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Neto Castro B, Martins D, João DA, Graça S, Oliveira M. Anterior Cervical Cystic Lymphangioma in an Adult Patient. ACTA MEDICA PORT 2024. [PMID: 38639719 DOI: 10.20344/amp.20960] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Accepted: 02/22/2024] [Indexed: 04/20/2024]
Affiliation(s)
- Bárbara Neto Castro
- General Surgery Department. Centro Hospitalar Vila Nova de Gaia/Espinho. Vila Nova de Gaia. Portugal
| | - Daniel Martins
- General Surgery Department. Centro Hospitalar Vila Nova de Gaia/Espinho. Vila Nova de Gaia. Portugal
| | - David Afonso João
- Department of Pathology. Centro Hospitalar de Vila Nova de Gaia/Espinho. Vila Nova de Gaia. Portugal
| | - Susana Graça
- General Surgery Department. Centro Hospitalar Vila Nova de Gaia/Espinho. Vila Nova de Gaia. Portugal
| | - Manuel Oliveira
- General Surgery Department. Centro Hospitalar Vila Nova de Gaia/Espinho. Vila Nova de Gaia. Portugal
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Zhang J, Fu B, Li T, Wang G. Adult giant cystic lymphangioma of the ascending mesocolon: A case report. Asian J Surg 2024:S1015-9584(24)00579-7. [PMID: 38604868 DOI: 10.1016/j.asjsur.2024.03.153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2024] [Accepted: 03/22/2024] [Indexed: 04/13/2024] Open
Affiliation(s)
- Jianfeng Zhang
- The Second Department of General Surgery, The 4th Hospital of Hebei Medical University, No. 12 Jiankang Road, Shijiazhuang, Hebei, China
| | - Bao Fu
- Department of General Surgery, Shijiazhuang Hospital of Traditional Chinese Medicine, Shijiazhuang, 050011, China
| | - Tian Li
- School of Basic Medicine, Fourth Military Medical University, 169 Changle West Rd, Xi'an, 710032, China.
| | - Guiying Wang
- General Surgery, The 2nd Hospital of Hebei Medical University, 215 Heping Road, Shijiazhuang, Hebei, China.
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Belhasan D, Ghalim F. Diffuse abdominal lymphangiomatosis without tumoral masses: a case report. Clin J Gastroenterol 2024:10.1007/s12328-024-01941-y. [PMID: 38460084 DOI: 10.1007/s12328-024-01941-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2023] [Accepted: 02/17/2024] [Indexed: 03/11/2024]
Abstract
Diffuse abdominal lymphangiomatosis is a rare and complex disease. It typically presents with non-specific gastrointestinal symptoms and characteristic cystic lesions or tumoral masses on imaging based on the literature to date. This report presents the rare case of a young man with an atypical form of diffuse abdominal lymphangiomatosis in the complete absence of cystic lesions or lymphangioma tumoral masses, thus presenting a unique diagnostic challenge. It was successively treated by surgery, gastric electrical stimulator, sirolimus, and imatinib.
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Affiliation(s)
- Dina Belhasan
- University of Minnesota School of Medicine, 420 Delaware Street SE, Minneapolis, MN, 55455, USA.
| | - Fahd Ghalim
- Mekka Clinic Digestive Endoscopy Unit, Boulevard de la Mecque, 2000, Casablanca, Morocco
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Cho YJ, Kwon H, Ha S, Kim SC, Kim DY, Namgoong JM, Cho MJ, Lee JY, Jung E, Nam SH. Successful outcome with oral sirolimus treatment for complicated lymphatic malformations: a retrospective multicenter cohort study. Ann Surg Treat Res 2024; 106:125-132. [PMID: 38435495 PMCID: PMC10902623 DOI: 10.4174/astr.2024.106.3.125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Revised: 12/18/2023] [Accepted: 01/02/2024] [Indexed: 03/05/2024] Open
Abstract
Purpose Sirolimus has emerged as a safe and effective treatment for complicated lymphatic malformations (LMs). We aim to prove the effectiveness and safety of sirolimus as a therapeutic option for patients with complicated LMs. Methods Fifty-eight patients with complicated LMs treated with sirolimus for at least 6 months at multicenter between July 2018 and January 2023 were enrolled. All patients were administered oral sirolimus starting at 0.8 mg/m2 every 12 hours, with target serum concentration levels of 8-15 ng/mL. Evaluation for clinical symptoms and LMs volume on MRI were reviewed to assess treatment response and toxicities. Evaluation of disease response was divided into 3 values: complete response, partial response (significant, moderate, and modest), and progressive disease. Results The median age at the initiation of sirolimus treatment was 6.0 years (range, 1 month-26.7 years). The median duration of treatment was 2.0 years (range, 6 months-4.4 years). The most common lesions were head and neck (25 of 58, 43.1%). Forty-six patients (79.3%) demonstrated a reduction in LMs volume on MRI or improvement of clinical symptoms including 2 complete responses. The young age group and the patients who underwent few prior therapies showed better responses. None of the patients had toxicities attributable to sirolimus with a Common Terminology Criteria for Adverse Events grade of ≥3. Conclusion Oral sirolimus treatment brought a successful outcome without severe adverse effects. It could be the first-line therapy, especially for the young age group of complicated LMs, and an additional option for refractory lesions that did not respond to conventional treatment.
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Affiliation(s)
- Yu Jeong Cho
- Department of Surgery, Hanyang University Guri Hospital, Hanyang University School Medicine, Guri, Korea
| | - Hyunhee Kwon
- Department of Pediatric Surgery, Asan Medical Center Children’s Hospital, University of Ulsan College of Medicine, Seoul, Korea
| | - Suhyeon Ha
- Department of Pediatric Surgery, Asan Medical Center Children’s Hospital, University of Ulsan College of Medicine, Seoul, Korea
| | - Seong Chul Kim
- Department of Pediatric Surgery, Asan Medical Center Children’s Hospital, University of Ulsan College of Medicine, Seoul, Korea
| | - Dae Yeon Kim
- Department of Pediatric Surgery, Asan Medical Center Children’s Hospital, University of Ulsan College of Medicine, Seoul, Korea
| | - Jung-Man Namgoong
- Department of Pediatric Surgery, Asan Medical Center Children’s Hospital, University of Ulsan College of Medicine, Seoul, Korea
| | - Min Jeng Cho
- Department of Surgery, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea
| | - Ju Yeon Lee
- Division of Pediatric Surgery, Department of Surgery, Chonnam National University Hospital, Gwangju, Korea
| | - Eunyoung Jung
- Department of Pediatric Surgery, Keimyung University Dongsan Hospital, Daegu, Korea
| | - So Hyun Nam
- Department of Surgery, Inje University Busan Paik Hospital, Busan, Korea
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Barma A, Kunwar S, Yadav NK, Karn M. Unusual cystic hygromas: Case report. Int J Surg Case Rep 2024; 116:109368. [PMID: 38342028 PMCID: PMC10943632 DOI: 10.1016/j.ijscr.2024.109368] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2023] [Revised: 02/02/2024] [Accepted: 02/05/2024] [Indexed: 02/13/2024] Open
Abstract
INTRODUCTION AND IMPORTANCE Cystic hygromas are congenital lymphangiomas that arise from a developmental anomaly in the lymphatic system. Typically detected in early childhood, their incidence in adolescents and at the chest wall or axillary area is rare. CASE PRESENTATION We report two cases, a 14-year-old male child (Case I) and a 1-year-old male infant (Case II), who presented with swelling in unusual locations, the right axillary region and the right anterolateral chest wall respectively. Local examination findings were indicative of a cystic hygroma in the first case, while in the second case, characteristic transillumination was not seen due to a complication: hemorrhage within the cyst. The diagnoses were established after a correlation of the patient's history, and clinical findings with radiological investigations. Both underwent surgical intervention and had no complications. Histopathology of the post-operative specimens confirmed the diagnoses. DISCUSSION The diagnosis of cystic hygroma is made in the totality of thorough history taking, clinical examination, and radiological and histopathological investigations. Though most cases typically manifest before the age of two years and in the cervicofacial area, unusual locations and delayed presentation can occur. Surgical excision is a safe and effective treatment modality for these lesions. CONCLUSION Although a rare entity, cystic hygroma should be considered a possible differential diagnosis of any swelling in the pediatric population.
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Affiliation(s)
- Aachal Barma
- Gandaki Medical College Teaching Hospital and Research Center, Pokhara 33700, Nepal.
| | - Sarjan Kunwar
- Gandaki Medical College Teaching Hospital and Research Center, Pokhara 33700, Nepal
| | - Nabin Kumar Yadav
- Gandaki Medical College Teaching Hospital and Research Center, Pokhara 33700, Nepal
| | - Mitesh Karn
- Gandaki Medical College Teaching Hospital and Research Center, Pokhara 33700, Nepal
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Jha T, Sharma M, Ahuja A. Mesenteric cystic lymphangioma in adults: a rare entity presenting as acute abdomen - a report of two cases. Autops Case Rep 2024; 14:e2024470. [PMID: 38476732 PMCID: PMC10927243 DOI: 10.4322/acr.2024.470] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2023] [Accepted: 01/08/2024] [Indexed: 03/14/2024]
Abstract
Lymphangiomas are rare benign tumors that mainly involve the head and neck region in pediatric patients. Lymphangiomas of the small bowel mesentery in adults are rarer. We present two cases of mesenteric lymphangioma with acute abdominal pain on presentation. Case 1: A 38-year-old female presented with abdominal pain, vomiting, fever, and difficult evacuation. On abdominal examination, she had an ill-defined, tender lump, and radiological findings raised a possibility of perforation peritonitis. Thus, exploratory laparotomy was planned. Per-operatively, a mesenteric mass was found, which, on histopathological evaluation, was found to be a mesenteric lymphangioma involving the bowel. Case 2: A 27-year-old male presented with abdominal pain and difficult evacuation. Radiological evaluation revealed a multilobulated lesion involving the mesentery and with differential diagnoses of mesenteric fibromatoses and inflammatory pseudotumor. Histopathological assessment of the resected mass revealed a lymphangioma that was limited to the mesentery. Owing to their rarity and non-specific presentation, mesenteric lymphangiomas are often misdiagnosed on clinical examination and imaging. Thus, histopathological examination is the gold standard to reach a definitive diagnosis.
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Affiliation(s)
- Tanvi Jha
- Atal Bihari Vajpayee Institute of Medical Sciences and Dr. Ram Manohar Lohia Hospital, Department of Pathology, New Dehli, India
| | - Monika Sharma
- Atal Bihari Vajpayee Institute of Medical Sciences and Dr. Ram Manohar Lohia Hospital, Department of Pathology, New Dehli, India
| | - Arvind Ahuja
- Atal Bihari Vajpayee Institute of Medical Sciences and Dr. Ram Manohar Lohia Hospital, Department of Pathology, New Dehli, India
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Dosemane D, Khadilkar MN, Praneetha P. Cervical thymic cyst ? A Rare Neck Swelling in an Adolescent. Indian J Otolaryngol Head Neck Surg 2024; 76:1344-1346. [PMID: 38440647 PMCID: PMC10909014 DOI: 10.1007/s12070-023-04324-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Accepted: 10/25/2023] [Indexed: 03/06/2024] Open
Abstract
Cystic neck masses in adolescents pose a diagnostic challenge as they be neoplastic or non-neoplastic, congenital, inflammatory, or infectious. Detailed history and examination, anatomical location of the lesion may help narrow down the differential diagnosis of such masses. Cervical thymic cysts contribute to less than 1% cystic lesions in the neck. We present one such case and our management strategy.
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Affiliation(s)
- Deviprasad Dosemane
- Department of Otorhinolaryngology and Head & Neck Surgery, Kasturba Medical College, Mangalore, Manipal Academy of Higher Education, Manipal, India
| | - Meera Niranjan Khadilkar
- Department of Otorhinolaryngology and Head & Neck Surgery, Kasturba Medical College, Mangalore, Manipal Academy of Higher Education, Manipal, India
| | - Puvvula Praneetha
- Department of Otorhinolaryngology and Head & Neck Surgery, Kasturba Medical College, Mangalore, Manipal Academy of Higher Education, Manipal, India
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Jiang T, Jin X, Li G. Lymphangioma of the pancreas: A case report. Int J Surg Case Rep 2024; 115:109233. [PMID: 38217922 PMCID: PMC10821606 DOI: 10.1016/j.ijscr.2024.109233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Revised: 01/02/2024] [Accepted: 01/05/2024] [Indexed: 01/15/2024] Open
Abstract
INTRODUCTION Lymphangiomas constitute a distinct subtype of benign lymphatic malformation. The occurrence of pancreatic involvement is exceedingly infrequent. Patients with this disease typically remain asymptomatic. Surgical resection serves as the primary therapeutic modality. CASE PRESENTATION A female patient, aged 42, was revealed to have a mass located at the back of the pancreas and occupying the body of the pancreas during imaging examinations. As a result, she underwent laparoscopic surgery for resection. CLINICAL DISCUSSION Lymphangioma is a congenital aberration of the lymphatic vessels without malignant properties. Patients typically present without symptoms, and laparoscopic surgery is the primary treatment approach. We have focused our discussion on the etiology, diagnosis, and management of this condition. CONCLUSION Pancreatic lymphangioma, a clinical entity of rarity, often manifests with nonspecific symptoms. We believe that laparoscopic surgery is the preferred option for treating such diseases.
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Affiliation(s)
- Ting Jiang
- Department of Hepatobiliary and Pancreatic Surgery, Affiliated Hospital of Yanbian University, Yanji City, China
| | - Xinglin Jin
- Department of Hepatobiliary and Pancreatic Surgery, Affiliated Hospital of Yanbian University, Yanji City, China
| | - Guangyi Li
- Department of Hepatobiliary and Pancreatic Surgery, Affiliated Hospital of Yanbian University, Yanji City, China.
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Abstract
The majority of the vascular anomalies are seen in the head and neck region. Even though the incidence of this anomaly could be construed as a rare disease entity, with only 5% of overall affliction, the lack of knowledgeable management has disfigured many. A comprehensive understanding of this benign yet complex life-changing entity is essential. A historical perspective, pathophysiology-logical evolution, and the current knowledge of management modalities are essential for rendering clinical care in this subspecialty care. We propose a very succint Head and Neck Surgical classification for vascular anamolies, which has been a good guide for surgical approaches.
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Affiliation(s)
- Srinivasa R Chandra
- Department of Oral and Maxillofacial Surgery - Head and Neck Oncology and Microvascular Reconstruction, Oregon Health and Sciences University, 3181 SW Sam Jackson Park Road, Portland, OR 97239, USA.
| | - Advaith Nair
- Department of Oral and Maxillofacial Surgery - Head and Neck Oncology and Microvascular Reconstruction, Oregon Health and Sciences University, 3181 SW Sam Jackson Park Road, Portland, OR 97239, USA
| | - Sanjiv Nair
- B M Jain Hospital, Bangalore Institute of Dental Sciences, 35, 4th Main 13 Cross, Malleswaram, Bangalore, 560003
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Tabrizi Z, Dadkhah A, soleimani S, Moaddab M. Generalized cystic lymphangiomatosis incidentally diagnosed in an asymptomatic adult: Imaging findings of a very rare case. Radiol Case Rep 2024; 19:130-135. [PMID: 37941984 PMCID: PMC10628799 DOI: 10.1016/j.radcr.2023.10.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Revised: 10/01/2023] [Accepted: 10/05/2023] [Indexed: 11/10/2023] Open
Abstract
Lymphangiomas are benign lesions of vascular origin with lymphatic differentiation, most commonly found in the head and neck. Generalized lymphangiomatosis is a very rare condition in adults, which is characterized by a diffuse proliferation of lymphatic vessels. The lymphangioma is composed of lymphatic endothelium-lined cystic spaces. This condition can be histologically differentiated from other vascular disorders such as cavernous or capillary hemangioma. However, many cases of lymphangioma can be confused with other vascular disorders, because of overlapping histologic findings. radiologic examinations, such as CT scan and MR imaging, are useful for assessing the morphologic feature and also the extent of disease, it is important to know the radiologic findings of generalized lymphangiomatosis. In this paper, we report a case of generalized lymphangiomatosis in a 42-year-old male who presented with left flank pain and hematuria. The first differential diagnosis was renal colic; hence he underwent an abdominopelvic computed tomography scan (CT scan). In the performed CT scan multiple cystic lesions were seen in the liver and spleen. Also, lytic lesions were seen in bones. CT-guided biopsy was performed and the result was compatible with generalized lymphangiomatosis, confirmed by cytology. Generalized lymphangiomatosis is a rarely reported disease in children and young adults. Delayed diagnosis in older patients or misdiagnosis is common due to its rarity and nonspecific clinical presentation. Different imaging modalities can incidentally diagnose the disease in asymptomatic patients. So radiologists should be aware of the disease manifestations in imaging modalities to diagnose the disease sooner and help the clinician start the therapy if needed.
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Affiliation(s)
- Zhale Tabrizi
- Department of Radiology, Iran University of Medical Science, Tehran, Iran
| | - Adeleh Dadkhah
- Department of Radiology, Hasheminejad Kidney Center (HKC), Iran University of Medical Science, Tehran, Iran
| | - Shakiba soleimani
- Department of Radiology, Iran University of Medical Science, Tehran, Iran
| | - Maryam Moaddab
- Department of Radiology, Iran University of Medical Science, Tehran, Iran
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Gilliam A, Reeves I, Childers ELB. Neonatal alveolar lymphangioma: A rare benign oral disease case report and literature review. J Am Dent Assoc 2023; 154:1106-1111. [PMID: 37831026 DOI: 10.1016/j.adaj.2023.08.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Revised: 08/17/2023] [Accepted: 08/21/2023] [Indexed: 10/14/2023]
Abstract
BACKGROUND Neonatal alveolar lymphangioma (NAL) is a rare benign condition most often reported in the oral cavity of neonates of African descent. CASE DESCRIPTION The authors present a case report of bilateral NAL, including follow-up images at 6 months and 17 months. The clinical differential diagnosis includes dental lamina cyst, hemangioma, congenital epulis of the neonate, and melanotic neuroectodermal tumor of infancy. Key differences to assist in making the distinction are described. PRACTICAL IMPLICATIONS The distinguishing characteristics of NAL make a clinical diagnosis possible. Accurate clinical recognition of NAL is essential because biopsy is not typically indicated. Because this is a clinical diagnosis, follow-up for 1 year or until complete resolution; biopsy is suggested if clinically indicated for residual or recurrent lesion.
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Sonvane K, Thakkar N, Gupta R. Case Series of Cervical Lymphangioma with Different Presentation. Indian J Otolaryngol Head Neck Surg 2023; 75:2747-2751. [PMID: 37974830 PMCID: PMC10646125 DOI: 10.1007/s12070-023-03848-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Accepted: 05/03/2023] [Indexed: 11/19/2023] Open
Abstract
Cervical lymphangioma is a congenital malformation of the lymphatic system. They are most common in children between the ages of 3 and 5 years and rarely present in adults. It is most often present in the posterior triangle of the neck. The treatment of choice is complete surgical resection, although other treatment alternatives are reported; the most significant being sclerotherapy. We have included six cases with large neck lymphangiomas in the period of 2020-2023. Two lympangioma were located on the left side of neck, one over the midline of neck, one at the right side of the neck, one in the right submandibular space and one at the right side parotid region. All were surgically resected sucessfully. No recurrence was seen in any cases.
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Affiliation(s)
- Krutika Sonvane
- Department of E.N.T. and Head-Neck Surgery, Baroda Medical College and S.S.G. Hospital, Vadodara, Gujarat India
| | - Nupur Thakkar
- Department of E.N.T. and Head-Neck Surgery, Baroda Medical College and S.S.G. Hospital, Vadodara, Gujarat India
| | - Rahul Gupta
- Department of E.N.T. and Head-Neck Surgery, Baroda Medical College and S.S.G. Hospital, Vadodara, Gujarat India
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Wu W, Mo J, Tan K, Chen X, Xu W, Liu J, Lv Z. Misdiagnosis of scrotal and retroperitoneal lymphangioma in children. BMC Pediatr 2023; 23:551. [PMID: 37924010 PMCID: PMC10623770 DOI: 10.1186/s12887-023-04380-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Accepted: 10/21/2023] [Indexed: 11/06/2023] Open
Abstract
BACKGROUND Scrotal and retroperitoneal lymphangioma (SRL) in children is relatively rare and its clinical symptoms are usually difficult to distinguish from other conditions such as hydrocele and incarcerated inguinal oblique hernia. This study aimed to explore the clinical diagnosis and treatment of abdominal scrotal lymphangioma in children, and thus, to increase our understandings of this disease in clinical practice. METHOD This study enrolled nine boys, aged 1-10, who were admitted to Shanghai Children's Hospital from January 2019 to December 2020 and who were finally confirmed with lymphangioma in the inguinal area. The clinical manifestations, diagnosis, and treatment of these children were analyzed retrospectively. The length of diagnostic process ranged from 3 weeks to 20 months. We also reviewed other cases of initially misdiagnosed cases of SRL in English publications from 2000 to 2022. RESULTS The nine cases were misdiagnosed as hydrocele, hematoma, or inguinal hernia. Three patients received intracystic injection of bleomycin, three underwent laparoscopic mass resection, and three underwent resection of the inguinal lymphangioma under direct vision. Postoperative pathological analysis of the surgical specimens confirmed the diagnosis of benign cystic lesions and lymphangioma. Meanwhile, among the 14 cases of SRL in literature review, eight were misdiagnosed. Six were initially diagnosed as hydrocele, one as inguinal oblique hernia, and one as testicular tumor, all of which underwent ultrasonography scans. All cases were confirmed as lymphangioma after pathological examination. CONCLUSION The non-specific clinical manifestations may contribute to the misdiagnosis of scrotal masses in children. A detailed and accurate medical history, careful physical examination, and imaging findings are important factors contributing to the preoperative differential diagnosis of scrotal lumps in children, but the final diagnosis is based on pathological examination.
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Affiliation(s)
- Wei Wu
- Department of General Surgery, Shanghai Children's Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, 200040, P. R. China
| | - Jiayu Mo
- Department of General Surgery, Shanghai Children's Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, 200040, P. R. China
| | - Kezhe Tan
- Department of General Surgery, Shanghai Children's Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, 200040, P. R. China
| | - Xingzhao Chen
- Department of General Surgery, Shanghai Children's Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, 200040, P. R. China
| | - WeiJue Xu
- Department of General Surgery, Shanghai Children's Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, 200040, P. R. China
| | - JiangBin Liu
- Department of General Surgery, Shanghai Children's Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, 200040, P. R. China
| | - Zhibao Lv
- Department of General Surgery, Shanghai Children's Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, 200040, P. R. China.
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Thorat S, Shaji FM. Splenic lymphangioma masquerading as splenic abscess managed by laparoscopic splenectomy: A case report. World J Clin Oncol 2023; 14:440-444. [PMID: 37970112 PMCID: PMC10631350 DOI: 10.5306/wjco.v14.i10.440] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Revised: 07/19/2023] [Accepted: 09/19/2023] [Indexed: 10/24/2023] Open
Abstract
BACKGROUND Primary benign splenic tumours are unique and account for < 0.007% of all tumours identified during surgery and autopsy. Splenic lymphangiomas are rarely seen in adults. Splenic lymphangiomas may be asymptomatic, or may present with upper left abdominal pain, splenomegaly, hypersplenism, or splenic rupture with haemorrhagic shock. The clinical and radiological features of these lesions are not specific. This case report serves to remind the clinician to consider the rare but important differential diagnosis of splenic lymphangioma while treating splenic lesions. CASE SUMMARY We report a case of splenic lymphangioma in a 22-year-old woman who presented with left upper quadrant abdominal pain for three months. Initial investigations were unremarkable; however, computed tomography later revealed multiple splenic micro-abscesses. The patient underwent laparoscopic splenectomy, and histopathological examination revealed splenic lymphangioma. The patient was discharged on postoperative day three. One month after surgery, the abdominal pain resolved completely, with no new complaints. Splenic lymphangiomas present clinically as splenomegaly or left upper quadrant abdominal pain; prompt intervention is necessary for avoiding complications. CONCLUSION This case report concludes that splenic lymphangiomas should be considered in the differential diagnosis of splenomegaly or left upper quadrant pain, even in adults, because they are amenable to curative treatment. Delays in surgical intervention may lead to severe complications, such as infection, rupture, and hemorrhage. Such lesions can be safely managed with laparoscopy, involving less postoperative pain and early patient discharge with excellent cosmetic outcomes.
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Affiliation(s)
- Santosh Thorat
- Department of General Surgery, Pimpri Chinchwad Municipal Corporation's Postgraduate Institute and Yashwantrao Chavan Memorial Hospital, Pune 411018, Maharashtra, India
| | - Febin Mohammed Shaji
- Department of General Surgery, Pimpri Chinchwad Municipal Corporation's Postgraduate Institute and Yashwantrao Chavan Memorial Hospital, Pune 411018, Maharashtra, India
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McInerney NJ, O'Keeffe N, Nae A, Morariu J, Timon C. Cystic hygroma in adults: a single-centre experience and review of the literature. Ir J Med Sci 2023; 192:2373-2377. [PMID: 36642745 PMCID: PMC10522499 DOI: 10.1007/s11845-022-03271-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Accepted: 12/30/2022] [Indexed: 01/17/2023]
Abstract
Cystic hygroma (CH) is a benign congenital lymphatic malformation, occurring predominantly in children, typically as an asymptomatic neck mass. Surgical resection or sclerotherapy is the recommended treatment options. A retrospective review of four cases of adult-onset CH was performed over 2 years by a single surgeon across two institutions. Four patients (two females, median age 31.5 years) who presented with supraclavicular neck masses (range 5-17 cm) are discussed. Ultrasound and MRI demonstrated supraclavicular masses, suggestive of CH. All patients underwent surgical resection. Post-operative courses were uncomplicated, with a mean length of stay of 4 days. All histological samples returned as CH. As of yet, there are no guidelines on the management of CH. Individualised care tailored to each patient, following careful discussion is the most prudent approach. This study demonstrates that surgical resection is a safe and effective treatment for adults in this rarely encountered clinical entity.
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Affiliation(s)
| | - Nick O'Keeffe
- Department of Otolaryngology, Royal Victoria Eye and Ear Hospital, Dublin, Ireland
| | - Andreea Nae
- Department of Otolaryngology, Royal Victoria Eye and Ear Hospital, Dublin, Ireland
| | - Juliana Morariu
- Department of Otolaryngology, Royal Victoria Eye and Ear Hospital, Dublin, Ireland
| | - Con Timon
- Department of Otolaryngology, Royal Victoria Eye and Ear Hospital, Dublin, Ireland
- Department of Otolaryngology, St. James Hospital, Dublin, Ireland
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16
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Sainz Sánchez J, Aranaz Murillo A, Andrés Villares E, García Maroto J. Generalized lymphatic anomaly in adult patients: An eminently radiological diagnosis. Radiologia (Engl Ed) 2023; 65:481-485. [PMID: 37758338 DOI: 10.1016/j.rxeng.2022.08.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Accepted: 08/09/2022] [Indexed: 10/03/2023]
Abstract
Generalized lymphatic anomaly (GLA) is an uncommon congenital disease secondary to the proliferation of lymphatic vessels in any organ except the central nervous system. GLA has a wide spectrum of clinical and radiological presentations, among which osteolytic lesions are the most widespread, being the ribs the most commonly affected bone. GLA is diagnosed mainly in children and young adults; nevertheless, on rare occasions it can remain asymptomatic and be detected incidentally in older patients. We present an unusual case of GLA in an asymptomatic 54-year-old man who had atypically distributed, purely cystic bone lesions on CT; measuring the Hounsfield (HU) of these lesions enabled us to suspect GLA. This suspicion was confirmed with MRI, PET/CT, CT-guided fine-needle aspiration biopsy, and fluoroscopy-guided percutaneous vertebral biopsy. After surgical resection of one of the lesions, histologic study provided the definitive diagnosis.
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Affiliation(s)
- J Sainz Sánchez
- Servicio de Radiodiagnóstico, Hospital Universitario Miguel Servet, Zaragoza, Spain.
| | - A Aranaz Murillo
- Servicio de Radiodiagnóstico, Hospital Universitario Miguel Servet, Zaragoza, Spain
| | - E Andrés Villares
- Servicio de Urgencias y Medicina Familiar y Comunitaria, Hospital Hernest Lluch, Zaragoza, Spain
| | - J García Maroto
- Servicio de Radiodiagnóstico, Hospital Universitario Miguel Servet, Zaragoza, Spain
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17
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Dessai GS, Soni NK, Pujari S, Prabhu R, Kantharia CV. Cystic Lymphangioma of Rectum-A Case Report and Review of Literature. Korean J Gastroenterol 2023; 82:91-95. [PMID: 37621244 DOI: 10.4166/kjg.2023.057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Revised: 07/18/2023] [Accepted: 07/21/2023] [Indexed: 08/26/2023]
Abstract
Colorectal cystic lymphangiomas are rare benign lesions. They are characterized by the presence of either single or multi-cystic spaces lined by endothelium. Though there are multiple case reports of right and transverse colonic lymphangioma; only around 10 cases of lymphangioma of the rectum have been reported. We present a case report of rectal lymphangioma with the relevant literature review.
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Affiliation(s)
- Govindraj S Dessai
- Department of Surgical Gastroenterology, Seth G S Medical College and KEM Hospital, Mumbai, India
| | - Nikhil Kumar Soni
- Department of Surgical Gastroenterology, Seth G S Medical College and KEM Hospital, Mumbai, India
| | - Sharvari Pujari
- Department of Surgical Gastroenterology, Seth G S Medical College and KEM Hospital, Mumbai, India
| | - Ramkrishna Prabhu
- Department of Surgical Gastroenterology, Seth G S Medical College and KEM Hospital, Mumbai, India
| | - Chetan V Kantharia
- Department of Surgical Gastroenterology, Seth G S Medical College and KEM Hospital, Mumbai, India
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18
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Heliö K, Weckström S, Kivistö S, Lohi J, Heliö T. Successful palliative resection of giant epimyocardial lymphatic malformation with 14 years of follow-up: a case report. BMC Cardiovasc Disord 2023; 23:414. [PMID: 37612617 PMCID: PMC10463819 DOI: 10.1186/s12872-023-03449-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Accepted: 08/14/2023] [Indexed: 08/25/2023] Open
Abstract
BACKGROUND Primary tumors of the heart are a rare phenomenon. Lymphatic malformations are congenital anomalies of the lymphatic system that tend to grow progressively. Lymphatic malformations are typically found in the cervical and axillary regions and found on pediatric patients. We report a 40-year-old woman with giant epimyocardial lymphatic malformation. CASE PRESENTATION A 40-year-old woman was assessed due to suspected traumatic cardiac tamponade. Computed tomography of the heart and cardiac magnetic resonance imaging were compatible with either a large pericardial hemangioma or angiosarcoma. The tumor infiltrated deeply into the myocardium and could only be partially resected. Histopathological diagnosis was a cardiac lymphatic malformation with micro- and macrocystic components. The patient has remained asymptomatic for fourteen years after the surgery. In the latest follow-up, her left ventricular function had remained normal and the maximum thickness of the residual tumor had regressed. CONCLUSIONS Even when a complete removal of a cardiac lymphatic malformation is not possible, a debulking procedure can yield a good long-term result.
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Affiliation(s)
- Krista Heliö
- Heart and Lung Center, Helsinki University Hospital and University of Helsinki, Helsinki, Finland.
| | - Sini Weckström
- Heart and Lung Center, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Sari Kivistö
- Department of Radiology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Jouko Lohi
- Department of Pathology, HUSLAB, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Tiina Heliö
- Heart and Lung Center, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
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19
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Haidari M, Malakzai HA, Haidary AM, Faizi FR, Abdul-Ghafar J. Huge accessory spleen with torsion, mimicking splenic lymphangioma: A case report and review of the literature. Int J Surg Case Rep 2023; 109:108597. [PMID: 37531882 PMCID: PMC10400468 DOI: 10.1016/j.ijscr.2023.108597] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Revised: 07/26/2023] [Accepted: 07/27/2023] [Indexed: 08/04/2023] Open
Abstract
INTRODUCTION AND IMPORTANCE Approximately 30 % of population can have an accessory spleen, which is most often asymptomatic. Only when it becomes large in size, it may elicit symptoms, mostly due to complications, such as torsion, infarction, or traumatic hemorrhage. The preoperative diagnosis of an accessory spleen is often challenging due to its propensity to manifest the neoplasms of adjacent organs. Here we report a rare case of a huge tortured accessory spleen mimicking splenic lymphangioma and to review the literature. CASE PRESENTATION A 27-year-old man was admitted to the emergency department following left hypochondrial pain that lasted for three days. The computed tomography scan findings demonstrate the spleen in its normal position, showing smooth outlines attached to a similar-density cystic heterogenous mass exhibiting strong radiological evidence of splenic lymphangioma. Surgical excision was performed, and a large tortured accessory spleen was discovered that was attached to the lower pole of the spleen by connective tissue. CLINICAL DISCUSSION An accessory spleen is always smaller than 4 cm, and accessory spleens larger than that, especially with torsion, are extremely uncommon. According to literature, the identification of accessory spleen on the basis of clinical and radiological features is very difficult, especially when the patient presents with symptoms of acute abdomen. CONCLUSION Considering the fact that accessory splenic tissue can mimics neoplasms of the spleen or nearby organs, it should be included in the differential diagnosis in an undiagnosed pre- or intraoperative hypochondrial mass, located in the vicinity of the spleen.
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Affiliation(s)
- Mujtaba Haidari
- Department of Pathology and Clinical Laboratory, French Medical Institute for Mothers and Children (FMIC), Kabul, Afghanistan
| | | | - Ahmed Maseh Haidary
- Department of Pathology and Clinical Laboratory, French Medical Institute for Mothers and Children (FMIC), Kabul, Afghanistan
| | - Fazel Rahman Faizi
- Department of Radiology, Kabul University of Medical Science (KUMS), Kabul, Afghanistan
| | - Jamshid Abdul-Ghafar
- Department of Pathology and Clinical Laboratory, French Medical Institute for Mothers and Children (FMIC), Kabul, Afghanistan.
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20
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Gomes JE, Canadas-Sousa A, Guimarães T, Cunha R, Dias-Pereira P. Preputial lymphangioma in a stallion: first report. Reprod Domest Anim 2023. [PMID: 37289190 DOI: 10.1111/rda.14402] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Revised: 05/23/2023] [Accepted: 06/05/2023] [Indexed: 06/09/2023]
Abstract
This short communication describes a case of a 30-year-stallion with a mass on the base of the penis causing paraphimosis. The patient was submitted to anti-inflammatory and diuretic therapy with no signs of improvement so, 16 days after the lesion was detected, the animal was euthanised. Necropsy was performed and histopathological assessment of the lesion was conducted. The mass was composed primarily of channels and cavernous structures, lined by elongated cells of vascular origin, located in the preputium. The lesion was diagnosed as a preputial lymphangioma. To the authors' best knowledge, the anatomical location of this neoplasm (which is rare in veterinary medicine) has not been previously reported.
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Affiliation(s)
- José Eduardo Gomes
- School of Medicine and Biomedical Sciences (ICBAS), University of Porto, Porto, Portugal
| | - Ana Canadas-Sousa
- School of Medicine and Biomedical Sciences (ICBAS), University of Porto, Porto, Portugal
| | - Tiago Guimarães
- School of Medicine and Biomedical Sciences (ICBAS), University of Porto, Porto, Portugal
- Associate Laboratory for Animal and Veterinary Sciences (AL4AnimalS), Lisbon, Portugal
- Centro de Estudos de Ciência Animal/Instituto de Ciências, Tecnologias e Agroambiente da Universidade do Porto (CECA/ICETA), Porto, Portugal
| | - Raquel Cunha
- School of Medicine and Biomedical Sciences (ICBAS), University of Porto, Porto, Portugal
- Associate Laboratory for Animal and Veterinary Sciences (AL4AnimalS), Lisbon, Portugal
- Centro de Estudos de Ciência Animal/Instituto de Ciências, Tecnologias e Agroambiente da Universidade do Porto (CECA/ICETA), Porto, Portugal
| | - Patrícia Dias-Pereira
- School of Medicine and Biomedical Sciences (ICBAS), University of Porto, Porto, Portugal
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21
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Khadilkar MN, Bajpai S, Dosemane D, Suresh PK. Web in the Neck - An Interesting Case Report. Indian J Otolaryngol Head Neck Surg 2023; 75:1196-1200. [PMID: 37274990 PMCID: PMC10235225 DOI: 10.1007/s12070-022-03434-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Accepted: 12/21/2022] [Indexed: 01/13/2023] Open
Abstract
Lateral neck masses are common in children, ranging from simple benign diseases to pathologies with malignant potential. Plexiform neurofibromas are extremely rare peripheral nerve sheath tumours involving multiple nerve sheath fascicles. They are typically seen in the paediatric population, with the majority affecting the craniofacial area and neck. Due to the close clinical and histological resemblance with other benign neck lesions such as lymphadenitis and branchial cysts, these cases can often go misdiagnosed. We describe a lesion in a young girl who presented with a progressive lateral neck swelling and how it was managed.
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Affiliation(s)
- Meera N. Khadilkar
- Department of Otorhinolaryngology and Head & Neck Surgery, Kasturba Medical College, Mangalore, Manipal Academy of Higher Education, Manipal, Karnataka 575001, India
| | - Sanchit Bajpai
- Department of Otorhinolaryngology and Head & Neck Surgery, Kasturba Medical College, Mangalore, Manipal Academy of Higher Education, Manipal, Karnataka 575001, India
| | - Deviprasad Dosemane
- Department of Otorhinolaryngology and Head & Neck Surgery, Kasturba Medical College, Mangalore, Manipal Academy of Higher Education, Manipal, Karnataka 575001, India
| | - Pooja K. Suresh
- Department of Pathology, Kasturba Medical College, Mangalore, Manipal Academy of Higher Education, Manipal, Karnataka 575001, India
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22
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Satheakeerthy S, Sharma V, Huynh F. Cystic lymphangioma presenting as an acute abdomen in an adult male with congenital aortic stenosis. Radiol Case Rep 2023; 18:2176-2179. [PMID: 37101888 PMCID: PMC10123318 DOI: 10.1016/j.radcr.2023.03.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Revised: 03/12/2023] [Accepted: 03/16/2023] [Indexed: 04/28/2023] Open
Abstract
Abdominal cystic lymphangioma rarely presents as an acute abdomen. In this article, we describe a young adult male with congenital aortic stenosis who initially presented with abdominal pain and raised inflammatory markers. The imaging in the form of a computed tomography scan was unfortunately inconclusive. In the evolution of this diagnostic dilemma, we describe the importance of early operative management as well as explore the link between cardiac and lymphatic malformations.
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Affiliation(s)
| | - Varsha Sharma
- Department of General Surgery, Western Health, Footscray Hospital, Footscray, VIC 3011, Australia
| | - Frederick Huynh
- Department of General Surgery, Western Health, Footscray Hospital, Footscray, VIC 3011, Australia
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23
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Kiran A, Komandla A. Cutaneous lymphangioma circumscriptum. Pan Afr Med J 2023; 45:46. [PMID: 37575519 PMCID: PMC10422030 DOI: 10.11604/pamj.2023.45.46.39047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Accepted: 05/05/2023] [Indexed: 08/15/2023] Open
Affiliation(s)
- Adithya Kiran
- Department of Pediatrics, Jawaharlal Nehru Medical College, Acharya Vinoba Bhave Rural Hospital, Datta Meghe Institute of Medical Sciences, Sawangi, Wardha, Maharashtra, India
| | - Asritha Komandla
- Department of Pediatrics, Jawaharlal Nehru Medical College, Acharya Vinoba Bhave Rural Hospital, Datta Meghe Institute of Medical Sciences, Sawangi, Wardha, Maharashtra, India
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24
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Dabas S, Menon NN, Ranjan R, Gurung B, Shukla H, Sharma AK, Tiwari S, Sinha A, Bhatti SS, Sangal R. Transoral robotic surgery for adult parapharyngeal lymphangioma: A case report. World J Otorhinolaryngol 2023; 10:23-29. [DOI: 10.5319/wjo.v10.i2.23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Revised: 12/17/2022] [Accepted: 02/09/2023] [Indexed: 05/08/2023] Open
Abstract
BACKGROUND Lymphangiomas are a group of benign swellings which are commonly seen in children. The most common sites of presentation is the head and neck region, less commonly seen in axilla, chest, liver, spleen, etc. The ideal modality of treatment has always been surgical excision irrespective of the site and age group. But with the advent of minimally invasive surgical techniques, it is now possible to perform excision of parapharyngeal space lesions with minimal morbidity and good clearance.
CASE SUMMARY A 42-year-old male patient who presented with difficulty in swallowing and had undergone surgery twice outside, where Transcervical approach was attempted to remove the parapharyngeal mass, but failed. Magnetic resonance imaging scan demonstrated a 6 cm x 5 cm x 4 cm left parapharyngeal mass. He underwent transoral robotic surgery for the excision of the parapharyngeal lesion and had an uneventful post-operative recovery.
CONCLUSION Lymphangiomas are hamartomatous swellings which are benign in nature. The symptoms of the patient with large parapharyngeal mass include dysphagia, dyspnoea and neck swelling. Clinicoradiological evaluation is of utmost importance to determine the adjacent vital structures and the approach to the tumor. With the advent of robotics in oncology, transoral robotic excision is one of the best approaches to perform such a surgery.
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Affiliation(s)
- Surender Dabas
- Department of Surgical Oncology, BLK MAX Superspeciality Hospital, Delhi 110007, India
| | - Nandini N Menon
- Department of Surgical Oncology, BLK MAX Superspeciality Hospital, Delhi 110007, India
| | - Reetesh Ranjan
- Department of Surgical Oncology, BLK MAX Superspeciality Hospital, Delhi 110007, India
| | - Bikas Gurung
- Department of Surgical Oncology, BLK MAX Superspeciality Hospital, Delhi 110007, India
| | - Himanshu Shukla
- Department of Surgical Oncology, BLK MAX Superspeciality Hospital, Delhi 110007, India
| | - Ashwani K Sharma
- Department of Surgical Oncology, BLK MAX Superspeciality Hospital, Delhi 110007, India
| | - Sukirti Tiwari
- Department of Surgical Oncology, BLK MAX Superspeciality Hospital, Delhi 110007, India
| | - Ajit Sinha
- Department of Surgical Oncology, BLK MAX Superspeciality Hospital, Delhi 110007, India
| | | | - Rishu Sangal
- Department of Radiology, BLK MAX Superspeciality Hospital, Delhi 110007, India
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25
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Mede A, Chotai PN, Huh WJ, Tan M. Intra-abdominal Cystic Lymphangiomas: The Vanderbilt Experience. J Surg Res 2023; 285:197-204. [PMID: 36696706 DOI: 10.1016/j.jss.2022.12.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Revised: 11/21/2022] [Accepted: 12/24/2022] [Indexed: 01/24/2023]
Abstract
INTRODUCTION Lymphangiomas are rare, cystic tumors that represent congenital malformation of the lymphatic vessels. We reviewed our institution's experience treating abdominal lymphangiomas with the purpose of describing the clinical features, management, and outcomes of this rare pathology. METHODS This is a single-institution, institutional review board-approved retrospective review of abdominal lymphangiomas presenting between January 2010 and February 2021. The diagnosis of lymphangioma was made on histopathology from either endoscopic or excisional biopsy of the lesion. Demographics, diagnostic imaging, histopathologic characteristics, and outcomes were analyzed. RESULTS We identified 48 patients, of whom 29 (60%) were female, >18 y (38; 79%), with a mean age of 43 y at the time of diagnosis (range, 4 d-87 y). Tumors ranged in size from <1 cm to 30 cm. Only 1/3 were symptomatic, most commonly with abdominal pain (9; 19%) On preoperative imaging, mural nodules or thickened walls were present in one case, in which pathology was consistent with benign lymphangioma. The majority of lymphangiomas were associated with the small bowel or its mesentery (31; 65%), followed by the colon/omentum (7; 15%). Most patients underwent surgical excision (29; 60%) with incomplete excision in one patient due to extensive local invasion, and three (10%) patients required multivisceral resection. The median duration of the follow-up was 13 mo (range, 1-105 mo), during which time, none of the patients developed malignancy. CONCLUSIONS Most abdominal lymphangiomas arise from the small bowel and are found incidentally and have a favorable prognosis. Resection should be reserved for symptomatic lesions or when there is a diagnostic uncertainty.
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Affiliation(s)
- Annmarie Mede
- Vanderbilt University School of Medicine, Nashville, Tennessee
| | - Pranit N Chotai
- Division of Transplantation, Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio; Division of Surgical Oncology and Endocrine Surgery, Department of Surgery, Section of Surgical Sciences, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Won Jae Huh
- Department of Pathology, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Marcus Tan
- Division of Surgical Oncology and Endocrine Surgery, Department of Surgery, Section of Surgical Sciences, Vanderbilt University Medical Center, Nashville, Tennessee.
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26
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Luo T, Ye C, Huang Y, Luo Q. Lymphangioma of the esophagus. Asian J Surg 2023; 46:1469-70. [PMID: 36184288 DOI: 10.1016/j.asjsur.2022.09.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Accepted: 09/02/2022] [Indexed: 11/21/2022] Open
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27
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Fernandez-Flores A, Cassarino D, Colmenero I. Vascular Malformations: A Histopathologic and Conceptual Appraisal. Actas Dermosifiliogr 2023; 114:T213-T228. [PMID: 36690143 DOI: 10.1016/j.ad.2022.10.039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Accepted: 10/19/2022] [Indexed: 01/22/2023] Open
Abstract
In the field of vascular anomalies, distinguishing between vascular malformations and tumors has become crucial for a correct therapeutic approach. However, the differential diagnosis between these two groups is not always well explained in classical texts, mainly because many vascular malformations are still known with old names that suggest a tumoral nature. Also, genetic and pathogenic knowledge of these entities has greatly increased in recent decades, so researchers and clinicians now have a better understanding of vascular malformations. In this paper, we present the main histopathological tips to recognize and identify a vascular malformation as such. We also contextualize such information in the clinical and pathogenic knowledge for a better understanding of these entities.
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Affiliation(s)
- A Fernandez-Flores
- Departamento de Histopatología, Hospital Universitario El Bierzo, Ponferrada, León, España; Departamento de Patología Celular, Hospital de la Reina, Ponferrada, León, España; Departamento de Investigación, Instituto de Investigación Biomédica de A Coruña (INIBIC), Universidad de A Coruña, A Coruña, España.
| | - D Cassarino
- Los Angeles Medical Center (LAMC), Southern California Kaiser Permanente, Department of Dermatology, Los Ángeles, CA, EE. UU
| | - I Colmenero
- Departamento de Histopatología Pediátrica, Hospital Universitario Niño Jesús, Madrid, España
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28
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Fernandez-Flores A, Cassarino D, Colmenero I. Vascular Malformations: A Histopathologic and Conceptual Appraisal. Actas Dermosifiliogr 2023; 114:213-228. [PMID: 36309042 DOI: 10.1016/j.ad.2022.10.035] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Accepted: 10/19/2022] [Indexed: 12/13/2022] Open
Abstract
In the field of vascular anomalies, distinguishing between vascular malformations and tumors has become crucial for a correct therapeutic approach. However, the differential diagnosis between these two groups is not always well explained in classical texts, mainly because many vascular malformations are still known with old names that suggest a tumoral nature. Also, genetic and pathogenic knowledge of these entities has greatly increased in recent decades, so researchers and clinicians now have a better understanding of vascular malformations. In this paper, we present the main histopathological tips to recognize and identify a vascular malformation as such. We also contextualize such information in the clinical and pathogenic knowledge for a better understanding of these entities.
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Affiliation(s)
- A Fernandez-Flores
- Department of Histopathology, University Hospital El Bierzo, Ponferrada, Spain; Department of Cellular Pathology, Hospital de la Reina, Ponferrada, Spain; Research Department, Institute for Biomedical Research of A Coruña (INIBIC), University of A Coruña (UDC), A Coruña, Spain.
| | - D Cassarino
- Los Angeles Medical Center (LAMC), Southern California Kaiser Permanente, Department of Dermatology, Los Angeles, CA, USA
| | - I Colmenero
- Department of Pediatric Histopathology, University Hospital Niño Jesús, Madrid, Spain
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29
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Wiegand S, Wichmann G, Dietz A, Werner JA. Association between malformation type, location and functional deficits in lymphatic malformations of the head and neck in children. Eur Arch Otorhinolaryngol 2023; 280:2535-2540. [PMID: 36695910 PMCID: PMC10066143 DOI: 10.1007/s00405-023-07844-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Accepted: 01/15/2023] [Indexed: 01/26/2023]
Abstract
PURPOSE Lymphatic malformations (LM) are congenital malformations of the lymphatic system, mainly located in the head and neck area. They can be staged based on location according to de Serres and based on different morbidity items using the Cologne Disease Score (CDS), a clinical staging system. In many cases, functional impairment greatly affects the life of patients suffering from lymphatic malformations. The present study aims to analyze a cohort of pediatric patients with LM. METHODS A retrospective analysis of 144 pediatric patients with head and neck LM was performed. Location, type of malformation (microcystic, macrocystic, mixed), scoring according to two different scoring systems and therapy were analyzed. Kruskal-Wallis test was used to analyze the difference in CDS between the patient groups and Dunn's test was used for post-hoc pairwise comparison. RESULTS The average age at presentation was 6.1 years. The most common sites were neck (47%), cheek/parotid gland (26%), tongue (17%) and orbit (8%). Macrocystic malformations dominated the lateral neck, while microcystic malformations were predominantly localized in the tongue and floor of mouth. Macrocystic malformations (mean CDS 9.44) were associated with significantly better CDS than microcystic (mean CDS 7.11) and mixed (mean CDS 5.71) malformations (p < 0.001). LM in stage V according to de Serres had the lowest values (mean CDS: 4.26). The most common therapeutic procedures were conventional surgical (partial) resection, laser therapy and sclerotherapy with OK-432. CONCLUSIONS There is an association between malformation type, location according to de Serres and CDS in children with LM of the head and neck. Patients with microcystic and mixed malformations in stage V had lowest CDS levels.
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Affiliation(s)
- Susanne Wiegand
- Department of Otolaryngology, Head and Neck Surgery, University of Leipzig, Liebigstr. 12, 04103, Leipzig, Germany.
| | - G Wichmann
- Department of Otolaryngology, Head and Neck Surgery, University of Leipzig, Liebigstr. 12, 04103, Leipzig, Germany
| | - A Dietz
- Department of Otolaryngology, Head and Neck Surgery, University of Leipzig, Liebigstr. 12, 04103, Leipzig, Germany
| | - J A Werner
- University Hospital Essen, Essen, Germany
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Safaei F, Sadeghi A, Ketabi Moghadam P, Taheri P. Small Bowel Lymphangiectasia Leading to Massive Gastrointestinal Bleeding: A Case Report. Middle East J Dig Dis 2023; 15:60-62. [PMID: 37547165 PMCID: PMC10404075 DOI: 10.34172/mejdd.2023.322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Accepted: 12/06/2022] [Indexed: 08/08/2023] Open
Abstract
Lymphangiomas are benign lymphatic system abnormalities that can appear anywhere on the skin and mucous membranes. Lymphangiomas are caused by congenital or acquired lymphatic system disorders. In the congenital form, although the cause is unknown it is said that it is formed by the incorrect attachment of lymphatic channels to the main lymphatic drainage duct before the age of 5 years. lymphangiectasia as a subgroup of lymphangioma occurs seldom in the small bowel, especially in adults. If that happens, protein-losing enteropathy will be the most common presenting sign. In the present study, we introduce a case of a 40-year-old man without a history of any congenital or acquired diseases who was admitted to the emergency room due to long-lasting obscure overt gastrointestinal (GI) bleeding. Normal upper and lower GI endoscopies were suggestive of GI bleeding originating from the small intestine. Despite receiving iron supplements, he continued to have melena and remained anemic. Further evaluation of the small intestine by deep enteroscopy revealed multiple white spots histologically consistent with dilated lymphatics. Intestinal lymphangiectasia was eventually introduced to be the final diagnosis of the patient.
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Affiliation(s)
- Farahnaz Safaei
- Gastroenterology and Liver Diseases Research Center, Research Institute for Gastroenterology and Liver Diseases, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Amir Sadeghi
- Gastroenterology and Liver Diseases Research Center, Research Institute for Gastroenterology and Liver Diseases, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Pardis Ketabi Moghadam
- Gastroenterology and Liver Diseases Research Center, Research Institute for Gastroenterology and Liver Diseases, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Peyman Taheri
- Medical School, Mashhad University of Medical Sciences, Mashhad, Iran
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Tay WC, Chia HY, Cheng SWN. Acquired lymphangioma circumscriptum of the vulva (secondary to lymphatic obstruction) occurring ten years after a hysterectomy and radiotherapy: A case report. Taiwan J Obstet Gynecol 2023; 62:184-186. [PMID: 36720539 DOI: 10.1016/j.tjog.2022.06.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/01/2022] [Indexed: 01/30/2023] Open
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Efared B, Bako ABA, Younssa H, Boubacar I, Zabeirou A, Koura HH, Boureima HS, Amadou S, Coulibaly IS, Lassey JD, Nouhou H. Splenic lymphangiomas as a common indication for splenectomy: a case series with literature review. BMC Surg 2022; 22:446. [PMID: 36582009 PMCID: PMC9801652 DOI: 10.1186/s12893-022-01898-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Accepted: 12/28/2022] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Splenic lymphangiomas (SL) are very rare benign cystic lesions found in pediatric population. Their occurrence in adults is exceptional. Splenectomy is the common management of splenic lesions for diagnostic and/or therapeutic purpose. Our aim is to report additional cases of SL diagnosed on splenectomy specimens at our Pathology laboratory with literature review. METHODS This is a retrospective study including all cases of splenectomy recorded at our Pathology laboratory (June 2020-August 2022). We performed a comparison of clinicopathological features between patients with SL and those with other benign splenic diseases. RESULTS Sixteen cases of splenectomy were included. The mean age was 30.25 years (range of 6-70 years). The final histopathological diagnoses were congestive spleens in all cases of sickle cell disease (SCD) (5/16 patients, 31.25%), splenic cystic lymphangiomas (4/16 patients, 25%), capsular splenic infiltration by gastric and colic cancers (3/16 cases, 18.75%), splenic abscess (2/16 cases, 12.5%) and splenic rupture with subcapsular hematoma (1/16 patients, 6.25%). 12/16 patients (75%) had benign splenic conditions (4/12 with SL, 5/12 with SCD, 2/12 with abscess and 1/12 with splenic trauma). Patients with SL were older than those with other benign splenic conditions (mean age of 28.27 years versus 20.87 years). Also patients with SL presented with massive splenomegaly (mean splenic weight of 1675 g versus 418.75 g, mean splenic size of 19.62 cm versus 14.63 cm). Open surgery was performed in 15/16 patients (93.75%). CONCLUSION Unlike previous studies, our series shows that SL are a common indication for splenectomy and occur in older patients with massive cystic splenomegaly. Open splenectomy is still an usual surgical practice in our country.
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Affiliation(s)
- Boubacar Efared
- grid.10733.360000 0001 1457 1638Faculté des Scientes de la Santé (FSS), Université Abdou Moumouni, BP: 10896, Niamey, Niger ,grid.414237.70000 0004 0635 4264Laboratoire de cytologie et d’anatomie pathologiques, Hôpital National de Niamey, Niamey, Niger
| | - Aïchatou Balaraba Abani Bako
- grid.10733.360000 0001 1457 1638Faculté des Scientes de la Santé (FSS), Université Abdou Moumouni, BP: 10896, Niamey, Niger ,Hôpital Général de Référence, Niamey, Niger
| | - Hama Younssa
- grid.10733.360000 0001 1457 1638Faculté des Scientes de la Santé (FSS), Université Abdou Moumouni, BP: 10896, Niamey, Niger ,grid.414237.70000 0004 0635 4264Service de chirurgie générale et viscérale, Hôpital National Amirou B. Diallo, Niamey, Niger
| | - Idrissa Boubacar
- grid.414237.70000 0004 0635 4264Laboratoire de cytologie et d’anatomie pathologiques, Hôpital National de Niamey, Niamey, Niger
| | | | | | | | - Soumaila Amadou
- grid.414237.70000 0004 0635 4264Service de Chirurgie générale et viscérale, Hôpital National de Niamey, Niamey, Niger
| | | | - James Didier Lassey
- grid.10733.360000 0001 1457 1638Faculté des Scientes de la Santé (FSS), Université Abdou Moumouni, BP: 10896, Niamey, Niger ,Hôpital Général de Référence, Maradi, Niger
| | - Hassan Nouhou
- grid.10733.360000 0001 1457 1638Faculté des Scientes de la Santé (FSS), Université Abdou Moumouni, BP: 10896, Niamey, Niger
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Abstract
Neck masses can be defined as any abnormal swelling or growth from the level of base of skull to clavicle. They can be benign or malignant so a thorough investigation is necessary to reach to a final diagnosis. Here we report a case series of three unusual neck masses presenting to the Out patient Department of Otorhinolaryngology and Head and Neck Surgery in R. G. Kar Medical College, a tertiary care hospital of Kolkata in a span of 1.5 years. The rarity of the etiology behind the neck masses makes this case series unique.
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Affiliation(s)
- Riya Das
- Dakshinpally, Kalibari Road, Post- Rahara, North 24 Paragnas, Calcutta, 700118 India
| | - Tanmoy Sarkar
- Dakshinpally, Kalibari Road, Post- Rahara, North 24 Paragnas, Calcutta, 700118 India
| | - Sweta Verma
- Dakshinpally, Kalibari Road, Post- Rahara, North 24 Paragnas, Calcutta, 700118 India
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Park JH, Lee D, Maeng YH, Chang WB. Surgical excision of a large retroperitoneal lymphangioma: A case report. World J Clin Cases 2022; 10:11561-11566. [PMID: 36387812 PMCID: PMC9649553 DOI: 10.12998/wjcc.v10.i31.11561] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Revised: 08/23/2022] [Accepted: 10/09/2022] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Lymphangiomas are rare benign tumors most commonly found in children under 2 years of age; adult cases are extremely rare. Retroperitoneal lymphangiomas represent less than 1% of all lymphangiomas. Because of their benign nature and possibility of spontaneous resolution, lymphangiomas are sometimes left untreated for long periods of time. However, if they grow large enough to compress surrounding structures, retroperitoneal lymphangiomas may cause symptoms such as abdominal pain, nausea or vomiting. We report a case of a rapidly growing retroperitoneal lymphangioma in an adult, treated with complete surgical excision.
CASE SUMMARY A 60-year-old female who was diagnosed with an intra-abdominal cystic mass (11 cm × 9.5 cm) seven years ago presented to our hospital with symptoms of early satiety, nausea, and intermittent abdominal pain. Computed tomography (CT) scan confirmed interval enlargement to a 24 cm × 22 cm-sized huge left retroperitoneal mass, causing left hydronephrosis by external compression. Laparotomy was done via long midline incision. Due to severe adhesion between the aorta and the medial border of the mass, the cyst was intentionally opened for fluid aspiration and size reduction. After suture closure of the opening, we proceeded carefully with dissection. Aspiration showed light yellowish serous fluid. The mass was excised completely, and the pathology was consistent with cystic lymphangioma. The post-operative period was uneventful, and the patient was discharged without complications. Follow-up CT scan one month after surgery confirmed complete removal of the mass and decreased left hydronephrosis.
CONCLUSION Excision of the huge retroperitoneal cystic mass resulted in relief of the patient’s symptoms, originally caused by external compression, and also ruled out the possibility of malignancy.
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Affiliation(s)
- John Hee Park
- Department of Surgery, Samsung Medical Center, Seoul 06351, South Korea
| | - Donghyoun Lee
- Department of Surgery, Jeju National University Hospital, Jeju-si 63241, Jeju-do, South Korea
| | - Young Hee Maeng
- Department of Pathology, Jeju National University Medical Center, Jeju-si 63241, Jeju-do, South Korea
| | - Won-Bae Chang
- Department of Surgery, Jeju National University Medical Center, Jeju-si 63241, Jeju-do, South Korea
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Pathiraja H, Rasnayake D, Muthukumarana T, de Silva C, Sathkorala W, Gunaratne S, Rajindrajith S, Mettananda S. A large pericardial cystic lymphangioma presenting as acute-onset respiratory distress in a child: a case report. J Med Case Rep 2022; 16:397. [PMID: 36316785 PMCID: PMC9623980 DOI: 10.1186/s13256-022-03576-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Accepted: 08/18/2022] [Indexed: 11/05/2022] Open
Abstract
Background Lymphangiomas are rare benign malformations of the lymphatics that occur due to blockage of the lymphatic system during fetal development. They commonly occur in the neck and axilla, while involvement of the pericardium is rare. We report herein the case of a 16-month-old Sri Lankan child with a large pericardial cystic lymphangioma presenting with sudden-onset shortness of breath. Case presentation A 16-month-old Sri Lankan boy presented with sudden-onset dyspnea for 1-day duration following a febrile illness that lasted 2 days. On examination, he was afebrile and had subcostal, intercostal, and suprasternal recessions, with a respiratory rate of 50 breaths per minute. He had a loud expiratory grunt. The chest expansion was reduced on the right side, which was dull to percussion. Auscultation revealed a marked reduction of air entry over the right lower and mid zones. Chest X-ray showed a well-demarcated opacity involving the lower and mid zones of the right hemithorax associated with a tracheal shift to the opposite side. Ultrasound scan of the chest revealed fluid-filled right hemithorax suggesting a septate pleural effusion. A contrast-enhanced computed tomography scan of the thorax showed a large multiloculated extrapulmonary cystic lesion involving the right hemithorax with a mediastinal shift towards the left side associated with displacement of the right-side mediastinal structures. He underwent mini-thoracotomy and surgical excision of the cyst. A large cyst originating from the pericardium was observed and excised during surgery. Histological examination revealed a lesion composed of cysts devoid of a lining epithelium but separated by connective tissue, mature adipose tissue, and lymphoid aggregates. The child showed complete recovery postoperatively with full expansion of the ipsilateral lung. Conclusion We report the case of a patient with cystic lymphangioma who was perfectly well and asymptomatic until 16 months of age. This case report presents the very rare occurrence of a large cystic lymphangioma originating from the pericardium. It highlights the importance of considering rare possibilities and performing prompt imaging in situations of diagnostic uncertainty to arrive at an accurate diagnosis that can be lifesaving.
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Affiliation(s)
| | | | | | | | | | | | - Shaman Rajindrajith
- Lady Ridgeway Children’s Hospital, Colombo, Sri Lanka ,grid.8065.b0000000121828067Department of Paediatrics, University of Colombo, Colombo, Sri Lanka
| | - Sachith Mettananda
- grid.470189.3Colombo North Teaching Hospital, Ragama, Sri Lanka ,grid.45202.310000 0000 8631 5388Department of Paediatrics, Faculty of Medicine, University of Kelaniya, Thalagolla Road, Ragama, 11010 Sri Lanka
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Holleboom RG, Bombosch D, Wispels MMH, Giglia G, Tobias TJ. Cystic hygroma in a female suckling pig: a case report. Porcine Health Manag 2022; 8:40. [PMID: 36180929 PMCID: PMC9524065 DOI: 10.1186/s40813-022-00285-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Accepted: 09/14/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Cystic hygromas (lymphangiomas) are rarely reported in various animal species, humans included. A hygroma is a benign congenital malformation of the lymphatic drainage system, presenting itself as a mass consisting of multiple cysts of various sizes with a watery content. CASE PRESENTATION This report describes clinical, ultrasonographic, and post-mortem findings of a cystic hygroma in a suckling pig. The mass was characterized by a few thin-walled cysts, containing clear yellow serous fluid. Histologically, the central cavity was lined by a single layer of squamous cells, supported by a thick fibrous stroma. On immunohistochemistry, scattered lining cells were weakly positive for Factor-VIII, suggesting their possible endothelial origin. CONCLUSIONS This case report contributes to raising awareness on this condition in pigs allowing early identification in life so that appropriate care can be provided. The case report attributes to science on hygromas in general, as better understanding of pathologic features, the aetiology and appropriate treatment are needed.
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Affiliation(s)
- R G Holleboom
- Department of Population Health Sciences, Faculty of Veterinary Medicine, Utrecht University, Yalelaan 7, 3584 CL, Utrecht, The Netherlands
| | - D Bombosch
- Department of Population Health Sciences, Faculty of Veterinary Medicine, Utrecht University, Yalelaan 7, 3584 CL, Utrecht, The Netherlands
| | - M M H Wispels
- Department of Population Health Sciences, Faculty of Veterinary Medicine, Utrecht University, Yalelaan 7, 3584 CL, Utrecht, The Netherlands
| | - G Giglia
- Department of Biomolecular Health Sciences, Veterinary Pathology Diagnostic Centre, Faculty of Veterinary Medicine, Utrecht University, Yalelaan 1, 3584 CL, Utrecht, The Netherlands
| | - T J Tobias
- Department of Population Health Sciences, Faculty of Veterinary Medicine, Utrecht University, Yalelaan 7, 3584 CL, Utrecht, The Netherlands.
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Marchand A, Caille A, Gissot V, Giraudeau B, Lengelle C, Bourgoin H, Largeau B, Leducq S, Maruani A. Topical sirolimus solution for lingual microcystic lymphatic malformations in children and adults (TOPGUN): study protocol for a multicenter, randomized, assessor-blinded, controlled, stepped-wedge clinical trial. Trials 2022; 23:557. [PMID: 35804404 PMCID: PMC9270761 DOI: 10.1186/s13063-022-06365-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Accepted: 04/28/2022] [Indexed: 11/24/2022] Open
Abstract
Background Lingual microcystic lymphatic malformations (LMLMs) are rare congenital vascular malformations presenting as clusters of cysts filled with lymph fluid or blood. Even small well-limited lesions can be responsible for a heavy burden, inducing pain, aesthetic prejudice, or oozing, bleeding, infections. The natural history of LMLMs is progressive worsening punctuated by acute flares. Therapeutic options include surgery, laser excision, and radiofrequency ablation but all are potentially detrimental and expose to local relapse. Therefore, the management frequently relies on a “watchful waiting” approach. In complicated LMLMs, treatment with oral sirolimus, a mammalian target of rapamycin (mTOR) inhibitor, is often used. Topical applications of sirolimus on the buccal mucosae have been reported in other oral diseases with good tolerance and none to slight detectable blood sirolimus concentrations. We aim to evaluate the efficacy and safety of a 1 mg/mL sirolimus solution applied once daily on LMLM of any stage in children and adults after 4, 8, 12, 16, 20, and 24 weeks of treatment compared to usual care (no treatment). Methods This is a randomized, multicentric study using an individually randomized stepped-wedge design over 24 weeks to evaluate topical application of a 1 mg/mL sirolimus solution once daily, on LMLM, versus usual care (no treatment), the control condition. Participants begin with an observational period and later switch to the intervention at a randomized time (week 0, 4, 8, or 12). Visits occur every 4 weeks, either in the study center or by teleconsulting. The primary outcome will be the evaluation of global severity of the LMLM on monthly standardized photographs by 3 independent blinded experts using the physical global assessment (PGA) 0 to 5 scale. Secondary outcomes will include lesion size measurement and quality of life assessment, investigator, and patient-assessed global disease and specific symptoms (oozing, bleeding, sialorrhea, eating impairment, taste modification, aesthetic impairment, pain, and global discomfort) assessment. A biological monitoring will be performed including residual blood sirolimus concentration and usual laboratory parameters. Discussion Given the disappointing state of current treatment options in LMLMs, topical sirolimus could become firstline therapy in treating LMLMs if its efficacy and safety were to be demonstrated. Trial registration ClinicalTrials.gov NCT04128722. Registered on 24 September 2019. EudraCT: EUCTR2019-001530-33-FR Sponsor (University Hospital Center of Tours – CHRU Tours): DR190041-TOPGUN French regulatory authorities: ID RCB: 2019-001530-33 Supplementary Information The online version contains supplementary material available at 10.1186/s13063-022-06365-y.
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Affiliation(s)
- A Marchand
- Department of Dermatology and Reference Center for Rare Diseases and Vascular Malformations (MAGEC), CHRU Tours, Avenue de la République, 37044, Tours, Cedex 9, France.
| | - A Caille
- Clinical Investigation Center, INSERM 1415, CHRU Tours, 37000, Tours, France.,INSERM U1246 -SPHERE « MethodS in Patients-centered outcomes and HEalth REsearch », University of Nantes, University of Tours, 37000, Tours, France
| | - V Gissot
- Clinical Investigation Center, INSERM 1415, CHRU Tours, 37000, Tours, France.,INSERM U1246 -SPHERE « MethodS in Patients-centered outcomes and HEalth REsearch », University of Nantes, University of Tours, 37000, Tours, France
| | - B Giraudeau
- Clinical Investigation Center, INSERM 1415, CHRU Tours, 37000, Tours, France.,INSERM U1246 -SPHERE « MethodS in Patients-centered outcomes and HEalth REsearch », University of Nantes, University of Tours, 37000, Tours, France
| | - C Lengelle
- Pharmacovigilance Regional Centre (CRPV), CHRU Tours, 37000, Tours, France
| | - H Bourgoin
- Department of Pharmacy, University Hospital Center of Tours, 37000, Tours, France
| | - B Largeau
- Department of Pharmacy, University Hospital Center of Tours, 37000, Tours, France
| | - S Leducq
- Department of Dermatology and Reference Center for Rare Diseases and Vascular Malformations (MAGEC), CHRU Tours, Avenue de la République, 37044, Tours, Cedex 9, France.,Clinical Investigation Center, INSERM 1415, CHRU Tours, 37000, Tours, France.,INSERM U1246 -SPHERE « MethodS in Patients-centered outcomes and HEalth REsearch », University of Nantes, University of Tours, 37000, Tours, France
| | - A Maruani
- Department of Dermatology and Reference Center for Rare Diseases and Vascular Malformations (MAGEC), CHRU Tours, Avenue de la République, 37044, Tours, Cedex 9, France. .,Clinical Investigation Center, INSERM 1415, CHRU Tours, 37000, Tours, France. .,INSERM U1246 -SPHERE « MethodS in Patients-centered outcomes and HEalth REsearch », University of Nantes, University of Tours, 37000, Tours, France.
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Achuthan N, Chandrasekaran B, John RR. Management of recurrent lymphangioma of the cheek in an adult patient: An interdisciplinary approach. J Oral Biol Craniofac Res 2022; 12:465-468. [PMID: 38304865 PMCID: PMC10831346 DOI: 10.1016/j.jobcr.2022.05.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Revised: 03/27/2022] [Accepted: 05/21/2022] [Indexed: 11/23/2022] Open
Abstract
Lymphangiomas are congenital malformations. Swellings in the cheek may arise from infection, cyst and tumors.Pathological lesions are not always confined to its common site and age of occurrence. Occurrence of lymphangioma in buccal mucosa especially in adults are very rare. Exact knowledge about anatomy and nature of lesion is mandatory for its complete removal as incomplete removal results in recurrence. Herewith,a rare case of recurrent lymphangioma involving left buccal mucosa in an adult is presented with its management. Emphasis is laid on the necessity of combined approach through multidisciplinary team while treating such lesions.
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Affiliation(s)
- Narendran Achuthan
- Department of Oral and Maxillofacial Surgery, Vinayaka Mission's Sankarachariyar Dental College, Vinayaka Mission's Research Foundation (Deemed to be University), Salem, 636 308, India
| | - Balamanikandasrinivasan Chandrasekaran
- Department of Oral and Maxillofacial Surgery, Vinayaka Mission's Sankarachariyar Dental College, Vinayaka Mission's Research Foundation (Deemed to be University), Salem, 636 308, India
| | - Reena Rachel John
- Department of Oral and Maxillofacial Surgery, Vinayaka Mission's Sankarachariyar Dental College, Vinayaka Mission's Research Foundation (Deemed to be University), Salem, 636 308, India
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Park K, Abbas P, Langenburg S, Poulik J, Hanan A, Shehata BM. Giant Anal Fibroepithelial Polyp in a Healthy Teenage Boy: A Case Report and Literature Review. Fetal Pediatr Pathol 2022; 41:493-498. [PMID: 33164595 DOI: 10.1080/15513815.2020.1843575] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Background: Fibroepithelial polyps of the anus have been described as mucosal hypertrophy in response to chronic irritation or tissue damage. Lesions usually remain small and mostly present in elderly adults with local disease. Case Report: An otherwise healthy 15-year-old male presented with a giant pedunculated mass projecting out of the anal verge that enlarged over 2 years, causing discomfort. Results: Upon surgical excision and histologic examination, the mass resembled a fibroepithelial polyp with numerous dilated lymphatics. Conclusions: While literature describes the spectrum of pathology possible in such lesions, often consisting of a mixture of stromal and epithelial components, dilated lymphatics are less common. This giant anal fibroepithelial polyp characterized by edematous stroma and numerous dilated lymphatics is consistent with lymphangioma. To our knowledge, this presentation is novel in this age group with no underlying risk factors.
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Affiliation(s)
- Kelley Park
- Children's Hospital of Michigan, Detroit, MI, USA
| | | | | | - Janet Poulik
- Pathology, Children's Hospital of Michigan, Detroit, MI, USA
| | - Abdul Hanan
- Pathology, Children's Hospital of Michigan, Detroit, MI, USA
| | - Bahig M Shehata
- Department of Pathology and Pediatrics, Childrens Hospital of Michigan Foundation, Detroit, MI, USA
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41
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Geisthoff U, Mahnken AH, Knaus P, Schnittler HJ, Stuck BA, Knöppel C. [Interdisciplinary management of extracranial vascular anomalies]. HNO 2022; 70:380-388. [PMID: 35420312 DOI: 10.1007/s00106-022-01163-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/02/2022] [Indexed: 11/04/2022]
Abstract
BACKGROUND A multitude of vascular anomalies exist and can lead to severe complications. Treatment can be complex. OBJECTIVE This overview aims to provide important information for the management of vascular anomalies. MATERIALS AND METHODS In addition to current literature, experiences from the interdisciplinary Vascular Anomalies Center in Marburg were included in this review. RESULTS Hemangiomas at critical sites, arteriovenous malformations, and vascular anomalies of uncertain etiology require particular attention. CONCLUSION Self-help and support groups, specialized interdisciplinary centers, scientific medical societies, and networks can provide help for the treatment of vascular anomalies.
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Affiliation(s)
- Urban Geisthoff
- VASCERN HHT Reference Centre, Klinik für Hals-, Nasen- und Ohrenheilkunde, Universitatsklinikum Giesen und Marburg GmbH, Standort Marburg, Philipps-Universität Marburg, Marburg, Deutschland. .,Klinik für Hals-Nasen-Ohrenheilkunde, Prosper-Hospital, Stiftungsklinikum PROSELIS gGmbH, Recklinghausen, Deutschland.
| | - Andreas H Mahnken
- VASCERN HHT Reference Centre, Klinik für Hals-, Nasen- und Ohrenheilkunde, Universitatsklinikum Giesen und Marburg GmbH, Standort Marburg, Philipps-Universität Marburg, Marburg, Deutschland
| | - Petra Knaus
- Lehrstuhl für Chemie und Biochemie, Freie Universität Berlin, Berlin, Deutschland
| | - Hans-Joachim Schnittler
- Max-Planck-Institut für molekulare Biomedizin, Münster, Deutschland.,Institut für Neuropathologie, Westfälische Wilhelms-Universität Münster, Münster, Deutschland
| | - Boris A Stuck
- VASCERN HHT Reference Centre, Klinik für Hals-, Nasen- und Ohrenheilkunde, Universitatsklinikum Giesen und Marburg GmbH, Standort Marburg, Philipps-Universität Marburg, Marburg, Deutschland
| | - Carmen Knöppel
- VASCERN HHT Reference Centre, Klinik für Kinder- und Jugendmedizin, Universitätsklinikum Gießen und Marburg GmbH, Standort Marburg, Philipps-Universität Marburg, Marburg, Deutschland
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42
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Kondo H, Ohki T, Ogawa S, Omori T, Onizuka H, Nagashima Y, Yamaguchi S. Multiple intestinal lymphangiomas with episodic hemorrhage requiring partial laparoscopic resection: a case report. Surg Case Rep 2022; 8:56. [PMID: 35357631 PMCID: PMC8971343 DOI: 10.1186/s40792-022-01411-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Accepted: 03/25/2022] [Indexed: 11/17/2022] Open
Abstract
Background Lymphangioma is a non-epithelial tumor marked by aggregates of abnormally dilated lymphatics. Mesenteric occurrences account for < 1% of all cases, and < 0.05% involve the gastrointestinal tract. Most are confined to children, rarely affecting adults. Case presentation Herein, we describe an elderly Japanese woman with anemia, hypoalbuminemia, and episodic bleeding due to multiple intestinal lymphangiomas. Abdominal computed tomography revealed multiple low-density defects of mesentery, with areas of intermediate (T1 images) or high (T2 images) signal intensity similarly dispersed in magnetic resonance scanning sequences. Single-balloon enteroscopy was undertaken, enabling identification and tattooing of a small intestinal bleeding source. Laparoscopy-assisted resection at this site served to control related hemorrhage, removing a histologically confirmed hemolymphangioma. Having recovered uneventfully, the patient remained stable 2 months postoperatively. Conclusions Although rare in adults, mesenteric or gastrointestinal lymphangiomas must be considered in a setting of anemia and hypoalbuminemia. Complete resection is advantageous to improve patient symptoms, but limited resection of multiple lesions may be equally effective.
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Affiliation(s)
- Hiroka Kondo
- Department of Surgery, Institute of Gastroenterology, Tokyo Women's Medical University, 8-1, Kawada-cho, Shinjuku-ku, Tokyo, 162-8666, Japan.
| | - Takeshi Ohki
- Department of Surgery, Institute of Gastroenterology, Tokyo Women's Medical University, 8-1, Kawada-cho, Shinjuku-ku, Tokyo, 162-8666, Japan
| | - Shimpei Ogawa
- Department of Surgery, Institute of Gastroenterology, Tokyo Women's Medical University, 8-1, Kawada-cho, Shinjuku-ku, Tokyo, 162-8666, Japan
| | - Teppei Omori
- Department of Gastroenterology, Tokyo Women's Medical University, 8-1, Kawada-cho, Shinjuku-ku, Tokyo, Japan
| | - Hiromi Onizuka
- Department of Surgical Pathology, Tokyo Women's Medical University, 8-1, Kawada-cho, Shinjuku-ku, Tokyo, Japan
| | - Yoji Nagashima
- Department of Surgical Pathology, Tokyo Women's Medical University, 8-1, Kawada-cho, Shinjuku-ku, Tokyo, Japan
| | - Shigeki Yamaguchi
- Department of Surgery, Institute of Gastroenterology, Tokyo Women's Medical University, 8-1, Kawada-cho, Shinjuku-ku, Tokyo, 162-8666, Japan
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43
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Parmeggiani A, Baldazzi M, Carfagnini F, Vivacqua D, Golfieri R, Lovato L, Greco L. Extensive solitary lymphatic malformation of the liver in a child: a case report and literature review. Radiol Case Rep 2022; 17:427-433. [PMID: 34917222 PMCID: PMC8666449 DOI: 10.1016/j.radcr.2021.11.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Revised: 11/07/2021] [Accepted: 11/10/2021] [Indexed: 11/24/2022] Open
Abstract
Intrabdominal lymphatic malformations are rare benign congenital vascular anomalies that account for less than 5% of benign masses in childhood, with an extremely variable clinical presentation. For this reason, although their radiological appearance is usually typical, diagnosis can be challenging and not always immediate. This report describes a unique case of extensive solitary hepatic lymphatic malformation in a 10-year-old boy with both extra- and intraparenchymal development with no associated symptoms. A literature review of reported cases of solitary hepatic lymphatic malformation is also included.
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Affiliation(s)
- Anna Parmeggiani
- Department of Radiology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy
| | - Michelangelo Baldazzi
- Pediatric Radiology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy
| | - Filomena Carfagnini
- Pediatric Radiology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy
| | - Donatella Vivacqua
- Pediatric Radiology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy
| | - Rita Golfieri
- Department of Radiology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy
| | - Luigi Lovato
- Cardio-Thoracic Radiology Unit, Cardio-Thoracic-Vascular Department, St. Orsola Hospital, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Italy
| | - Laura Greco
- Pediatric Radiology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy
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44
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Aouad P, Young NM, Saratsis AM, Reynolds MA, Ryan ME. Gorham Stout disease of the temporal bone with cerebrospinal fluid leak. Childs Nerv Syst 2022; 38:455-460. [PMID: 34115176 DOI: 10.1007/s00381-021-05245-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Accepted: 06/01/2021] [Indexed: 11/29/2022]
Abstract
Gorham Stout disease (GSD) is a rare disease characterized by the proliferation of endothelial lined vessels and replacement of bone by fibrous tissue. The main imaging features are progressive osteolysis and cortical resorption. Temporal bone involvement is rare but presents as a destructive bone lesion that may be misinterpreted as more common lytic processes in the pediatric population, such as infection or Langerhans cell histiocytosis. GSD of the temporal bone is associated with cerebrospinal fluid (CSF) leaks, may present with otorrhea, and can mimic other causes of ear drainage. Here, we report the clinical course, imaging features, and outcomes of a 3-year-old girl with GSD of the temporal bone presenting with CSF leak initially attributed to infection.
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Affiliation(s)
- Pascale Aouad
- Department of Medical Imaging, Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
| | - Nancy M Young
- Division of Otolaryngology, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA.,Department of Otolaryngology - Head and Neck Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Amanda M Saratsis
- Department of Surgery, Division of Pediatric Neurosurgery, Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.,Department of Neurological Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.,Department of Biochemistry and Molecular Genetics, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Meredith A Reynolds
- Department of Pathology & Lab Medicine/Anatomic Pathology, Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Maura E Ryan
- Department of Medical Imaging, Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
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45
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Pichler Sekulic S, Sekulic M. Primary cardiac and pericardial lymphangiomas: clinical, radiologic, and pathologic characterization derived from an institutional series and review of the literature. Virchows Arch 2022; 480:1211-1221. [PMID: 35013774 DOI: 10.1007/s00428-022-03269-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Revised: 12/30/2021] [Accepted: 01/03/2022] [Indexed: 11/24/2022]
Abstract
Lymphangiomas are comprised of aggregates of lymphatic vessels, considered to represent either aberrant embryogenic remnants or developing secondary to obstruction. Lymphangiomas primary to the heart and pericardial are exceedingly rare, and to date sparingly reported in individual case reports. In this study, the histopathologic, clinical, and radiologic features of 35 cases of cardiac/pericardial lymphangiomas described in the literature to date together with four cases from our own institution (39 cases in total) are examined to provide clinicopathologic characterization. Cardiac/pericardial lymphangiomas were identified in both children and adults, with two cases initially discovered in utero. If presenting with symptoms, patients most commonly exhibited respiratory distress/dyspnea. By X-ray, a widened cardiac silhouette could be noted, and echocardiogram generally showed an echogenic mass with cystic and septal components. On computed tomography (CT) and magnetic resonance imaging (MRI), cystic and septal components were again observed, with CT showing an absence of calcifications or macroscopic fat. Most lymphangiomas were pericardial (specifically visceral) based, and frequently situated in the right atrioventricular groove. A majority of cases proceeded to surgical resection, with no evidence of recurrence post-operatively. Grossly, lesions had a median size of 6 cm and in almost all cases were multicystic/multilocular. Microscopically, the lymphangiomas were composed of lymphatic spaces lined by endothelial cells that specifically express podoplanin (D2-40) with immunoperoxidase staining. Further investigation with a larger and more uniformly organized cohort is required to better characterize the clinicopathologic features of lymphangiomas of this unusual anatomic location.
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Affiliation(s)
- Simona Pichler Sekulic
- Department of Pathology and Cell Biology, Columbia University Irving Medical Center, 630 West 168th Street, VC14-238C, New York, NY, 10032, USA
| | - Miroslav Sekulic
- Department of Pathology and Cell Biology, Columbia University Irving Medical Center, 630 West 168th Street, VC14-238C, New York, NY, 10032, USA.
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46
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Gidi NW, Tasew B, Abera G. A Case Report of Huge Lymphangioma over the Chest Wall: A Rare Presentation of a Newborn. Ethiop J Health Sci 2022; 32:209-212. [PMID: 35250232 PMCID: PMC8864385 DOI: 10.4314/ejhs.v32i1.22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/12/2021] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Lymphangioma is a rare benign tumor of lymphatic system that is often diagnosed in the first few years of life. The presentation and complications depend on the site and the size of the lesion. CLINICAL DESCRIPTION This was a term male newborn weighing 3230g born to a 38 year old para IIV mother. Delivery was spontaneous and uneventful. The neonate was active, had no gross dysmorphic feature except the huge, 20cm by 28cm cystic, non-tender mass over the left lateral chest area. DIAGNOSIS Lymphangioma was diagnosed based on chest ultrasound, there was a large multiloculated cystic lesion over left lateral chest, and the cyst had no communication with spinal canal, and had no solid component. THERAPY The patient was observed for complications, otherwise not needing intervention in the first few days. OUTCOMES He developed superinfection of the mass, for which intravenous antibiotics administered, infection was controlled and surgery was postponed until a few months. However, the patient was presented with severe malnutrition at the age of three months and subsequently lost to follow up. CONCLUSION Huge lymphangiomas at neonatal age are likely to get superinfected; a close observation for signs of complications is needed. Though surgical intervention could be postponed until the baby grows to avoid the complications of surgery, adequate counseling is needed to reassure the parents about the benign and treatable nature of the disease. And individualized decision on earlier surgical intervention has to be considered with adequate postoperative care whenever follow up is not guaranteed.
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Affiliation(s)
| | - Basazin Tasew
- Department of Pediatrics and Child Health, Jimma University, Jimma, Ethiopia
| | - Gersam Abera
- Department of Surgery, Jimma University, Jimma, Ethiopia
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47
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Pichler Sekulic S, Kalfa DM, Fenlon E, Shah A, LaCorte J, Sekulic M. Pericardial lymphangioma: a rare benign albeit variably symptomatic tumefactive lesion. Cardiovasc Pathol 2021; 57:107402. [PMID: 34875365 DOI: 10.1016/j.carpath.2021.107402] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Revised: 11/10/2021] [Accepted: 11/25/2021] [Indexed: 11/03/2022] Open
Abstract
Primary pericardial-based tumefactive lesions include pericardial cysts, mature teratomas, and lymphangiomas, and while benign they may result in clinical symptomatology that leads to their radiologic detection. We present the case of a 5-year-old boy with a heart murmur who was otherwise healthy and without significant medical history. Transthoracic echocardiogram, computed tomography, and magnetic resonance imaging studies revealed a pericardial multicystic mass imparting compression upon the right atrium and ventricle. The case proceeded to surgery in which complete resection of the mass was performed without complication, and the patient was discharged three days after. Pathology examination of the lesion determined it to be a pericardial lymphangioma with characteristic histologic features of sequestered vascular channels lined by endothelium that specifically expressed lymphatic-specific podoplanin (also known as D2-40), and with associated adipose tissue, smooth muscle bundles, and reactive lymphoid aggregates. Although a rare underlying etiology for mediastinal and specifically pericardial tumors, lymphangiomas should be considered in the differential of tumefactive lesions in this anatomic location.
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Affiliation(s)
- Simona Pichler Sekulic
- Department of Pathology and Cell Biology, Columbia University Irving Medical Center, New York, NY, USA
| | - David M Kalfa
- Section of Congenital and Pediatric Cardiac Surgery, Division of Cardiac, Thoracic and Vascular Surgery, Columbia University Irving Medical Center, New York, NY, USA
| | - Edward Fenlon
- Department of Radiology, Division of Pediatric Radiology, Columbia University Irving Medical Center, New York, NY, USA
| | - Amee Shah
- Department of Pediatrics, Division of Pediatric Cardiology, Columbia University Irving Medical Center, New York, NY, USA
| | - Jared LaCorte
- Department of Pediatrics, New York University School of Medicine, New York, NY, USA
| | - Miroslav Sekulic
- Department of Pathology and Cell Biology, Columbia University Irving Medical Center, New York, NY, USA.
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48
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Markovic-Sovtic G, Djuricic S, Sovtic A, Minic P, Rakonjac Z, Colmenero I. Neonatal Generalized Lymphatic Anomaly with Skin Involvement. Ann Dermatol 2021; 33:577-581. [PMID: 34858011 PMCID: PMC8577903 DOI: 10.5021/ad.2021.33.6.577] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2020] [Revised: 04/25/2020] [Accepted: 06/12/2020] [Indexed: 11/25/2022] Open
Abstract
Generalized lymphatic anomaly (GLA) is a rare congenital disorder of lymphatic development, presenting with multiple lymphatic malformations in different organs and tissues. Here, we present a case of a female neonate prenatally diagnosed with foetal hydrops and a mediastinal cystic lymphatic malformation that showed postnatal expansive and infiltrative growth into the major airways, compromising mechanical ventilation and further management of the neonate. Complications that arose during surgical treatment of mediastinal structures led to the patient’s death. Lymphatic malformations were also noted in the skin at birth. Furthermore, a skin biopsy performed immediately after birth and the autopsy revealed an extremely rare diagnosis of combined macrocystic and microcystic forms of GLA with skin involvement.
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Affiliation(s)
- Gordana Markovic-Sovtic
- Department of Neonatology, Mother and Child Health Care Institute of Serbia Belgrade, Belgrade, Serbia
| | - Slavisa Djuricic
- Department of Clinical Pathology, Mother and Child Health Care Institute of Serbia Belgrade, Belgrade, Serbia.,Dapartment of Pathology, School of Medicine, University of Banjaluka, Banjaluka, Bosnia and Herzegovina
| | - Aleksandar Sovtic
- Department of Pulmonology, Mother and Child Health Care Institute of Serbia, Belgrade, Serbia.,Department of Pediatrics, School of Medicine, University of Belgrade, Belgrade, Serbia
| | - Predrag Minic
- Department of Pulmonology, Mother and Child Health Care Institute of Serbia, Belgrade, Serbia.,Department of Pediatrics, School of Medicine, University of Belgrade, Belgrade, Serbia
| | - Zorica Rakonjac
- Department of Neonatology, Mother and Child Health Care Institute of Serbia Belgrade, Belgrade, Serbia
| | - Isabel Colmenero
- Department of Pathology, Hospital Infantil Universitario Niño Jesús, Madrid, Spain
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49
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Wu CH, Lu CH. Case report: Omental lymphangioma mimicking gastric cystic tumor. Radiol Case Rep 2021; 17:212-215. [PMID: 34824652 PMCID: PMC8605189 DOI: 10.1016/j.radcr.2021.10.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2021] [Revised: 10/10/2021] [Accepted: 10/11/2021] [Indexed: 11/25/2022] Open
Abstract
Omental lymphangioma is a rare pathology presented in the abdomen, and it can mimic several clinical conditions. Owing to its variable signs and symptoms, making a correct diagnosis by clinicians may be difficult. Surgical excision is the gold standard treatment. In this article, we report a case who presented with nonspecific abdominal complaints, and underwent surgery. Final pathologic diagnosis revealed omental cystic lymphangioma.
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Affiliation(s)
- Chia-Hui Wu
- Department of Medical Imaging, Kaohsiung Medical University Hospital, No.100, Tzyou 1st Rd., Sanmin Dist., Kaohsiung City, 80756, Taiwan.,Department of Radiology, School of Medicine, College of Medicine, Kaohsiung Medical University, No.100, Shih-Chuan 1st Road, Sanmin Dist., Kaohsiung City, 80708, Taiwan
| | - Chia-Hsin Lu
- Department of Medical Imaging, Kaohsiung Medical University Hospital, No.100, Tzyou 1st Rd., Sanmin Dist., Kaohsiung City, 80756, Taiwan.,Department of Radiology, School of Medicine, College of Medicine, Kaohsiung Medical University, No.100, Shih-Chuan 1st Road, Sanmin Dist., Kaohsiung City, 80708, Taiwan.,Department of Medical Imaging, Kaohsiung Municipal Ta-Tung Hospital, No.68, Jhonghua 3rd Rd, Cianjin District, Kaohsiung City 80145, Taiwan
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50
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Bedir R, Safa-Ayazoğlu M, Çeliker M. Laryngeal Cavernous Lymphangioma in an Adult Patient. Iran J Otorhinolaryngol 2021; 33:399-402. [PMID: 35223659 PMCID: PMC8829784 DOI: 10.22038/ijorl.2021.55065.2889] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Accepted: 09/19/2021] [Indexed: 11/06/2022]
Abstract
INTRODUCTION Lymphangiomas are uncommon congenital lesions of the lymphatic system, and most of them are detected by the second year of life. Although head and neck region is the most common location, laryngeal involvement isextremely rare, and the literature is largely limited to few case reports. CASE REPORT A 51-year-old male patient was admitted to the hospital with clinical history of hoarseness. Performed direct laryngoscopy revealed a pedunculated cystic mass located in the right ventricle of the larynx. The mass was totally excised, and the case was reported as cavernous lymphangioma. CONCLUSION Isolated laryngeal lymphangioma is extremely rare in adults. The other benign lesions or inflammatory processes in this region can mimic laryngeal lymphangioma. Therefore, this entity should be kept in mind in differential diagnosis especially in adults, to avoid overtreatment.
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Affiliation(s)
- Recep Bedir
- Department of Pathology, Recep Tayyip Erdoğan University School of Medicine, Rize, Turkey.,Corresponding author: Department of Pathology, Recep Tayyip Erdoğan University School of Medicine, Rize, Turkey. E-mail:
| | - Muhammet Safa-Ayazoğlu
- Department of Pathology, Recep Tayyip Erdoğan University School of Medicine, Rize, Turkey.
| | - Metin Çeliker
- Department of Otorhinolaryngology, Recep Tayyip Erdogan University School of Medicine, Rize, Turkey.
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