomatosis is a rare disease characterized by an abnormal lymphatic proliferation involving the liver alone, liver and spleen, or multiple organs. Hepatic lymphangiomatosis becomes symptomatic secondary to compression or replacement of the normal parenchyma, which can lead to liver failure. Resection and orthotopic liver transplantation (OLT) can be used as treatment for this disease. We herein describe a 42-year-old female who had undergone successful OLT for hepatic lymphangiomatosis with recurrent disease detected 19 yr later in the transplanted liver. This is, to our knowledge, the first described case of recurrent hepatic lymphangiomatosis after OLT. In conclusion, we discuss the clinical, radiologic, pathologic, and immunohistochemical findings and review other reported cases of hepatic lymphangiomatosis that have undergone OLT.
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Affiliation(s)
- Seong H Ra
- Department of Pathology and Laboratory Medicine, David Geffen School of Medicine at University of California, Los Angeles (UCLA), Los Angeles, CA 90095-1732, USA
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Nzegwu MA, Ekenze SO, Okafor OC, Anyanwu PA, Odetunde OA, Olusina DB. Solitary hepatic lymphangioma in an infant. J Perinat Med 2007; 35:164-5. [PMID: 17302516 DOI: 10.1515/jpm.2007.022] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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Levy AD, Cantisani V, Miettinen M. Abdominal lymphangiomas: imaging features with pathologic correlation. AJR Am J Roentgenol 2004; 182:1485-91. [PMID: 15149994 DOI: 10.2214/ajr.182.6.1821485] [Citation(s) in RCA: 101] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Affiliation(s)
- Angela D Levy
- Department of Radiologic Pathology, Armed Forces Institute of Pathology, 6825 16th Street NW, Washington, DC 20306-6000, USA.
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Nishio I, Mandell GL, Ramanathan S, Sumkin JH. Epidural labor analgesia for a patient with disseminated lymphangiomatosis. Anesth Analg 2003; 96:1805-1808. [PMID: 12761016 DOI: 10.1213/01.ane.0000066014.08416.df] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
IMPLICATIONS We describe a case of a parturient with disseminated lymphangiomatosis involving the thorax, retroperitoneum, and lumbar vertebrae who received epidural labor analgesia. Clinical presentations vary depending on the organ systems involved, the extent of the disease, and the stage of pregnancy. Anesthetic implications are discussed.
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Affiliation(s)
- Isuta Nishio
- *Department of Anesthesiology, University of Pittsburgh, UPMC St. Margaret Pain Medicine Center, Pittsburgh, Pennsylvania; and Departments of †Anesthesiology and ‡Radiology, University of Pittsburgh, Magee-Womens Hospital, Pittsburgh, Pennsylvania
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Vanhoenacker FM, Schepper AM, Raeve H, Berneman Z. Cystic angiomatosis with splenic involvement: unusual MRI findings. Eur Radiol 2003; 13 Suppl 6:L35-9. [PMID: 16440230 DOI: 10.1007/s00330-002-1805-4] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2002] [Revised: 11/15/2002] [Accepted: 12/09/2002] [Indexed: 11/27/2022]
Abstract
Cystic angiomatosis is a rare disorder with a poor prognosis. We describe a case of a 33-year-old woman who presented with longstanding bone pain, hemolytic anemia, and an enlarged spleen. Radiologically, multiple osseous lesions with a mixed pattern of lytic and sclerotic areas were seen within the shoulders, spine, and pelvis. On CT and MRI of the abdomen, the spleen was markedly enlarged, with internal hyperdense foci on non-contrast CT scan, corresponding to low signal intensity areas on all MR pulse sequences. After administration of contrast, a mottled enhancement pattern throughout the entire spleen was seen both on CT and MRI. Cystic angiomatosis was proven by histological analysis of a biopsy specimen of an involved vertebra and histopathological examination of the spleen after subsequent splenectomy. This is the first report of a patient with disseminated cystic angiomatosis with splenic involvement in which the MRI features differ from the previous reports. Instead of the usual pattern consisting of multiple well-defined cystic lesions, a diffuse involvement replacing the entire spleen, with heterogeneous signal intensities on T2-weighted images and heterogeneous enhancement pattern, was seen in our patient.
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Affiliation(s)
- F M Vanhoenacker
- Department of Radiology, University Hospital Antwerp, Wilrijkstraat 10, 2650, Edegem, Belgium.
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Abstract
Benign liver tumors are becoming a subject of great interest because increased access to medical care has allowed discovery of many incidental focal lesions. These tumors may be hepatocellular, biliary, or stromal in nature. Several new lesions have been described in recent years causing a need to reassess the pathogenesis and classification of hepatic tumors. Hepatocellular nodules may be neoplastic or a regenerative response to injury. The size and structure of regenerative nodules varies with the distribution and severity of the hepatic injury, leading to a complex classification. Variation in fat content is easily detected on ultrasonography as focal fatty change and focal fatty sparing. Biliary and stromal cells also produce neoplastic or regenerative lesions. Biliary lesions are often cystic in nature. Stromal lesions are varied because of the many nonparenchymal cell types in the liver.
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Affiliation(s)
- Ian R Wanless
- Department of Pathology, Toronto General Hospital, 200 Elizabeth Street, Room E4-305, Toronto, ON M5G 2C4, Canada.
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Abstract
A variety of benign focal liver lesions are easily characterized with currently available imaging techniques and contrast agents. The most common benign liver lesions, such as hemangioma, bile duct cyst, and FNH, reveal characteristic cross-sectional imaging features that allow an accurate diagnosis. For atypical variants and more uncommon lesions, including HCA, angiomyelioma, infantile hemagioendothelioma, and mesenchymal hamartoma, integration of clinical data can often help in the interpretation of imaging studies. Finally, for the remaining lesions, such as hepatic adenomatosis, the imaging findings may not be specific enough to negate the need for a tissue biopsy.
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Affiliation(s)
- Koenraad J Mortele
- Department of Radiology, Brigham & Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA.
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Abstract
We present a multiseptated mesenchymal hamartoma of the liver in a 10-year-old male patient, a rare benign tumor of childhood. The characteristic ultrasound and CT appearances of this unusual tumor are reviewed. A single septal calcification associated with this tumor was demonstrated, an association which has not previously been reported. The differential diagnosis for cystic liver lesions is discussed in detail.
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Affiliation(s)
- O Konez
- Department of Radiology, Children's Hospital Medical Center of Akron, Northeastern Ohio Universities College of Medicine (NEOUCOM), 300 Longwood Avenue, Boston, MA 02115, USA.
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