Duodenal Lymphangioma - A Rare Cause of Incidental Duodenal Polyp

Abstract

Introduction: Submucosal lymphangiomas are benign tumors which rarely occur in the gastrointestinal tract. There are very few reported cases of intestinal lymphangioma's and even less in the duodenum. We report the case of a lymphangioma of the duodenum which was found incidentally. The diagnosis was confirmed by biopsy taken during endoscopy. Case Report: 75 y/o gentleman presented to his primary care physician for routine clinic visit. He was found to have Anemia with Hb of 9.6 g/dL, Hematocrit of 30.8% and MCV of 70.6 fL. He was asymptomatic at the time of presentation. Iron Studies were obtained and showed Serum Iron of 26 μg/dL, Iron saturation of 5%, TIBC of 490 μg/dL and Ferritin of 3.1 ng/mL. He was referred for esophagogastroduodenoscopy (EGD) and colonoscopy to evaluate the iron deficiency anemia. Colonoscopy showed severe diverticulosis and few hyper plastic polyps in the rectum. EGD showed a medium sized hiatal hernia, several small polyps in the stomach which turned out to be fundic gland polyps and a small raised yellowish white duodenal polyp that was biopsied. The surface of the polyp was smooth with some white specks. Biopsy of the polyp revealed a lymphangioma. The pt was brought back for repeat EGD and polyp was removed completely endoscopically. Conclusion: Lymphangiomas are congenital malformations of the lymphatic system and are commonly seen in the skin and subcutaneous tissues. They consist of thin walled lymphatic channels lined by endothelial cells. These tumors are more common in the head, neck and axilla. They are extremely rare in the intestinal tract and even more rare in the duodenum. Lymphangiomas are benign tumors and have no malignant potential. They are usually diagnosed by a combination of radiology and endoscopy. However, few may be found incidentally on endoscopy, as in our patient. If the polyps are large they may cause abdominal pain or obstruction symptoms. Radiographically they are difficult to distinguish from other masses like lipomas, leiomyomas and hemangiomas. Endoscopically these usually look smooth, yellowish white in color and are pliable. Diagnosis of lymphangioma is usually confirmed by biopsy and polypectomy during endoscopy. Treatment is by complete excision since they have a strong tendency for local recurrence unless they are completely excised. The sclerosing agent, OK-432, has been used as a nonsurgical therapy with some success in a few small tumors.