Cystic lymphangioma of the colon

Abstract

1 Springer Indian J Gastroenterol 2009(November–December):28(6):195–197 A 66-year-old woman presented to our hospital with pain and bleeding per rectum for 2 days and constipation since 3 years. Colonoscopy showed grade 2 hemorrhoids and an incidental pedunculated polyp in the ascending colon. A polypectomy was performed. The polyp measured 1 cm × 0.7 cm × 0.5 cm and was soft and compressible. Microscopy showed normal mucosa with a submucosal lesion composed of cystic spaces lined by endothelial cells and separated by thin fibrous septae. The spaces contained eosinophilic material. The muscularis propria and serosa were normal. We made a diagnosis of lymphangioma of the ascending colon. Lymphangioma is a benign neoplasm of lymphatics and is common in the head, neck, axilla and other soft tissues. Colonic lymphangiomas are uncommon. They may be detected incidentally in colonic resections for other pathology or on colonoscopy or barium enema, or during investigation for positive fecal occult blood test. Patients may also present with bleeding per rectum, mild abdominal discomfort, constipation, hematochezia, protein-losing enteropathy or intussusception. The differential diagnosis of a benign colonic polyp that can cause intussusception includes lipoma, leiomyoma, inflammatory fibroid polyp and enteric duplication cyst. Pedunculated polyps <2 cm in diameter can be removed by endoscopic polypectomy while non-pedunculated polyps or those over 2 cm can be snared and ligated or excised surgically.