An adult case of lymphangioma of the hepatoduodenal ligament mimicking a hepatic cyst

Toshihiko Kohashi,Toshiyuki Itamoto,Hideki Nakahara,Yasuhiro Matsugu,Takashi Nishisaka

doi:10.1186/s40792-016-0280-0

Toshihiko Kohashi, Toshiyuki Itamoto + Show 3 more

Open Access

https://doi.org/10.1186/s40792-016-0280-0

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Abstract

BackgroundIntra-abdominal lymphangiomas are rare, benign tumors in adults. This report is the third documented case of a lymphangioma originating in the hepatoduodenal ligament that mimicked a simple liver cyst.Case presentationA 50-year-old woman was admitted with a cystic tumor in the right lobe of her liver and underwent laparoscopic excision of the cyst. Operative findings revealed that the cyst had developed in the hepatoduodenal ligament, not in the liver. A small part of the cystic wall remained on the dorsal surface of the hepatoduodenal ligament. Immunohistochemically, the tumor cells stained positive only for D2-40, leading to a diagnosis of lymphangioma (cystic type). Six months later, a cystic tumor recurred and was completely excised via laparotomy. No recurrence was observed after the second operation.ConclusionsThe incomplete excision of the cystic tumor led us to re-operate 6 months after the first operation for the local disease recurrence.

Highlights

Intra-abdominal lymphangiomas are rare, benign tumors in adults
We describe a rare adult case of lymphangioma arising from the hepatoduodenal ligament, mimicking a simple liver cyst
These findings suggested a unilocular cyst of the liver

Summary

Background

Lymphangiomas are rare, benign tumors and most of them occur in children. Approximately 90% of these childhood patients are diagnosed within the second year of life. We describe a rare adult case of lymphangioma arising from the hepatoduodenal ligament, mimicking a simple liver cyst. The cystic wall was not enhanced by the contrast medium (Fig. 1). These findings suggested a unilocular cyst of the liver. Laparoscopy revealed a large cyst at the caudal site of the right lobe of the liver that compressed the duodenum to the left and the transverse colon downward (Fig. 2a). Hematoxylin-eosin staining revealed that the cystic wall was fibrotic with collagen fiber and flattened endothelium lining the inner-surface (Fig. 3a). The patient re-presented with abdominal distension and epigastric discomfort, and CT revealed a recurrent cyst in the same region of the previous resection (Fig. 4a, b). The patient was alive without recurrence 1 year and 6 months after the second operation

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