Abstract
BackgroundLymphatic malformations are the second most common vascular malformations after venous malformations. These slow-flow lesions occur most often in the paediatric population and seldom in the extremities. We report a case of lymphangioma at the popliteal fossa in an adult who underwent complete surgical resection.Case presentationA 30-year-old male presented to the department of orthopaedics with a swelling in the right calf region. Clinically, it was suspected to be a Baker’s cyst. Ultrasound showed a multiloculated anechoic cystic lesion in the inferior aspect of popliteal fossa along the intermuscular plane with multiple internal septations. Infected Baker’s cyst was considered, and MRI was suggested for further evaluation. On MRI, the lesion measured 7.2 × 4.6 × 5.8 cm, appeared as a low signal on T1 and high signal on STIR and T2, with multiple internal septations and was situated in the inferior aspect of the right popliteal fossa along the intermuscular plane between the lateral head of gastrocnemius and soleus muscles. No obvious synovial extension. A post-contrast study showed minimal peripheral and septal enhancement. Neither internal enhancing solid components nor significant internal derangement of the knee was observed. Diagnosis of lymphangioma was considered based on the imaging features and ruling out the common differentials for cystic lesions around the knee. Wide local excision was performed. Histopathological evaluation showed multiple irregularly dilated lymphatic channels lined by flatted epithelium. The lymphatic channels were seen to be surrounded by thick fibro collagenous cyst wall with scattered congested blood vessels, skeletal muscle fibre and chronic inflammatory cells.ConclusionLymphangioma must be included in the differential diagnosis of any cystic lesion if the lesion appears multiseptated and/or infiltrative. At the popliteal fossa, it presents as a multiseptated cyst with no synovial continuity or internal derangement of the knee.
Highlights
Lymphatic malformations are the second most common vascular malformations after venous malformations
Lymphangioma must be included in the differential diagnosis of any cystic lesion if the lesion appears multiseptated and/or infiltrative
It presents as a multiseptated cyst with no synovial continuity or internal derangement of the knee
Summary
Lymphangioma must be included in the differential diagnosis of any cystic lesion if the lesion appears multiseptated and/or infiltrative (Table 1). It presents as a multiseptated cyst with no synovial continuity or internal derangement of the knee. Lymphangioma has no specific imaging features; still should be considered in the differential diagnosis if Baker’s cyst is not evident. Well-defined anechoic cyst extending to the joint space. ‘Speech bubble’ sign Internal echoes can be seen if infected. Synovial tissue lining with Lined by synoviocytes, Macroscopic multiseptated lymphatic spaces fibrous component collagen and fibroelastic cartilage
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