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Xu J, Lv TF. Rupture of a giant jejunal mesenteric cystic lymphangioma misdiagnosed as ovarian torsion: A case report. World J Clin Cases 2024; 12:847-852. [PMID: 38322678 PMCID: PMC10841141 DOI: 10.12998/wjcc.v12.i4.847] [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: 11/06/2023] [Revised: 12/22/2023] [Accepted: 01/12/2024] [Indexed: 01/25/2024] Open
Abstract
BACKGROUND Cystic lymphangioma is a rare benign tumor that affects the lymphatic system. Mesenteric lymphangiomas in the small bowel are extremely uncommon. CASE SUMMARY We present a 21-year-old female patient who complained of abdominal pain. The diagnosis of ovarian torsion was suspected after abdominopelvic unenhanced computed tomography and ultrasound revealed a large cyst in contact with the bladder, ovary, and uterus. The patient underwent emergency laparotomy performed by gynecologists, but it was discovered that the cystic tumor originated from the jejunum. Gastrointestinal surgeons were then called in to perform a cystectomy. Pathological examination confirmed the diagnosis of cystic lymphangioma of the mesentery. The patient had an uneventful postoperative recovery. CONCLUSION Mesenteric lymphangiomas can cause abdominal pain, and imaging techniques can help determine their characteristics, location, and size. Complete surgical excision and pathological examination are considered the standard treatment and diagnostic method.
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Affiliation(s)
- Jing Xu
- Department of Hepatopathy, Hangzhou Xixi Hospital, Hangzhou 310023, Zhejiang Province, China
| | - Tie-Feng Lv
- Department of Hepatopathy, Hangzhou Xixi Hospital, Hangzhou 310023, Zhejiang Province, China
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Abdulraheem AK, Al Sharie AH, Al Shalakhti MH, Alayoub SY, Al-Domaidat HM, El-Qawasmeh AE. Mesenteric cystic lymphangioma: A case report. Int J Surg Case Rep 2021; 80:105659. [PMID: 33636409 PMCID: PMC7918257 DOI: 10.1016/j.ijscr.2021.105659] [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: 01/15/2021] [Revised: 02/09/2021] [Accepted: 02/13/2021] [Indexed: 11/17/2022] Open
Abstract
Mesenteric cystic lymphangiomas are rare benign lesions characterized by lymphatic vessels malformation with an unknown etiology. Although, mesenteric cystic lymphangiomas are rare but should be included in the differential diagnosis of abdominal pain. Surgical resection of mesenteric lymphangiomas should be performed as fast as possible to avoid many serios complications.
Introduction and importance Mesenteric cystic lymphangiomas are rare benign lesions of the abdominal cavity characterized by lymphatic vessels malformation with an unknown etiology. Despite the silent clinical course of mesenteric cystic lymphangiomas, they are considered as clinically tricky lesions with an immense spectrum of presentations. Case presentation We present a case of abdominal mesenteric cystic lymphangioma in a 1-year 9-month-old female patient, who complained of fever and abdominal pain for 10 days duration. Laboratory investigations, abdominal X-ray, ultrasonography, computed tomography and histopathological examination were all used to establish the diagnosis. Clinical discussion A trial of true-cut biopsies performed by an interventional radiologist was not informative, so a multidisciplinary team decision was made to excise the mass. Intraoperative findings include multiloculated fused cystic lesion (8.0 × 5.0 × 4.0 cm) on the descending mesocolon. Histopathological examination revealed the diagnosis of a mesenteric cystic lymphangioma. The postoperative period was not complicated. Conclusion Mesenteric cystic lymphangiomas are mostly asymptomatic in nature, yet predisposed to life threating events. Surgical excision is the modality of treatment characterized by low recurrence rate and a non-complicated postoperative period.
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Affiliation(s)
- Ahmad K Abdulraheem
- Department of General Surgery and Urology, Faculty of Medicine, Jordan University of Science & Technology, Irbid, 22110, Jordan.
| | - Ahmed H Al Sharie
- Faculty of Medicine, Jordan University of Science & Technology, Irbid, 22110, Jordan
| | - Majd H Al Shalakhti
- Department of General Surgery and Urology, Faculty of Medicine, Jordan University of Science & Technology, Irbid, 22110, Jordan
| | - Saleh Y Alayoub
- Department of General Surgery and Urology, Faculty of Medicine, Jordan University of Science & Technology, Irbid, 22110, Jordan.
| | - Hamzeh M Al-Domaidat
- Department of General Surgery and Urology, Faculty of Medicine, Jordan University of Science & Technology, Irbid, 22110, Jordan
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Kitamura H, Yamamoto D, Kadoya S, Bando H, Okayama Y, Minato H. Jejunal mesenteric lymphangioma treated by pancreaticoduodenectomy: A case report. Int J Surg Case Rep 2020; 77:165-169. [PMID: 33161289 PMCID: PMC7653000 DOI: 10.1016/j.ijscr.2020.10.088] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [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: 10/01/2020] [Revised: 10/19/2020] [Accepted: 10/19/2020] [Indexed: 12/24/2022] Open
Abstract
Small bowel mesenteric lymphangiomas in adults are rare. A huge lymphangioma infiltrated the pancreas and duodenum. A pancreaticoduodenectomy was required to remove it completely.
Introduction A lymphangioma is a benign congenital malformation of the lymphatic system that generally appears in the head, neck, and axillary regions. Small bowel mesenteric lymphangiomas have been described in less than 1% of lymphangiomas. Presentation of case We report the case of a 20-year-old woman who presented with abdominal pain. Computed tomography revealed a large (22 cm in diameter) multi-cystic lesion inferior to the processus uncinatus of the pancreas. As the presumptive diagnosis was a lymphangioma of the jejunal mesentery, we decided to perform a laparotomy. Intraoperatively, the peritoneal cavity was found to be fully occupied by a multi-cystic lesion that arose from the root of the jejunal mesentery and the processus uncinatus of the pancreas. It was adherent to the duodenum and inseparable from the duodenum and the processus uncinatus. A subtotal stomach-preserving pancreaticoduodenectomy was performed. The tumor was diagnosed as a lymphangioma of the jejunal mesentery after histopathological analysis. Discussion Although lymphangioma is benign, complete resection, including resection of the involved organs, is necessary. Incomplete resection has a 10% postoperative recurrence rate and may also be associated with complications. To the best of our knowledge, this is the first reported case of a mesenteric lymphangioma treated by pancreaticoduodenectomy. Conclusion Although the lymphangioma was pathologically benign, a pancreaticoduodenectomy was required to remove it completely. When a tumor’s location and size cause impingement on surrounding structures, surgeons should consider performing a pancreaticoduodenectomy to treat similar cases.
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Affiliation(s)
- Hirotaka Kitamura
- Department of Gastroenterological Surgery, Ishikawa Prefectural Central Hospital, Kanazawa, Japan.
| | - Daisuke Yamamoto
- Department of Gastroenterological Surgery, Ishikawa Prefectural Central Hospital, Kanazawa, Japan.
| | - Shinichi Kadoya
- Department of Gastroenterological Surgery, Ishikawa Prefectural Central Hospital, Kanazawa, Japan.
| | - Hiroyuki Bando
- Department of Gastroenterological Surgery, Ishikawa Prefectural Central Hospital, Kanazawa, Japan.
| | - Yurie Okayama
- Department of Diagnostic Pathology, Ishikawa Prefectural Central Hospital, Kanazawa, Japan.
| | - Hiroshi Minato
- Department of Diagnostic Pathology, Ishikawa Prefectural Central Hospital, Kanazawa, Japan.
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Nagano H, Kimura T, Iida A, Togawa T, Goi T, Sato Y. Cystic lymphangioma in the peripheral jejunal mesentery in an adult and excision with laparoscopic-assisted surgery: a case report. World J Surg Oncol 2019; 17:170. [PMID: 31651341 PMCID: PMC6814111 DOI: 10.1186/s12957-019-1713-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [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: 06/27/2019] [Accepted: 09/20/2019] [Indexed: 12/14/2022] Open
Abstract
Background Lymphangiomas are uncommon congenital malformations that present mainly in the head, neck, and axillar regions in pediatric patients. Mesenteric cystic lymphangiomas (MCLs), which occasionally present with substantial growth and the invasion of adjacent vital structures, are rarely reported in adults. We report a case of MCL in an adult who was treated with laparoscopic-assisted excision. Case presentation A 40-year-old Japanese man visited his family physician for prolonged periumbilical pain. Plain computed tomography (CT) showed a low-density mass in his left abdomen, and he was referred to our hospital 2 weeks later. His abdomen was flat and soft, and no mass was felt upon palpation. Routine laboratory data showed no abnormalities in the blood cell counts. The levels of tumor markers, such as carcinoembryonic antigen (CEA), carbohydrate antigen 19-9 (CA19-9), and cancer antigen 125 (CA125), were within normal ranges. Contrast-enhanced CT was performed, and a low-density mass was observed with an irregular outline and poor contrast, as well as involvement of the peripheral mesenteric artery and partial compression of the adjacent jejunum without dilatation of the oral side of the bowel. The patient was diagnosed with lymphatic cysts and observed for 1 month without symptom exacerbation. Follow-up CT showed no increase in the size of the mass but showed apparent invasion of the jejunal wall without bowel obstruction. Magnetic resonance imaging (MRI) showed intermediate intensity on T1-weighted imaging (T1WI) and high intensity on T2-weighted imaging (T2WI). The coronal view on T2WI clearly showed an accumulation of cystic lesions. We performed tumor excision with partial resection of the jejunum in a laparoscopic-assisted manner. Pathological examination showed multicystic lesions with an attenuated endothelial lining, surrounding rich adipose tissue and scattered smooth muscle fibers; the patient was diagnosed with MCL. Immunohistochemical assays supported this diagnosis. Conclusions This is rare case of MCL presenting in an adult who underwent successful laparoscopic-assisted resection. Mesenteric lymphangioma (ML) should be considered in the differential diagnosis of patients with intraabdominal cysts. Radical excision is optimal, even when the patient is asymptomatic. Laparoscopic-assisted tumor resection is a suitable surgical method for treating MLs located in the peripheral mesentery.
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Affiliation(s)
- Hideki Nagano
- Department of Surgery, National Hospital Organization Tsuruga Medical Center, 33-1, Sakuragaoka, Tsuruga, Fukui, 914-0195, Japan.
| | - Toshihisa Kimura
- Department of Surgery, National Hospital Organization Tsuruga Medical Center, 33-1, Sakuragaoka, Tsuruga, Fukui, 914-0195, Japan
| | - Atsushi Iida
- Department of Surgery, National Hospital Organization Tsuruga Medical Center, 33-1, Sakuragaoka, Tsuruga, Fukui, 914-0195, Japan
| | - Tamotsu Togawa
- Department of Surgery, National Hospital Organization Tsuruga Medical Center, 33-1, Sakuragaoka, Tsuruga, Fukui, 914-0195, Japan
| | - Takanori Goi
- First Department of Surgery, Faculty of Medicine, University of Fukui, 23-3, Matsuokashimoaizuki, Eiheiji-cho, Yoshida-gun, Fukui, 910-1193, Japan
| | - Yasunori Sato
- Department of Human Pathology Kanazawa University Graduate School of Medicine, 13-1, Takara-machi, Kanazawa, Ishikawa, 920-8640, Japan
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Kashogi G, Prasetya D, Fauzi AR, Daryanto E, Dwihantoro A. Pediatric patients with mesenteric cystic lymphangioma: A case series. Int J Surg Case Rep 2019; 64:89-93. [PMID: 31622933 PMCID: PMC6796738 DOI: 10.1016/j.ijscr.2019.09.034] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [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: 08/15/2019] [Accepted: 09/23/2019] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION Mesenteric cystic lymphangioma (MCL) is a benign malformation of the lymphatic system. MCL seldomly occurs with a very rare incidence of around 1: 250,000. This neoplasm is more common in pediatric patients. Symptoms can appear with various clinical features ranging from asymptomatic abdominal mass to acute abdomen. PRESENTATION OF CASES Here we report four pediatric patients with MCL: two males presented with bilious vomiting and ileus, one female with abdominal pain, and one female with asymptomatic abdominal mass. All patients underwent explorative laparotomy and mass excision was done and/or marsupialization. All patients were discharged at the third - fourth postoperative day uneventfully. DISCUSSION Although benign, lymphangioma can cause other symptoms such as bleeding, torsion, or lymphangioma rupture. Therefore, MCL should be considered as one of the differential diagnoses in acute abdominal and abdominal mass cases in children. CONCLUSION In conclusion, although sometimes asymptomatic and found incidentally, the MCL should be resected because it has the potential to grow and invade vital organs and cause life-threatening complications.
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Affiliation(s)
- Gibran Kashogi
- Pediatric Surgery Division, Department of Surgery, Faculty of Medicine, UGM/Dr. Sardjito Hospital, Yogyakarta 55281, Indonesia
| | - Dedi Prasetya
- Pediatric Surgery Division, Department of Surgery, Faculty of Medicine, UGM/Dr. Sardjito Hospital, Yogyakarta 55281, Indonesia; Pediatric Surgery Division, Department of Surgery, PKU Muhammadiyah Wonosobo Hospital, Wonosobo 56371, Indonesia
| | - Aditya Rifqi Fauzi
- Pediatric Surgery Division, Department of Surgery, Faculty of Medicine, UGM/Dr. Sardjito Hospital, Yogyakarta 55281, Indonesia
| | - Eddy Daryanto
- Pediatric Surgery Division, Department of Surgery, Banyumas General Hospital, Banyumas 53192, Indonesia
| | - Andi Dwihantoro
- Pediatric Surgery Division, Department of Surgery, Faculty of Medicine, UGM/Dr. Sardjito Hospital, Yogyakarta 55281, Indonesia
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