Asymptomatic lymphangioma involving the spleen and retroperitoneum in adults

Splenic Lymphangioma Mimicking Lymphomatous Involvement: A Case Report with Review of the Literature

Lymphangioma is a benign malformation of lymphatic vessels usually found in the head and neck areas or axilla. They may involve visceral organs with a lower percentage. Splenic lymphangioma is a rare tumor. This disease is often seen in children but may be diagnosed incidentally in adults. Most patients are asymptomatic, but in large and multifocal lesions, the patient may have some nonspecific symptoms such as abdominal pain, abdominal distention, nausea, vomiting, and loss of appetite. Physical examination may show no specific findings or detect palpable masses. The preoperative diagnosis of splenic lymphangioma is challenging. Histopathological evaluation and sometimes immunohistochemistry tests can result in a definitive diagnosis. In this study, we present an 18-year-old man, with Burkitt's lymphoma who underwent laparotomy and total splenectomy as a result of cystic lesions discovered accidentally during imaging with the final diagnosis of splenic lymphangioma after histopathological evaluation.

Case report and literature review: Giant retroperitoneal cystic lymphangioma

Background

Cystic lymphangioma is a rare benign tumor of the lymphatic system, which is most commonly observed in the neck, head and armpit.Less than 5% of lymphangiomas occur in the abdominal cavity and even less in the retroperitoneum.

Case description

A 65-year-old male patient was diagnosed with an "abdominal mass that had persisted for 1 year, accompanied by abdominal pain, abdominal distension and dyspnea for 7 days". After abdominal computerd tomography, a giant multilobed abdominal lymphangioma was suspected, which squeezed the intestinal canal and was closely related to the inferior vena cava. The patient underwent an exploratory laparotomy, during which, it was found that the tumor formed extensive adhesions to the transverse colon, small intestine and pelvic wall, and enveloped the abdominal aorta, superior mesenteric artery, inferior mesenteric artery and inferior vena cava to varying degrees. It was diffcult to remove the cyst completely. Postoperative pathology confirmed the diagnosis of retroperitoneal cystic lymphangioma. The patient recovered well after the operation, was eating normally by 5 days postoperatively,and was discharged 10 days postoperatively.The patient was followed up 1 month after postoperatively and no evidence of recurrence was observed.

Conclusion

In this case, we report a patient with giant retroperitoneal cystic lymphangioma who underwent exploratory laparotomy combined with preoperative abdominal computerd tomography and acute abdominal pain, abdominal distension and dyspnea. Because of the large volume of the tumor and its close relationship with the superior mesenteric artery and other blood vessels, the surgeon used scissors to separate the tumor sharply and removed the whole tumor completely.

Splenic lymphangioma in adult patient treated with laparoscopic splenectomy: A rare case report

Splenic lymphangioma is a benign cystic tumor that develops as a result of lymphatic vessels' congenital abnormalities. It is a rare condition that mostly occurs in children and young adults. Due to the lack of typical symptoms and signs, splenic lymphangioma is difficult to diagnose and often incidentally revealed during radiological examinations. We report a case of a 55-year-old Asian female, who presented with left upper quadrant abdominal pain in the past 3 days. She had mild upper abdominal tenderness, with no other specific findings. Abdominal contrast material-enhanced computed tomography revealed three hypodense lesions arising from a normal-sized spleen. The histologic findings after laparoscopic splenectomy demonstrated a 3-cm-diameter yellowish-white tumor made up of multiple cystic structures. Primary benign splenic tumors are exceedingly rare, especially in adults over 20. While small lesions are mostly asymptomatic, bigger lesions can cause organ compression or even rupture. Therefore, even in adults with pain in the left upper quadrant abdomen or enlarged spleen, splenic lymphangioma should be taken into account in the differential diagnosis. The case serves as an example of a rare congenital splenic tumor. Treatment of this benign splenic abnormality with laparoscopic splenectomy is a good, safe approach.

Focal splenic lesions: Imaging spectrum of diseases on CT, MRI and PET/CT

The spleen can be affected by a variety of diseases. Some of them are readily identified as variations of normal or benign diseases on imaging. However, for a substantial number of focal splenic abnormalities, the diagnosis can be difficult so that histopathologic analysis may be required for a definite diagnosis. In this review, the typical splenic abnormalities that can be diagnosed with imaging with a high degree of confidence are illustrated. The complementary role of computed tomography (CT), magnetic resonance imaging and positron emission tomography/CT that helps make a diagnostic approach is discussed. Finally, current applications and future trends of radiomics and artificial intelligence for the diagnosis of splenic diseases are addressed.

Hemorrhagic shock from post-traumatic rupture of microcystic splenic lymphangioma: A case report and review of the literature

INTRODUCTION

Lymphangioma is an abnormal proliferation of lymphatic vessels. Isolated splenic lymphangioma (SL) is rare; in the last 30 years only 22 cases were reported in the literature. Diagnosis is difficult by the absence of typical symptoms and signs. SL is often asymptomatic and occasionally detected through radiological exams or, after the onset of a life-threatening complication, at surgery or pathological examination. Surgery represents the treatment of choice.

PRESENTATION OF CASE

A 22-year-old Caucasian male was admitted to the Emergency Department after a car accident, complaining of sudden onset, severe, left upper quadrant abdominal pain. Abdominal examination revealed mild abdominal distention and a severe abdominal pain on superficial and deep palpation of left upper abdominal quadrant with obvious muscle guarding and rebound tenderness. Abdominal computed tomography scan showed splenic rupture with hemoperitoneum. Laboratory tests reported severe anemia. The patient received blood transfusions and was taken emergently to the operating room for exploratory laparotomy, evacuation of hemoperitoneum and splenectomy. The postoperative course was uneventful, the patient was discharged on the 7th post-operative day. Diagnosis of microcystic SL was made at pathological examination.

DISCUSSION

Post-traumatic splenic rupture may be favored by the presence of a unknown and asymptomatic isolated SL. Although different types of treatment of SL are reported in the literature, splenectomy represents the treatment of choice to avoid complications.

CONCLUSION

Isolated SL is difficult to diagnose and suspect because of lack of pathognomonic symptoms and specific diagnostic signs. It can be diagnosed after the onset of a life-threatening complication. Splenectomy is the preferable definitive treatment.

Splenic lymphangioma in adulthood: A case report

INTRODUCTION

Splenic disease are uncommon and primary tumors of the spleen are very rare. These are classified as splenic cyst, benign and malignant tumors. Splenic lymphangioma is a rare, slow-growing benign tumor of the spleen. More often seen in children, it is a congenital malformation of the lymphatic system and is rarely seen in adulthood. When present in adults, it is usually asymptomatic and would be incidentally detected through imaging studies. Infrequently, some patients would present with abdominal pain, distension, nausea, and may have palpable abdominal mass. It may be solitary or may have multiple splenic lesions.

PRESENTATION OF CASE

We present of a case of splenic mass in a 56-year old female, which remained undetected until incidentally discovered on work-up for chronic back pain. Laparoscopic splenectomy was eventually performed with eventual resolution of the chronic back pain. Histopathologic examination revealed splenic lymphangioma.

DISCUSSION

Splenic tumors are uncommon. Splenic lymphangiomas presenting in adulthood are extremely rare, and preoperative diagnosis may be difficult in asymptomatic patients.

CONCLUSION

Surgical removal of splenic lymphangiomas may be necessary to relieve symptoms, prevent complications and confirm diagnosis.

Miniprobe endoscopic ultrasonography for the diagnosis of colon hemangiolymphangioma

Hemangiolymphangioma is a very rare benign vascular tumor that affects the gastrointestinal tract in less than 1% of cases. We present the case of an asymptomatic 52-year-old female referred for endoscopic colorectal cancer screening. A sub-epithelial pediculated polypoid lesion in the splenic angle of the colon was identified. An endoscopic ultrasonography with a miniprobe was performed, which identified an anechoic lesion in the submucosal layer. Surgery was performed and the histologic findings were compatible with two hemangiolymphangioma lesions. This is one of the few cases reported in the literature of hemangiolymphangioma diagnosed by miniprobe endoscopic ultrasonography and the first to describe two lesions in the same patient.

Isolated cystic lymphangiomatosis of spleen in an adult: a diagnostic conundrum

Lymphangiomatosis is a rare developmental disorder characterised by diffuse proliferation of anastomosing lymphatic channels (lymphangiomas). It is believed to result from anomalous lymphatic development and usually presents in childhood. It typically occurs as a part of systemic lymphangiomatosis and isolated organ involvement is rare. Only nine cases of isolated cystic lymphangiomatosis of spleen have been reported between 1990 and 2010. Tuberculosis is a significant health problem in India and varied forms of this disease are seen in clinical practice. Isolated splenic tuberculosis, though a rare entity, has been described in the Indian population. We present a case of isolated splenic lymphangiomatosis in a 42-year-old woman that was initially misdiagnosed as splenic tuberculosis and was treated accordingly. Unresponsive to medical treatment, the patient underwent splenectomy and on histopathological examination, cystic lymphangiomatosis was diagnosed. The patient's symptoms resolved after surgery and she is doing well at a follow-up of 3 months.

Giant pulmonary teratoma with huge splenic lymphangiomatosis: a very rare case

Teratomas are tumors composed of tissues derived from more than one germ cell line. They manifested with a great variety of clinical and radiological features. We report a case of a giant left hemithorax teratoma in a female with huge spleen tumor and review the relevant literature. A 38-year-old female with progressively aggravating dyspnea at rest from a mild trauma. Absent breath sounds on the left side. There was splenomegaly. Computed tomography scan revealed a huge mass (20 × 15 × 18 cm), containing elements of heterogeneous density in the left hemithorax. The spleen tumor was occupying most of the spleen without any other abdominal manifestations. The patient underwent left thoracotomy and laparoscopic splenectomy. Histopathological examination revealed a benign mature teratoma and cystic lymphangiomatosis of the spleen. To the best of our knowledge and after reviewing the available literature this is the first case of huge mature pulmonary teratoma with large cystic spleen lymphangiomatosis.

Cystic lymphangioma of spleen in adults

Splenic diseases are rare. Tumours of the spleen are classified as either benign or malignant. Primary benign tumours of the spleen are extremely rare, identified on surgery and autopsy, accounting for <0.007% of all splenic tumours. Splenic lymphangiomas are benign cystic tumours resulting from congenital malformations of the lymphatic system that appear as a single or multiple lesions of the spleen. It mainly affects children and is rarely manifested after the age of 20 years of age. We report a case of cystic lymphangioma of spleen in a 40-year-old woman admitted with a huge mass in the abdomen, which on imaging found to be a cystic mass arising from spleen. On laparotomy the spleen was found occupying a major part of the abdomen. Splenectomy was performed and histopathological examination revealed it to be a cystic lymphangioma of spleen. This case report emphasises on the rarity of the case at this age and the sheer size of the tumour, being largest until as per our knowledge.

Disorders of the lymphatic system of the abdomen

The lymphatic system of the abdomen comprises of the cisterna chyli, its major and minor lymphatic tributaries, and lymph nodes. Disorders of the lymphatic system of the abdomen are rarely encountered and consist of primary and secondary types. Abdominal lymphangiomas constitute the majority and have characteristic imaging features. Complicated lymphangiomas may pose a diagnostic dilemma. Generalised systemic lymphangiomatosis is a rare condition and affects major organs with a poor prognosis. Retroperitoneal lymphangiectasia in the appropriate setting might predict underlying infection, such as filariasis. Other acquired conditions include iatrogenic or treatment-induced chylocoele. Chylous ascites can be secondary to multiple causes and can be confirmed by biochemical testing and lymphangiogram in appropriate settings.

18F-FDG PET/CT Findings in a Splenic Lymphangioma

A 16-year-old girl with abdominal pain for 3 years underwent FDG PET/CT scan for evaluating identifiable origin. The images showed multifocal, subcapsular thin-walled low-attenuation masses on CT and focal, slight increased ¹⁸F-FDG uptake on PET with an SUV(max) of 3.0. Based on the findings, malignancy cannot be excluded. Then, pathologic examination was performed, and it was identified to be splenic lymphangioma. We herein presented the FDG PET/CT findings of this splenic lymphangioma, which is a rare benign vascular tumor and commonly caused by congenital malformation of the lymphatic vessels.

Splenic cystic lymphangioma with atypical ultrasound findings

Splenic lymphangiomas are rare benign tumors occurring more frequently in children. Because of their asymptomatic growth, splenic lymphangiomas are usually suspected based on incidental findings, the diagnosis relying on different imaging techniques and requiring histological confirmation. The rarity of the disease and its atypical imaging findings make the diagnosis of splenic lymphangiomas challenging. We describe the case of an isolated splenic cystic lymphangioma affecting an elderly female patient. The patient was asymptomatic and the blood tests were normal. The tumor appeared on gray-scale ultrasound as an inhomogeneous, mostly hyperechoic septated mass, which is atypical for a cystic lymphangioma. Contrast-enhanced ultrasound and contrast-enhanced computed tomography suggested the benign nature of the tumor and narrowed the diagnosis. The tumor received histopathological confirmation after splenectomy. Various CT and MRI findings in splenic lymphangiomas have been described, but very few reports regarding CEUS exist to this point.

Splenic Lymphangioma

Splenic lymphangioma is a rare malformation of the splenic lymphatic channels, mostly seen in children. It is characterized by the presence of cysts, resulting from increases in the size and number of thin-walled lymphatic vessels that are abnormally interconnected and dilated. The condition may be restricted to the spleen, but in most cases it involves multiple organs (systemic lymphangiomatosis). The clinical picture is variable; small lesions are often incidentally detected through imaging studies, while larger lesions can result in compression of organs, causing pain or rupture even after minor trauma. Therefore, splenic lymphangiomas should be considered in the differential diagnosis of splenomegaly or left upper quadrant pain even among adults and should be immediately treated with splenectomy; delay in the therapeutic intervention can lead to life-threatening complications.

Gigantic lymphangioma with marked extraluminal progression of the ascending colon: report of a case

We report a case of gigantic cystic lymphangioma of the ascending colon excised through an open laparotomy. A 34-year-old woman consulted a gynecologist for treatment of infertility. Transvaginal ultrasonography revealed a cystic mass in the pelvis, and she was transferred to our hospital for further investigation. Abdominal enhanced computed tomography (CT) showed a bulky cystic mass, 25 cm or larger, in the abdominal and pelvic cavity. Colonoscopy revealed a cystic submucosal tumor with a cushion sign. Cystic lymphangioma was diagnosed and excised via open surgery as we could not exclude its malignant potential. Pathological examination confirmed lymphangioma. To our knowledge, this is the most gigantic lymphangioma of the colon documented in the literature. About 3 months after surgery, the patient discovered that she was pregnant and her first baby was delivered at term, uneventfully.

Cystic pancreatic lymphangioma

Lymphangioma of the pancreas is a rare benign tumor of lymphatic origin. Retroperitoneal lymphangiomas account for 1% of all lymphangiomas. Herein, we report a case of cystic pancreatic lymphangioma diagnosed in 34 year-old female patient who was hospitalized for a slight pain in the epigastrium and vomiting. Radiological imaging revealed a large multiloculated cystic abdominal mass with enhancing septations involving the upper retroperitoneum. During the laparoscopic surgery, a well circumscribed polycystic tumor was completely excised preserving the pancreatic duct. The patient made a complete recovery and is disease-free 12 months postoperatively.

Diagnosis and treatment of retroperitoneal lymphangioma: an analysis of 15 cases

AIM: To summarize the clinical and imaging characteristics, operative methods and curative effect of retroperitoneal lymphangioma.

METHODS: The clinical and radiological data for 15 patients with retroperitoneal lymphangioma were analyzed retrospectively.

RESULTS: All the patients were diagnosed with retroperitoneal lymphangioma by imaging examination and underwent surgical resection. Pathological examination of resected specimens confirmed the initial diagnosis. The follow-up period ranges from 1 month to 17 years. Relapse occurred in one patient, who subsequently underwent a complete resection and showed no recurrence during one-year follow-up.

CONCLUSION: Retroperitoneal lymphangioma has non-specific clinical manifestations and is easily misdiagnosed. Ultrasound is useful for screening retroperitoneal lymphangioma, while CT can help make a definite diagnosis. Patients with retroperitoneal lymphangioma need to undergo complete resection and often have good prognosis.