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Wang ZZ, Shen LY, Zhou JJ, Tang JL, Ye LP, Shen CB, Li SW, Zhou XB. Clinical manifestation and treatment of small intestinal lymphangioma: A single center analysis of 15 cases. Front Med (Lausanne) 2022; 9:975698. [PMID: 36213633 PMCID: PMC9537564 DOI: 10.3389/fmed.2022.975698] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Accepted: 08/31/2022] [Indexed: 11/17/2022] Open
Abstract
Background Small intestinal lymphangioma is a very rare benign lesion. Thus far, the literature on small intestinal lymphangioma has mainly involved case reports. The present study retrospectively examined the clinical features of patients with a pathological diagnosis of small intestinal lymphangioma. Materials and methods From January 2010 to January 2021, 15 patients were pathologically diagnosed with small intestinal lymphangioma. The age, gender, clinical manifestation, computed tomography (CT) findings, endoscopic findings, localization of the lesion, treatment method, complications, and follow-up were retrospectively analyzed. Results Most of the patients had no symptoms, and those with symptoms had melena or abdominal pain. Lymphangioma was located in the duodenum in nine cases (60.0%), jejunum in two (13.3%), jejunal-ileal junction with mesentery involvement in one (6.7%) and ileum in three (20.0%). Three cases (20.0%) had multiple lesions, and the other 12 (80.0%) had single lesions. The median size of the lesions was 0.8 cm. Thirteen cases were found by endoscopy, and nine cases of them had white-colored spots on the surface. Ten cases (66.7%) underwent endoscopic treatment, three (20.0%) underwent surgical treatment, and two (13.3%) were followed up. Postoperative acute pancreatitis developed in one patient after endoscopic resection of duodenal papillary lymphangioma; postoperative abdominal bleeding occurred in one patient with jejunal lymphangioma who underwent partial small bowel resection. Conclusion Small intestinal lymphangioma is extremely rare, and its clinical manifestations are non-specific. Endoscopy is of great value in the diagnosis of small intestinal lymphangioma. Depending on the clinical manifestations, the size, location and scope of the lesions, follow-up, endoscopic treatment and surgery can be selected.
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Affiliation(s)
- Zhen-zhen Wang
- Department of Gastroenterology, Taizhou Hospital of Zhejiang Province Affiliated to Wenzhou Medical University, Linhai, Zhejiang, China
| | - Ling-yan Shen
- Department of Gastroenterology, Taizhou Hospital of Zhejiang Province Affiliated to Wenzhou Medical University, Linhai, Zhejiang, China
| | - Jing-jing Zhou
- Department of Gastroenterology, Taizhou Hospital of Zhejiang Province Affiliated to Wenzhou Medical University, Linhai, Zhejiang, China
| | - Jia-li Tang
- Department of Gastroenterology, Taizhou Hospital of Zhejiang Province Affiliated to Wenzhou Medical University, Linhai, Zhejiang, China
| | - Li-ping Ye
- Department of Gastroenterology, Taizhou Hospital of Zhejiang Province Affiliated to Wenzhou Medical University, Linhai, Zhejiang, China
| | - Chen-bo Shen
- Department of Gastroenterology, Taizhou Hospital of Zhejiang Province Affiliated to Wenzhou Medical University, Linhai, Zhejiang, China
| | - Shao-wei Li
- Department of Gastroenterology, Taizhou Hospital of Zhejiang Province Affiliated to Wenzhou Medical University, Linhai, Zhejiang, China
- Key Laboratory of Minimally Invasive Techniques and Rapid Rehabilitation of Digestive System Tumor of Zhejiang Province, Taizhou Hospital Affiliated to Wenzhou Medical University, Linhai, Zhejiang, China
- Institute of Digestive Disease, Taizhou Hospital of Zhejiang Province Affiliated to Wenzhou Medical University, Linhai, Zhejiang, China
- *Correspondence: Shao-wei Li,
| | - Xian-bin Zhou
- Department of Gastroenterology, Taizhou Hospital of Zhejiang Province Affiliated to Wenzhou Medical University, Linhai, Zhejiang, China
- Key Laboratory of Minimally Invasive Techniques and Rapid Rehabilitation of Digestive System Tumor of Zhejiang Province, Taizhou Hospital Affiliated to Wenzhou Medical University, Linhai, Zhejiang, China
- Institute of Digestive Disease, Taizhou Hospital of Zhejiang Province Affiliated to Wenzhou Medical University, Linhai, Zhejiang, China
- Xian-bin Zhou,
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Bai K, Dai Y, Jiang C, Lin S, Wang G. Gastric lymphangioma: a case report and review of literature. BMC Gastroenterol 2022; 22:407. [PMID: 36058923 PMCID: PMC9441034 DOI: 10.1186/s12876-022-02431-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2022] [Accepted: 07/19/2022] [Indexed: 11/21/2022] Open
Abstract
Background Gastric lymphangioma is one of the highly rare benign tumors characterized by multilocular or unilocular lymphatic spaces. Herein, we report a case of lymphangioma in the gastric antrum. Case presentation A 77-year-old male patient who had been experiencing epigastric discomfort for a year was presented to our hospital. A gastric subepithelial lesion was diagnosed by upper endoscopy and was entirely excised via diatal subtotal gastrectomy. Endoscopic ultrasonography revealed an echoless homogenous echo pattern in the third wall layer. A lymphangioma was diagnosed by pathologic investigation of the resected specimen. The PubMed, Embase and Web of Science databases were reviewed for literature in English while using the keywords of “gastric lymphangioma” or “lymphangioma of stomach” or “gastric lymphatic cyst” or “lymphatic cyst of stomach” and the results were discussed. Conclusion Gastric lymphangioma is a rarely occurring submucosal tumor that should be considered when diagnosing subepithelial lesions in the stomach.
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Affiliation(s)
- Kunhao Bai
- Department of Endoscopy, Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, 651 Dongfengdong Street, Yuexiu District, Guangzhou, 510060, Guangdong, China.,Department of Epidemiology, School of Public Health, Sun Yat-Sen University, Guangzhou, Guangdong, China
| | - Yujun Dai
- Department of Hematology, Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, Guangdong, China
| | - Chen Jiang
- Department of Pathology, Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, Guangdong, China
| | - Shiyong Lin
- Department of Endoscopy, Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, 651 Dongfengdong Street, Yuexiu District, Guangzhou, 510060, Guangdong, China.
| | - Guobao Wang
- Department of Endoscopy, Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, 651 Dongfengdong Street, Yuexiu District, Guangzhou, 510060, Guangdong, China.
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3
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Nayak M, Purkait S, Sasmal PK, Singh PK. Cystic lymphangioma of the stomach with marked reactive changes: a rare cause of gastric outlet obstruction in adult. BMJ Case Rep 2020; 13:13/7/e233582. [PMID: 32641314 DOI: 10.1136/bcr-2019-233582] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Cystic lymphangiomas are benign lymphatic tumours which usually affect the paediatric population and are predominantly located in the head and neck region. Its occurrence during adulthood and an intra-abdominal location are both extremely uncommon. Clinically and radiologically, these lesions often mimic malignancy. Infrequently, these tumours can undergo degenerative and reactive changes obscuring the diagnostic features. We describe hereby an anecdote of cystic lymphangioma with marked reactive changes presenting with the features of gastric outlet obstruction in an adult patient.
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Affiliation(s)
- Mamita Nayak
- Pathology and Lab Medicine, All India Institute of Medical Sciences Bhubaneswar, Bhubaneswar, Odisha, India
| | - Suvendu Purkait
- Pathology and Lab Medicine, All India Institute of Medical Sciences Bhubaneswar, Bhubaneswar, Odisha, India
| | - Prakash Kumar Sasmal
- General Surgery, All India Institute of Medical Sciences Bhubaneswar, Bhubaneswar, Odisha, India
| | - Pradip Kumar Singh
- General Surgery, All India Institute of Medical Sciences Bhubaneswar, Bhubaneswar, Odisha, India
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4
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Badipatla KR, Chandrala C, Ayyadurai P, Biyyam M, Sapkota B, Niazi M, Nayudu SK. Cystic Lymphangioma of the Colon: Endoscopic Removal beyond the Frontiers of Size. Case Rep Gastroenterol 2017; 11:178-183. [PMID: 28512390 PMCID: PMC5422721 DOI: 10.1159/000462966] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2016] [Accepted: 02/09/2017] [Indexed: 12/13/2022] Open
Abstract
Cystic lymphangiomas are benign colonic neoplasms arising from the submucosa. Traditionally, endoscopic resection has been described for smaller lesions, while surgery is reserved for larger symptomatic lesions. We present a case of a 69-year-old asymptomatic individual noted to have a cystic lymphangioma of the colon measuring 5 cm, which was successfully removed with endoloop endoscopic resection without any complications.
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5
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Luo D, Ye L, Wu W, Zheng H, Mao X. Huge Lymphangioma of the Esophagus Resected by Endoscopic Piecemeal Mucosal Resection. Case Rep Med 2017; 2017:5747560. [PMID: 28408932 PMCID: PMC5376932 DOI: 10.1155/2017/5747560] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2016] [Accepted: 01/18/2017] [Indexed: 11/18/2022] Open
Abstract
We present an unusual case of a 41-year-old male patient with a large lymphangioma of the esophagus. Endoscopy revealed that the structure measured 60 × 10 mm in the mucosa and the submucosa and had a heterogenous echo pattern. The esophageal mass was successfully resected by endoscopic piecemeal mucosal resection. However, most esophageal lymphangiomas that are larger than 2 cm in diameter reported in the literature can be removed only through open surgery. Thus far, we know of no reported cases of endoscopic resection as a treatment for this case.
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Affiliation(s)
- Dinghai Luo
- Department of Gastroenterology, Taizhou Hospital, 150 Ximen Street, Linhai, Zhejiang 317000, China
| | - Liping Ye
- Department of Gastroenterology, Taizhou Hospital, 150 Ximen Street, Linhai, Zhejiang 317000, China
| | - Weidan Wu
- Department of Gastroenterology, Taizhou Hospital, 150 Ximen Street, Linhai, Zhejiang 317000, China
| | - Haihong Zheng
- Department of Pathology, Taizhou Hospital, 150 Ximen Street, Linhai, Zhejiang 317000, China
| | - Xinli Mao
- Department of Gastroenterology, Taizhou Hospital, 150 Ximen Street, Linhai, Zhejiang 317000, China
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6
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Barbosa M, Ribeiro PM, Cotter J. Oesophageal lymphangioma: an exceedingly rare tumour. BMJ Case Rep 2015; 2015:bcr-2015-209605. [PMID: 26336182 DOI: 10.1136/bcr-2015-209605] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
An asymptomatic 57-year-old man was referred for evaluation of a 10 mm pale pink subepithelial polypoid lesion of the distal oesophagus; the lesion was found incidentally during an upper gastrointestinal endoscopy. The endoscopic ultrasound (EUS) revealed a heterogeneous, although primarily hypoechogenic, well-circumscribed lesion, located in the submucosa. Owing to the absence of endosonographic features, which would have allowed for a precise diagnosis, EUS-guided fine-needle aspiration was performed; however, the cytology was inconclusive because of the lack of cellular representation. We chose to remove it by cap-assisted endoscopic mucosal resection. However, due to its shape and deep location, complete removal was not achieved. A macrobiopsy was taken, and histological examination, of all oesophageal layers except the adventitia, revealed many irregularly dilated lymphatic vessels, beneath normal squamous epithelium. These findings are consistent with the diagnosis of lymphangioma. A follow-up EUS did not reveal any changes. The patient is currently asymptomatic and is under surveillance.
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Affiliation(s)
- Mara Barbosa
- Department of Gastroenterology, Centro Hospitalar do Alto Ave, Guimaraes, Portugal
| | | | - José Cotter
- Department of Gastroenterology, Centro Hospitalar do Alto Ave, Guimaraes, Portugal
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7
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Jung SW, Cha JM, Lee JI, Joo KR, Choe JW, Shin HP, Kim KY. A case report with lymphangiomatosis of the colon. J Korean Med Sci 2010; 25:155-8. [PMID: 20052363 PMCID: PMC2800000 DOI: 10.3346/jkms.2010.25.1.155] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2008] [Accepted: 08/01/2008] [Indexed: 02/06/2023] Open
Abstract
The incidence of lymphangiomas in the gastrointestinal tract is low, particularly in the colon and rectum, and most cases are solitary. Lymphangiomatosis of the colon are encountered infrequently with only one report in the English literature, and polypectomy was performed for the diagnosis in that case report. However, trends in the diagnosis of lymphangiomatosis of colon have been changing since the development of endoscopic ultrasonography (EUS), and this case is the first in that lymphangiomatosis of the colon was diagnosed without invasive procedures. Here we describe the case of 31-yr-old woman with lymphangiomatosis of the colon with numerous polyposis-like appearing lesions diagnosed by endoscopic ultrasonography and a colonoscopy.
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Affiliation(s)
- Sung Won Jung
- Department of Internal Medicine, University of Kyunghee College of Medicine, Seoul, Korea
| | - Jae Myung Cha
- Department of Internal Medicine, University of Kyunghee College of Medicine, Seoul, Korea
| | - Joung Il Lee
- Department of Internal Medicine, University of Kyunghee College of Medicine, Seoul, Korea
| | - Kwang Ro Joo
- Department of Internal Medicine, University of Kyunghee College of Medicine, Seoul, Korea
| | - Jae Won Choe
- Department of Internal Medicine, University of Kyunghee College of Medicine, Seoul, Korea
| | - Hyun Phil Shin
- Department of Internal Medicine, University of Kyunghee College of Medicine, Seoul, Korea
| | - Kyo Young Kim
- Department of Pathology, University of Kyunghee College of Medicine, Seoul, Korea
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8
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Kang JH, Lim JS, Kim JH, Hyung WJ, Chung YE, Choi JY, Park MS, Kim MJ, Kim KW. Role of EUS and MDCT in the diagnosis of gastric submucosal tumors according to the revised pathologic concept of gastrointestinal stromal tumors. Eur Radiol 2008; 19:924-34. [PMID: 19023576 DOI: 10.1007/s00330-008-1224-2] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2008] [Accepted: 10/20/2008] [Indexed: 12/22/2022]
Abstract
Gastric submucosal tumors (SMTs) consist of various lesions arising from the deep layers of the stomach. Gastrointestinal stromal tumors (GISTs) are undoubtedly the commonest malignant SMTs of the stomach, and therefore the attitude towards the general diagnostic approach for GISTs defines the extended diagnostic plan for SMTs. Two recent consensus meetings were assembled concerning the classification and therapeutic plans for GISTs. These meetings shed light upon the need for the modification of the current role of imaging modalities, including endoscopic ultrasound (EUS) and computed tomography (CT). According to the revised concepts of GISTs, the most important and plausible current role of imaging for the diagnostic approach of gastric SMTs is to differentiate GISTs from other gastric SMTs. This review discusses the newly established diagnostic role of radiology according to the revised classification of GISTs and provides the differential diagnoses based on EUS and CT findings.
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Affiliation(s)
- Jung-Ho Kang
- Department of Diagnostic Radiology, Yonsei University Health System, Seoul, Republic of Korea
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9
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Oka S, Tanaka S, Fukumoto A, Chayama K. Endoscopic Ultrasonography with Double Balloon Enteroscopy for Small Bowel Diseases. TECHNIQUES IN GASTROINTESTINAL ENDOSCOPY 2008. [DOI: 10.1016/j.tgie.2008.03.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
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10
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Sylla P, Deutsch G, Luo J, Recavarren C, Kim S, Heimann TM, Steinhagen RM. Cavernous, arteriovenous, and mixed hemangioma-lymphangioma of the rectosigmoid: rare causes of rectal bleeding--case series and review of the literature. Int J Colorectal Dis 2008; 23:653-8. [PMID: 18330577 DOI: 10.1007/s00384-008-0466-4] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/13/2008] [Indexed: 02/04/2023]
Abstract
INTRODUCTION Cavernous hemangiomas of the sigmoid colon and rectum are uncommon vascular malformations usually found in young adults with a long history of episodic and painless rectal bleeding. Alternatively, they may present with massive life-threatening hemorrhage. DISCUSSION We report three cases of hemangioma of the rectosigmoid including one case of cavernous hemangioma, one case of arteriovenous hemangioma, and one case of hemangiolymphangiomatosis with emphasis on clinical presentation, radiologic, operative, and pathologic findings. Definitive treatment consists of complete resection with a sphincter-preserving procedure or abdominoperineal resection, based on extent of disease. CONCLUSION Therapy is typically delayed by several years in these patients due to erroneous diagnosis and failed treatment of hemorrhoids and inflammatory bowel disease. Relative to hemangiomas, lymphangiomas of the rectosigmoid are even more rare and when symptomatic, present with rectal bleeding and pelvic pain.
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Affiliation(s)
- Patricia Sylla
- Division of Colon and Rectal Surgery, Department of Surgery, Mount Sinai Medical Center, One Gustave L. Levy Place, Box 1259, New York, NY 10029, USA
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11
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Best SR, Coelho DH, Ahrens WA, Atez G, Sasaki CT. Laser excision of multiple esophageal lymphangiomas: a case report and review of the literature. Auris Nasus Larynx 2008; 35:300-3. [PMID: 18243618 DOI: 10.1016/j.anl.2007.07.016] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2006] [Revised: 04/30/2007] [Accepted: 07/31/2007] [Indexed: 11/18/2022]
Abstract
Lymphangiomas of the gastrointestinal tract are rare and benign submucosal tumors. We present the first case of multiple lymphangiomas in the cervical esophagus and only the 15th case of an esophageal lymphangioma. A 63-year-old male presented to our clinic with two years of dysphagia and an esophageal mass noted on MRI. A barium swallow confirmed a polypoid mass of the upper esophagus with operative findings of two smooth pedunculated lymphangiomas occupying the entire lumen of the esophagus. Previous reports have documented successful surgical intervention through open or endoscopic techniques, whereas the favorable location of the tumors in this case allowed for the first successful excision utilizing a CO2 laser. We demonstrate here that esophageal laser surgery can provide an accurate, complete, and minimally invasive excision technique for lymphangiomas of the upper digestive tract with minimal morbidity for the patient. A complete review of all published cases is presented, with a focus on the clinical presentation and surgical treatment of this disease.
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Affiliation(s)
- Simon R Best
- Yale University School of Medicine Division of Otolaryngology, Head & Neck Surgery, New Haven, CT, USA.
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12
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Fukumoto A, Manabe N, Tanaka S, Yamaguchi T, Matsumoto Y, Chayama K. Usefulness of EUS with double-balloon enteroscopy for diagnosis of small-bowel diseases. Gastrointest Endosc 2007; 65:412-20. [PMID: 17321241 DOI: 10.1016/j.gie.2006.08.045] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2006] [Accepted: 08/28/2006] [Indexed: 02/08/2023]
Abstract
BACKGROUND Until recently, EUS of the small bowel has been performed only in limited regions because of difficulties in endoscopically approaching the small bowel. Double-balloon enteroscopy (DBE) now permits investigation of the entire small bowel. OBJECTIVE To evaluate the usefulness of EUS with DBE for diagnosis of small-bowel diseases. DESIGN Pilot study. SETTING All patients were examined at Hiroshima University Hospital. PATIENTS EUS with DBE was performed in 20 consecutively analyzed patients (14 men, 6 women; mean age, 47.6 +/- 3.8 years). DBE was performed to investigate obscure GI bleeding (n = 12), small-bowel diseases suggested by other modalities (n = 7), recurring ileus (n = 1), or follow-up (n = 1). INTERVENTIONS Endoscopic biopsies were performed as clinically indicated. MAIN OUTCOME MEASUREMENTS EUS image quality for various types of small-bowel diseases and comparison with abdominal US. RESULT Protruding lesions were detected in 7 examinations, ulcerative lesions in 7, and no abnormalities in 7. EUS could be performed in 20 of 21 examinations. These images were adequately detailed evaluations and with more detail than US images in 16 examinations. LIMITATION Small nonblinded study. CONCLUSIONS EUS with DBE offers high-resolution cross-sections of small-bowel lesions and may contribute to the diagnosis of small-bowel diseases.
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Affiliation(s)
- Akira Fukumoto
- Department of Medicine and Molecular Science, Hiroshima University Hospital, 1-2-3 Kasumi, Minami-ku, Hiroshima, Japan
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13
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Sushil A, Aline PC, Metin O, Nadim H. Lymphangioma of the esophagus treated with endoscopic submucosal resection. J Gastroenterol Hepatol 2007; 22:284-6. [PMID: 17295891 DOI: 10.1111/j.1440-1746.2006.04476.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/09/2022]
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14
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Goh BKP, Tan YM, Ong HS, Chan WH, Yap CK, Wong WK. Endoscopic Ultrasound Diagnosis and Laparoscopic Excision of an Omental Lymphangioma. J Laparoendosc Adv Surg Tech A 2005; 15:630-3. [PMID: 16366873 DOI: 10.1089/lap.2005.15.630] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Omental lymphangiomas are rare intra-abdominal tumors. We describe a case of an omental lymphangioma which appeared on computed tomography scan as a possible gastric duplication cyst. The lesion was correctly diagnosed preoperatively via endoscopic ultrasound and complete excision of the cyst was performed laparoscopically.
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Affiliation(s)
- Brian K P Goh
- Department of Surgery, Singapore General Hospital, Singapore
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15
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Abstract
Most of the submucosal lesions encountered on endoscopy are benign; however, the fact that some of them may be malignant considerably influences the attitude toward the whole group. This article reviews the current status of endosonography in the management of submucosal lesions and focuses on determining the risk of malignancy. The predictive value of various endoscopic ultrasonography (EUS) features and their combinations and the capabilities and limitations of EUS-guided fine needle biopsy are discussed. Other issues addressed include differentiation between extraluminal compressions and true submucosal lesions, EUS-assisted endoscopic removal of submucosal lesions, and the potential role of catheter-based endosonography in the setting of submucosal lesions. Problems related to the surveillance of patients with submucosal lesions who are not candidates for surgical treatment are outlined. An overview of the recent changes in the pathologic classification of gastrointestinal mesenchymal tumors and their impact on the role of EUS in the management of submucosal lesions is given.
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Affiliation(s)
- Marcin Polkowski
- Department of Gastroenterology, Medical Center for Postgraduate Education, Institute of Oncology, Roentgena 5, 02-781 Warsaw, Poland.
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16
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Bouhaouala MH, Nouira K, Nagi S, Ben Mami N, Ben Cheikh M, Kort B, Mzabi-Reguaya S, Balti H. [Gastro-epiploic lymphangioma. A case report]. JOURNAL DE RADIOLOGIE 2004; 85:332-4. [PMID: 15192528 DOI: 10.1016/s0221-0363(04)97588-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/29/2023]
Abstract
The authors report a case of a gastro-epiploic lymphangioma in a 29-year-old male patient presenting with epigastric cramps. Physical examination was normal. Ultrasound and abdominal CT-scan showed a cystic mass under the left lobe of the liver containing fine septations and extending to the lesser sac. At surgery, a large cystic mass was found, situated around the celiac trunk. It was adherent to the lesser curvature of the stomach and posterior surface of the antrum and extended to the lesser sac. Excision of the mass and antrectomy were performed. Histologic examination was consistent with a diagnosis of cystic lymphangioma.
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Affiliation(s)
- M H Bouhaouala
- Service d'imagerie médicale, Hôpital des Forces de sécurité intérieure, La Marsa, Tunisie.
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18
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Hizawa K, Kawasaki M, Kouzuki T, Suekane H, Matsumoto T, Fujishima M. ENDOSONOGRAPHIC CLASSIFICATIONS OF GASTROINTESTINAL SUBMUCOSAL TUMORS. Dig Endosc 2001. [DOI: 10.1046/j.1443-1661.2000.00020.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/23/2023]
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19
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Irisawa A, Bhutani MS. Cystic lymphangioma of the colon: endosonographic diagnosis with through-the-scope catheter miniprobe and determination of further management. Report of a case. Dis Colon Rectum 2001; 44:1040-2. [PMID: 11496086 DOI: 10.1007/bf02235494] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Lymphangioma of the colon is rare. There are several reports that endoscopic ultrasound is useful for diagnosis of colonic lymphangioma. We report a case of lymphangioma of colon diagnosed by catheter endosonography and review the literature on endoscopic ultrasound in cystic lymphangioma of the gastrointestinal tract. A 70-year-old female was found to have two submucosal lesions in the colon by colonoscopy. Endoscopic ultrasound revealed that these lesions were anechoic, multicystic, and confined to the submucosa, and the underlying muscularis propria was intact. These findings were consistent with cystic lymphangioma. If typical endosonographic images of an anechoic, septated lesion within colonic submucosa are obtained, further workup or treatment may not be necessary if the patient is asymptomatic.
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Affiliation(s)
- A Irisawa
- Center for Endoscopic Ultrasound, University of Florida, P.O. Box 100214, Gainesville, FL 32610, USA
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20
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Ishikawa N, Fuchigami T, Kikuchi Y, Kobayashi H, Sakai Y, Nakanishi M, Matsumoto T. EUS for gastric lymphangioma. Gastrointest Endosc 2000; 52:798-800. [PMID: 11115926 DOI: 10.1067/mge.2000.108292] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Affiliation(s)
- N Ishikawa
- Departments of Gastroenterology and Pathology, Matsuyama Red Cross Hospital, Ehime, Japan
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Kim KM, Choi KY, Lee A, Kim BK. Lymphangioma of large intestine: report of ten cases with endoscopic and pathologic correlation. Gastrointest Endosc 2000; 52:255-9. [PMID: 10922105 DOI: 10.1067/mge.2000.107710] [Citation(s) in RCA: 22] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND Lymphangioma of the intestinal tracts is extremely rare and usually presents as a sessile or pedunculated polyp. The cause of these gross morphologic differences is unknown. The aim of this study was to investigate the characteristic histopathology of the colonic lymphangiomas in comparison with their endoscopic findings. METHODS Ten colonic lymphangiomas, diagnosed and resected endoscopically between 1992 and 1999, were microscopically examined and immunohistochemically stained with CD31, CD34, Factor VIII-related antigen, and smooth muscle actin. RESULTS The characteristic endoscopic finding was a transparent, fluctuating sessile (7 cases) or pedunculated (3 cases) polypoid mass with the color of normal colonic mucosa. Proliferative and dilated lymphatic tumor vessels were found in the colonic mucosa as well as in the submucosa in seven cases. In three pedunculated lymphangiomas, dilated lymphatics were exclusively restricted to the submucosa. The endothelial lining cells stained positively for both CD31 and Factor VIII-related antigen in all 10 cases tested, but most cases were negative for CD34. CONCLUSION A pedicle does not exclude the endoscopic diagnosis of lymphangioma and there is a close correlation between its presence and histologic submucosal localization of dilated lymphatic vessels.
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Affiliation(s)
- K M Kim
- Departments of Gastroenterology and Clinical Pathology, Catholic University, College of Medicine, Seoul, Korea
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22
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Sriram PV, Weise C, Seitz U, Brand B, Schröder S, Soehendra N. Lymphangioma of the major duodenal papilla presenting as acute pancreatitis: treatment by endoscopic snare papillectomy. Gastrointest Endosc 2000; 51:733-6. [PMID: 10840315 DOI: 10.1067/mge.2000.106111] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Affiliation(s)
- P V Sriram
- Department of Endoscopic Surgery, University Hospital Eppendorf and Pathologie, Labor Keeser/Arndt, Hamburg, Germany
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Mortensen MB. The role of gastrointestinal endosonography in diagnostic and therapeutic interventional procedures. EUROPEAN JOURNAL OF ULTRASOUND : OFFICIAL JOURNAL OF THE EUROPEAN FEDERATION OF SOCIETIES FOR ULTRASOUND IN MEDICINE AND BIOLOGY 1999; 10:93-104. [PMID: 10586014 DOI: 10.1016/s0929-8266(99)00057-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Over the past 15 years endoscopic ultrasonography (EUS) has become an integrated part of gastrointestinal imaging. The more recent development of echoendoscopes and needles for EUS guided fine needle aspiration has stimulated the interest in interventional EUS procedures, both for diagnostic and therapeutic purposes. This paper describes the technique and experience with some of the interventional EUS procedures based on the present literature. Many of the techniques must still be considered experimental and will need substantial clinical testing in larger series before any final conclusions can be made. However, the present level of interventional EUS seems to indicate, that some of these techniques could be cost-effective alternatives in specific clinical situations, and in some cases even the only possible theraputic action. Future research in interventional EUS should be concentrated in experienced endosonography centers under careful monitoring of complications and clinical outcome.
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Affiliation(s)
- M B Mortensen
- Center for Advanced Endoscopic and Intraoperative Ultrasonography, Department of Surgical Gastroenterology, Odense University Hospital, Sdr Boulevard 29, 5000, Odense, Denmark
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Hizawa K, Kawasaki M, Kouzuki T, Aoyagi K, Fujishima M. Unroofing technique for the endoscopic resection of a large duodenal lipoma. Gastrointest Endosc 1999; 49:391-2. [PMID: 10049428 DOI: 10.1016/s0016-5107(99)70021-0] [Citation(s) in RCA: 22] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Affiliation(s)
- K Hizawa
- Second Department of Internal Medicine and Second Department of Pathology, Faculty of Medicine, Kyushu University, Fukuoka, Japan
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Hizawa K, Suekane H, Kawasaki M, Yao T, Aoyagi K, Fujishima M. Diffuse cystic malformation and neoplasia-associated cystic formation in the stomach. Endosonographic features and diagnosis of tumor depth. J Clin Gastroenterol 1997; 25:634-9. [PMID: 9451678 DOI: 10.1097/00004836-199712000-00017] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
We have evaluated the endoscopic ultrasonography (EUS) features of cystic malformation of the stomach and the depth of associated neoplasia. We included 15 patients with multiple cystic components identified on EUS: 6 patients with multiple cysts restricted focally to gastric neoplasia and 9 patients with diffusely distributed cysts. We categorized the former findings as focal cystic malformation (FCM), and the latter as diffuse cystic malformation (DCM) of the stomach and reviewed the endosonographic features. Both FCM and DCM tended to show male preponderance and develop in older patients. Cystic changes in FCM extended from the neoplastic lesion to the submucosa regardless of the location in the stomach. Diffuse cystic malformation was located predominantly in the gastric body and mainly was shown as the thickened submucosa and/or deep mucosa with multiple cystic components. The boundary between the mucosal layer or the tumor echo and the submucosal layer was indistinct in eight patients, which led to a lower accuracy in EUS diagnosis of tumor depth. Diffuse cystic malformation has characteristic EUS features and occasionally is accompanied by gastric neoplasia. Endoscopic ultrasonography is inaccurate in determining tumor depth when multiple submucosal cysts are present.
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Affiliation(s)
- K Hizawa
- Second Department of Internal Medicine, Faculty of Medicine, Kyushu University, Fukuoka, Japan
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