Rupture of a giant jejunal mesenteric cystic lymphangioma misdiagnosed as ovarian torsion: A case report

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 per-formed 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.

Intermittent melena and refractory anemia due to jejunal cavernous lymphangioma:A case report

BACKGROUND Lymphangiomas in the gastrointestinal tract are extremely rare in adults.As a benign lesion,small intestine lymphangiomas often remain asymptomatic and pose challenges for definitive diagnosis.However,lymphangiomas can give rise to complications such as abdominal pain,bleeding,volvulus,and intussusception.Here,we report a case of jejunal cavernous lymphangioma that presented with intermittent melena and refractory anemia in a male adult.CASE SUMMARY A 66-year-old man presented with intermittent melena,fatigue and refractory anemia nine months prior.Esophagogastroduodenoscopy and colonoscopy were performed many times and revealed no apparent bleeding.Conservative management,including transfusion,hemostasis,gastric acid secretion inhibition and symptomatic treatment,was performed,but the lesions tended to recur shortly after surgery.Ultimately,the patient underwent capsule endoscopy,which revealed a more than 10 cm lesion accompanied by active bleeding.After singleballoon enteroscopy and biopsy,a diagnosis of jejunal cavernous lymphangioma was confirmed,and the patient underwent surgical resection.No complications or recurrences were observed postoperatively.CONCLUSION Jejunal cavernous lymphangioma should be considered a cause of obscure gastrointestinal bleeding.Capsule endoscopy and single-balloon enteroscopy can facilitate diagnosis.Surgical resection is an effective management method.

Congenital Cervico-Mandibular Cystic Lymphangioma in Pediatric Surgical Setting in Guinea

Introduction: Cystic lymphangiomas are rare benign malformative tumors of the lymphatic system of obscure etiopathogenesis. The cervico-facial location remains the most common (75%). Although benign, these tumors remain potentially fatal, due to possible compression of the upper aero-digestive tract. The aim of this work is to study the epidemiological, diagnostic and therapeutic characteristics of cervico-mandibular congenital cystic lymphangiomas in the pediatric surgery department of the Donka National Hospital (HND) Conakry. Patients and methods: This is a retrospective and descriptive study of 13 files lasting 7 years from January 2015 to December 31, 2021. The files of children whose age is less than or equal to 15 years operated on cervical tumor with histological evidence of cystic lymphangioma were retained. The data were analyzed using SPSS statistical software 21 and anonymously. Results: The incidence of this study was 1.86 cases per year and a sex ratio of 0.62 in favor of girls. The average age was 8 months 19 days. In the antecedents, we only find poorly monitored pregnancies. The average size of the tumors was 11.85 cm. Cervical ultrasound and standard x-ray of the cervical mass were the only examinations performed. Total surgical excision of the cervical tumor was performed in all patients. The mass was polycystic on exploration. The histological examination of the surgical specimens was in favor of a cystic lymphangioma. The surgical consequences were simple in 11 patients (84.62%) and complicated by parietal suppuration in 2 cases (15.38%). There were no cases of recurrence after one year of follow-up. Conclusion: Cervico-mandibular cystic lymphangiomas are the most frequent locations of congenital lymphangiomas in children. Their severity is linked to the risk of compression of the aero-digestive tracts. Their diagnosis must be confirmed by the histology of the surgical specimen. Despite the therapeutic arsenal, excision of the cystic mass remains the only effective alternative in our socio-economic conditions to avoid recurrences and loss of follow-up of patients.

Splenic lymphangioma masquerading as splenic abscess managed by laparoscopic splenectomy: A case report

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.

Transoral robotic surgery for adult parapharyngeal lymphangioma:A case report

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.

Abdominal lymphangiomatosis in a 38-year-old female:Case report and literature review

Lymphangioma is an uncommon benign tumor that develops in the lymphatic system. Abdominal lymphangiomatosis is extremely rare in adult patients, and the clinical symptoms of this condition are complicated and atypical. We report a case of abdominal lymphangiomatosis in a 38-year-old female who presented with intestinal bleeding and protein-losing enteropathy, as well as lesions in the lung and bones. A computed tomography scan revealed multiple small cystic lesions without enhancement. Histological examination revealed microscopic cysts were submucosal, with walls composed of thin fibrous tissue, and D2-40 stained highlight the lining of the lymphatic channels by immunohistochemical method. We make a comparison with the cases re-ported before, and also discuss the diagnose of diffuse pulmonary lymphangiomatosis and Gorham's disease.

Small intestinal hemolymphangioma treated with enteroscopic injection sclerotherapy: A case report and review of literature

BACKGROUND Hemolymphangiomas are rare malformations composed of both lymphatic and vascular vessels and are located in the pancreas,spleen,mediastinum,etc.Small intestinal hemolymphangioma is extremely rare and often presents as obscure gastrointestinal bleeding.It is rarely diagnosed correctly before the operation.Endoscopic injection sclerotherapy is usually used as a management of bleeding in esophageal varices and was occasionally reported as a treatment of vascular malformation.The treatment of small intestinal hemolymphangioma with enteroscopic injection sclerotherapy has not been reported.CASE SUMMARY A 42-year-old male complained of recurrent episodes of melena and dizziness,fatigue and reduced exercise capacity for more than 2 mo.Gastroduodenoscopy and blood test revealed a gastric ulcer and anemia.Treatment with oral protonpump inhibitors and iron did not improve symptoms.We then performed a capsule endoscopy and anterograde balloon-assisted enteroscopy and revealed a hemolymphangioma.Considering it is a benign tumor without malignant potential,we performed enteroscopic injection sclerotherapy.He was discharged 4 days later.At follow-up 3 mo later,the melena disappeared.Balloon-assisted enteroscopy revealed an atrophied tumor atrophied and no bleeding.Argon plasma coagulation was applied to the surface of the hemolymphangioma to accelerated healing.When he returned for follow-up 1 year later,anemia was resolved and the tumor had been cured.CONCLUSION Balloon-assisted enteroscopy and capsule endoscopy are effective methods for diagnosis of hemolymphangioma.Enteroscopic injection sclerotherapy is an effective treatment.

Retroperitoneal cystic lymphangioma in an adult:A case report and review of the literature

Lymphangiomas are rare benign cystic tumors of the lymphatic system.Retroperitoneal lymphangiomas account for 1%of all lymphangiomas,and approximately 186 cases have been reported.They may clinically present as a palpable abdominal mass and can cause diagnostic dilemmas with other retroperitoneal cystic tumors,including those arising from the liver,kidney and pancreas.This report describes the rare case of a cystic retroperitoneal lymphangioma in a 54-year-old male patient.The lymphangioma had progressed to the point of inducing clinical symptoms of abdominal distention,abdominal pain,anorexia,fever,nausea and diarrhea.Radiological imaging revealed a large multiloculated cystic abdominal mass with enhancing septations involving the upper retroperitoneum and extending into the pelvis.Surgical removal of the cyst was accomplished without incident.A benign cystic retroperitoneal lymphangioma was diagnosed on histology and confirmed with immunohistochemical stains.

Splenic lymphangioma that manifested as a solid-cystic mass:A case report

Lymphangioma,a congenital malformation of the lymphatic system,is usually found in children,and generally occurs in the neck and mediastinum.It is rarely found in the spleen.The clinical features of splenic lymphangioma typically include abdominal pain,nausea,and abdominal distention.Frequently,however, this condition is asymptomatic and is incidentally detected by abdominal ultrasonography or by an abdominal computed tomography(CT)scan.In this paper,we retrospectively describe a case of incidentally detected splenic lymphangioma in a 30-year-old woman with special abdominal contrast material-enhanced CT findings,which was accurately diagnosed by histopathology.The clinical and physical examinations related to the mass were negative.A few cases of splenic lymphangioma have been reported previously;however,the presentation of the mass and the enhancement pattern in the contrast medium-enhanced CT images were quite extraordinary.These findings had misled our abdominal radiologists to consider it as other neoplastic diseases of the spleen.

Giant cystic lymphangioma originating from the lesser curvature of the stomach

Cystic lymphangiomas are rare benign tumors.Most frequently occurring in children and involving the neck or axilla,these tumors are much less common in adults and very rarely involve the abdomen.The known congenital and acquired(traumatic)etiologies result in failure of the lymphatic channels and consequent proliferation of lymphatic spaces.This case report describes a very rare case of a giant mesenteric cystic lymphangioma in an adult male with no clear etiology and successful resolution by standard radical resection.A previously healthy 44-year-old male presented with a 6-wk history of progressive upper abdominal pain,vomiting,anorexia and unintentional weight loss accompanied by rapid abdominal distension.A palpable mass was detected upon physical examination of the distended abdomen and abdominal computed tomography scan showed a giant multilobulated cystic process,measuring 40 cm in diameter.Exploratory laparotomy revealed an enormous cystic mass containing 6 L of serous fluid.The process appeared to originate from the lesser omentum and the lesser curvature of the stomach.Radical resection of the tumor was performed along with a partial gastrectomy to address potential invasion into the adjacent tissues.Histological analysis confirmed the diagnosis of a multicystic lymphangioma.The postoperative recovery was uneventful and the patient was discharged after 6 d.At 3-mo follow-up,the patient was in good health with no signs of recurrence.

Adrenal lymphangioma masquerading as a pancreatic tail cyst

Cystic lymphangiomas of the adrenal gland are rare. A 79-year-old female presented in the emergency room with epigastric discomfort, and an immovable mass was palpated in her abdomen upon physical examination. Imaging studies revealed a large cystic lesion in the pancreatic tail. The radiologic impression ruled out the possibility of a mucinous cystic neoplasm, or a pseudocyst in the pancreas. The operative findings demonstrated that the cystic mass originated in the left adrenal gland. A laparoscopic excision of the cystic mass was performed, and immunohistochemistry confirmed that this mass was a lymphangioma of the adrenal gland. Several prior reports have suggested that lymphangioma can mimic renal or splenic cysts. However, lymphangioma cases mimicking pancreatic cysts are very rare.

Laparoscopic segmental colectomy for colonic lymphangiomas: A definitive, minimally invasive surgical option

Colonic lymphangioma is an unusual benign malformation.We herein describe two cases.A 36-year-old woman was admitted with one year of intermittent abdominal pain;colonoscopy,abdominopelvic computed tomography and endoscopic ultrasonography(EUS)revealed enlarged cystic masses at the ascending colon.In another 40-year-old man,colonoscopy and EUS revealed an asymptomatic lobulated cystic mass with four small sessile polyps at the sigmoid colon.Both patients underwent laparoscopic segmental colectomy.Both masses were histologically confirmed as cystic lymphangiomas,and the patients were discharged without complications.The management of colonic lymphangioma depends on the individual situation;close surveillance or endoscopic therapy may be appropriate for asymptomatic lesions smaller than 2.5 cm in diameter.Surgical intervention can be considered for larger lesions or in patients who develop complication risks.Laparoscopic segmental colon resection may be recommended to excise relatively large submucosal lesions because it is a definitive,minimally invasive intervention with a fast postoperative recovery.

Solitary hepatic lymphangioma mimicking liver malignancy: A case report and literature review

BACKGROUND Hepatic lymphangioma,a malformation of the liver lymphatic system,is a rare benign neoplasm and usually coexists with other visceral lymphangiomas.Solitary hepatic lymphangioma is much more rarely seen and could cause a clinical misinterpretation as malignancy.CASE SUMMARY A 50-year-old woman with a liver mass of approximately 3.5 cm was initially diagnosed with hepatocellular carcinoma given the risk factors for liver cancer that she presented with,including Schistosome japonicum infection and jaundice,and also together with imaging results,which showed the mass enhanced quickly in the arterial phase and faded fast in the venous phase.The patient did not have the surgery first but received three rounds of transarterial chemoembolization because of her anxiety and fears for operation.Finally,the patient underwent laparoscopic liver segment 4b resection and cholecystectomy and was discharged from the hospital only 10 d after the operation.The pathological examination indicated the mass as hepatic lymphangioma.The patient has been followed up for 30 mo without recurrence.To raise the awareness of this misdiagnosed case and to better diagnose and treat this rare disease in future,we reviewed the published literature of solitary hepatic lymphangioma for its clinical symptoms,imaging presentation,operative techniques,histology features and prognosis.CONCLUSION Solitary hepatic lymphangioma mimicking malignancy makes diagnosis difficult.Complete surgical resection is the first choice to treat solitary hepatic lymphangioma.

Experience in the diagnosis and treatment of mesenteric lymphangioma in adults:A case report and review of literature

BACKGROUND Mesenteric lymphangioma(ML) in adults is a very rare disease. We report six hospitalized adult patients with ML in our hospital between January 2013 and July 2018 to investigate the characteristics and prognosis of ML in adults.CASE SUMMARY The male-to-female ratio was 3:3, and the median age at diagnosis was 55.2 years. Clinical manifestations varied; however, most were acute cases(5/6). No history of trauma was reported. None(0/6) of the patients were accurately diagnosed with ML in the emergency and outpatient departments. Mesenteric cysts were identified in four patients(66.7%) by abdominal ultrasound and in five patients(83.3%) by computed tomography. ML was postoperatively confirmed by pathology. Most MLs(4/6) were associated with infection of other systems. ML was located in the mesentery of the small intestine(n = 4), ileum(n = 1) and rectum(n = 1). Cyst fluid was clear(n = 4), chylous(n = 1) and bloody(n = 1). Surgical procedures included complete tumor removal and partial intestinal excision(n = 6). Recurrence and adhesive intestinal obstruction were not observed during the 3-12 mo follow-up period.CONCLUSION ML in adults is a rare benign acquired disease that can be cured by surgical treatment. Infection may be a cause of ML.

Jejunal cavernous lymphangioma manifested as gastrointestinal bleeding with hypogammaglobulinemia in adult: A case report and literature review

BACKGROUND Lymphangioma is a benign lesion that rarely involves the gastrointestinal tract,especially in adults.Small bowel lymphangioma is a rare cause of gastrointestinal bleeding.Here,we report a case of an adult diagnosed with jejunal lymphangioma presenting with melena,anemia and hypogammaglobulinemia.We also summarize and analyze all 23 reported cases from 1961 to 2019,and propose an algorithm for identification and management of small bowel lymphangioma.CASE SUMMARY A case of a 29-year-old woman presented with persistent melena and irondeficiency anemia,accompanied by hypogammaglobulinemia.No lesions were found in the initial workup with esophagogastroduodenoscopy,colonoscopy and computed tomography(CT)enterography.Ultimately,capsule endoscopy and double-balloon enteroscopy revealed a 3 cm×2 cm primary lesion with intensive white lymphatic dilatatory changes and visible fresh blood stains,accompanied by a small satellite lesion.The patient underwent complete surgical resection of these lesions,and histopathological examination confirmed a diagnosis of cavernous lymphangioma of the jejunum.The patient showed no evidence of disease at the time of this report.CONCLUSION We recommend CT,capsule endoscopy and enteroscopy to identify the lesions of lymphangioma.Laparoscopic surgery with histological diagnosis is an ideal curative method.

Rare case of a solitary huge hepatic cystic lymphangioma

A hepatic lymphangioma is a rare benign neoplasm and is usually associated with lymphangiomas of other viscera.A hepatic lymphangioma can be solitary,cystic or associated with multiple liver lesions and is characterized by cystic dilatation of lymphatic vessels in the hepatic parenchyma.A solitary lymphangioma is unusual.Here we report a rare case of a solitary huge primary hepatic cystic lymphangioma in a 42-yearold woman.It was discovered on routine physical examination and the patient had no obvious symptoms.Ultrasonography and computed tomography(CT) showed a giant "hepatic neoplasm" that occupied the right liver lobe.The lesion was approximately 20.0 cm × 15.0 cm × 10.0 cm in size and contained cystic and solid components.There were multiple septa inside the tumor,with some calcifications in the septa.Surgical resection was performed.Histological examination revealed multiple cystic structures lined with epithelial cells on the inner walls,accompanied by interstitial swelling and necrosis.The patient has now been followed up for nearly two years after surgery,with no recurrence to date.

Acute spontaneous thoracic epidural hematoma associated with intraspinal lymphangioma: A case report

BACKGROUND Spontaneous spinal epidural hematoma is a rare neurosurgical emergency.CASE SUMMARY A 53-year-old healthy woman suffered from complete paraplegia in both legs and loss of all sensation below the xiphoid process.She was diagnosed as acute spontaneous thoracic epidural hematoma caused by an intraspinal lymphangioma.The primary lab survey showed all within normal limits.Presence of a posteriorly epidural space-occupying lesion at the T4-T8 level of the spinal canal was confirmed on magnetic resonance imaging.A decompressive laminectomy was performed from the T4 to T7 levels at the sixth hour following abrupt onset of complete paraplegia.The lesion was confirmed as lymphangioma.This patient recovered well within one month.CONCLUSION This study reports a case of acute spontaneous thoracic epidural hematoma caused by an intraspinal lymphangioma with well recovery after surgical intervention.

Lymphangiomatosis associated with protein losing enteropathy:A case report

BACKGROUND Lymphangiomatosis is a multisystem disorder that is rarely localized to the gastrointestinal tract.Lymphangiomatosis usually has no specific clinical presentation and is easily misdiagnosed.A case report and review of the literature on lymphangiomatosis associated with protein-losing enteropathy will help to improve the overall understanding of this disease.CASE SUMMARY We report a case of lymphangiomatosis of the bowel and other solid organs.A 78-year-old man presented with recurrent bowel bleeding and protein-losing enteropathy,as well as cystic lesions in the spleen,liver,and kidney.Imaging examinations revealed many cystic lesions on the spleen,liver,kidney,and thickened wall of the ascending colon,as well as pleural effusion and ascites.Colonoscopy revealed a strawberry mucosa,variable spontaneous bleeding,and surface erosion located in the terminal ileum.Several cystic masses with a translucent and smooth surface as well as diffuse white spots were located in the colon.A laterally spreading tumor(LST)was located in the ascending colon.Pathology indicated highly differentiated adenocarcinoma(LST)and lymphangiomatoid dilation,and D2-40 was positive.The final diagnosis was lymphangiomatosis.The patient underwent surgery for LST and then was administered thalidomide 75-150 mg/d.His condition,however,did not improve.He eventually died 6 mo after the initial diagnosis.CONCLUSION Lymphangiomatosis usually occurs diffusely and can involve many organs,such as the spleen,kidney,liver,lung,mesentery,and bowel.Recurrent bowel bleeding or protein-losing enteropathy is an important indicator that should alert clinicians about the possibility of this disease when it afflicts the bowel.Doctors should improve the medical understanding of lymphangiomatosis.

Treatment of Retroperitoneal Cavernous Lymphangioma: A Case Report

A 32-year-old man who complained of recurrent nauseat and vomiting was admitted to our hospital.The contrast-enhanced computed tomography revealed a cystic mass located behind the duodenum which was suggestive of lymphangioma.Laparoscopic resection of the retroperitoneal mass was successfully performed.The postoperatively pathological examination confirmed the diagnosis of cavernous lymphangioma.Ultrasound and enhanced CT can be used for making a preoperative diagnosis.Once symptoms of the disease develop,complete surgical resection should be performed.

Surgical excision of a large retroperitoneal lymphangioma: A case report

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.