Abdominal Cystic Lymphangioma in Adults
Journal Title: Biomedical Journal of Scientific & Technical Research (BJSTR) - Year 2018, Vol 11, Issue 5
Abstract
Cystic lymphangioma is a benign vascular tumor originating from the lymphatic pathways, mainly seen in children. This pathology has various locations dominated by the cranio-facial, cervical and axillary regions. Abdominal localization is rare, accounting for 7% of abdominal cysts in adults. We report the case of a 39-year-old patient with a left ectopic testicle, who consulted for chronic abdominal pain. Since the clinical examination was normal, ultrasound and CT were performed, showing a cystic intra-abdominal mass suggesting a mesenteric cystic lymphangioma extended to retroperitoneum. Surgical exploration found a cystic mass of the pancreas, extended to the mesentery and proximal jejunum, encompassing the mesenteric pedicle. The diagnosis of cystic lymphangioma was confirmed by histology. In adults, the mesenteric and retroperitoneal involvement are estimated to be less than 1% of cases. Clinical presentation can be very variable, and here comes the role of imaging in guiding the diagnosis, in the preoperative assessment and in the follow-up. The final diagnosis is made by histology.First described in 1913 by Koch, the cystic lymphangioma is a benign vascular tumor from lymphatics more common in children, suggesting a malformities origin [1]. The majority of cystic lymphangiomas occur at the cervico-axillary region. However, intra-abdominal locations such as the mesentery, retroperitoneum and epiploon are possible, but less common, representing about 5% of cases [2]. We report a case of mesenteric cystic lymphangioma extended to retroperitoneum with an emphasis on the role of imaging in leading to diagnosis.This is a 39-year-old patient, known to have an ectopic left testis, who suffered from a chronic abdominal pain with no general condition deterioration. With a normal clinical examination, abdominal ultrasound was performed showing a partitioned cystic mass of the left flank, with anechoic content, non-vascularized on color Doppler, extended to the pelvis (Figure 1). The inguino-scrotal ultrasound revealed an ectopic left testicle (inguinal) with a normal morphology. Abdominal CT was performed showing an extensive cystic mass along the mesentery, encompassing the divisional branches of the superior and inferior mesenteric vessels, the terminal portion of the abdominal aorta and the origin of its divi sional branches, which remain permeable, evoking a cystic lymphangioma. This mass had an intimate contact with the tail of the pancreas and the jejunum at the angle of Treitz (Figures 2 & 3). The surgical exploration found a pancreatic cystic mass extended to the mesentery and proximal jejunum and encompassing the mesenteric pedicle. As a result, the resection could not be complete leaving a residue near the mesenteric pedicle. In the anatomopathological analysis, the macroscopic and histological aspect was compatible with a cystic lymphangioma (Figure 4).
Authors and Affiliations
Elatiqi K, Z Belhadj K, Bicane MA, Haraki I, Finech B, Krati K, M Ouali Idrissi, N Cherif Idrissi Ganouni
Keywords
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- EP ID EP586804
- DOI 10.26717/BJSTR.2018.11.002174
- Views 196
- Downloads 0
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