Haemolymphangioma of the small bowel mesentery in adults: two case reports and a literature review

A Rare Case of Cystic Hemolymphangioma Associated With Intestine Duplication

Cystic hemolymphangioma and jejunal duplication are both typically congenital conditions and primarily identified in childhood, making adult diagnoses exceedingly uncommon. Cystic hemolymphangioma and intestinal duplication together are particularly rare. In this report, we present the case of an adult female patient with both. A pedunculated mass was identified outside the jejunal wall, with duplicated intestine on the stalk and cystic hemolymphangioma within the mass. Both lesions were surgically excised, and the patient has remained recurrence-free for five years postoperatively.

Clinical characteristics and risk factors for acute abdomen in patients with abdominal lymphatic malformations

OBJECTIVE

The diagnosis of abdominal lymphatic malformations (ALMs) is often overlooked in clinical practice. However, reports in the literature about ALMs are limited to case reports and series with small sample sizes. This study aimed to review our currently available data to describe the clinical characteristics of ALMs and evaluate the risk factors for acute abdomen caused by ALMs.

METHODS

We reviewed the records of patients with ALMs who were diagnosed between December 2008 and January 2023 in our institution. The associations between acute abdomen and ALMs were analyzed based on single-factor and multivariate logistic regression analyses.

RESULTS

This study included 345 patients with pathologically confirmed ALMs, with a slight female predominance of 1:1.4. Approximately 39.1% (135/345) of patients were asymptomatic, and 24.6% (85/345) presented with acute abdomen. Among the ALMs in the cohort, 42.6% (147/345) were retroperitoneal lymphatic malformations (LMs). The maximal lesion dimensions in patients with acute abdomen and nonacute abdomen were 10.0 cm and 7.8 cm, respectively, with no significant difference based on multivariate analyses. Children were more likely to develop acute abdomen than adults were (P = .002; odds ratio, 5.128; 95% confidence interval, 1.835-14.326). ALMs accompanying acute abdomen were more common for lesions involving the small intestinal mesentery (P = .023; odds ratio, 2.926; 95% confidence interval, 1.157-7.400).

CONCLUSIONS

ALMs are rare with an insidious onset, and retroperitoneal LMs are the most common ALMs, followed by jejunal mesenteric LMs. Our retrospective analysis suggested that young age and small intestinal mesenteric lymphatic malformation are independent risk factors for acute abdomen with ALMs.

Focal hemolymphangioma of the rectum: A case report and literature review

RATIONALE

Gastrointestinal hemolymphangiomas are very rare, especially in the rectum. Only 3 cases of rectal hemolymphangioma, all of which are diffuse lesions, have been reported in the English literature on PubMed. Our case is the first focal lesion of the rectum. It is important for radiologists to correctly identify the imaging features of rectal hemolymphangiomas.

PATIENT CONCERNS

A 51-year-old woman visited our hospital because of intermittent constipation for 3 years.

DIAGNOSES

Colonoscopy revealed a prominent lesion on the left anterior wall of the lower rectum. Transvaginal color Doppler ultrasonography showed that the posterior vaginal wall area had a mixed-echo mass, and blood flow signals of the dots and stripes could be seen. Pelvic magnetic resonance imaging showed that the cystic space-occupying lesion in the region between the left anterior wall of the lower rectum and the posterior wall of the middle and lower vagina had a clear boundary.

INTERVENTIONS

The patient underwent surgery to remove the rectal lesions. The surgical specimen was finally diagnosed as local hemolymphangioma by pathological analysis.

LESSONS

Localized hemolymphangioma of the rectum is very rare, and imaging examination is essential for the diagnosis and evaluation of the extent of lesion invasion.

Mesenteric cystic lymphangioma in an adolescent male; a diagnostic dilemma: A case report

INTRODUCTION AND IMPORTANCE

Hemolymphangioma, a rare type of lymphangioma, is a benign hamartoma of the blood vessels and lymphatic system. Considered to be extremely rare among adults with infrequent occurrence in abdominal regions, lymphangioma involving mesentery accounts for <1 % of cases and only 0.05 % involve the GI tract. Due to the absence of typical clinical presentation, making a confirmatory preoperative diagnosis is challenging.

CASE PRESENTATION

An 18-year-old Bangladeshi man visited the hospital with the complaints of epigastric and umbilical pain for 15 days which was insidious in onset. Physical examination revealed an ill defined lump that was palpable on the right side of the abdomen. Ultrasonography showed multiloculated cystic mass having septation approximately 13 × 6 cm in size. An abdominal CT scan showed cystic lesion with septations measuring about 14.5 × 12.3 cm, compressing the bowel loops towards left, that was suggestive of mesenteric lymphangioma. The patient underwent partial surgical resection. The excised mass was sent for histopathology. Histopathology disclosed a benign tumor composed of proliferation of blood vessels of different sizes lined by endothelium in a fibromuscular stroma.

CLINICAL DISCUSSION

Mesenteric lymphangiomas are infrequent malformations and very few cases of mesenteric hemolymphangioma have been reported in adults. Histopathology is required for confirmatory diagnosis and immunohistochemistry is required to differentiate the tumor subtype. Surgical resection is deemed a standard treatment modality.

CONCLUSION

We report an extremely rare case of mesenteric hemolymphangioma to bring it to concern that even with the vague clinical presentations and involvement of age groups beyond the status quo, surgeons must be vigilant about abdominal MCL/hemolymphangioma and proceed accordingly.

Case report: obstruction in the right ventricular outflow tract due to hemolymphangioma

Cardiac masses commonly involve primary tumors, metastatic diseases, and nonbacterial thrombotic and infective endocarditis. myxomas are the most common primary tumors, accounting for 75%. Hemolymphangiomas are a group of congenital vascular and lymphatic malformations that originate from the mesenchyme, with an incidence rate of 0.12%-0.28% per year. Hemolymphangiomas have been found in the rectum, small intestine, spleen, liver, chest wall, and mediastinum but have not yet been reported in the ventricular outflow tract in the heart. Herein, we report a case of a hemolymphangioma tumor in the right ventricular outflow tract (RVOT). The tumor was successfully resected, and the patient was followed up for 18 months and did not exhibit tumor recurrence.

Rare Case of Large Hemolymphangioma in the Small Bowel Mesentery: A Case Report

Hemolymphangioma or hemangiolymphangioma is a rare venolymphatic vascular malformation composed of proliferations or networks of vascular spaces including the lymphatics, capillaries, veins, or arteries. The small bowel is a rare location for hemolymphangioma, and the small bowel mesentery is an even rarer site. Herein, we report a surgically confirmed large complex hemolymphangioma in the small bowel mesentery in a 55-year-old male.