Pancreatic lymphangioma: A case report and review of literature

Abstract

Lymphangiomas are cystic lesions that arise due to malformations (congenital or acquired) in the lymphatic system and are composed of thin-walled septa lined by endothelial cells that enclose blocked lymph fluid. Lymphangiomas can occur in any part of the body and at any age, but generally, 90 % occur in children under 2 years of age and 90 % of the time in the upper part of the body like the head, neck, and axillae. Abdominal lymphangiomas are rare (only 1 % of all lymphangiomas), and pancreatic lymphangiomas are even rarer. When occurring in the pancreas, they mostly present at later ages with recurrent abdominal pain +/– palpable abdominal mass and mostly in ‘women’, although most commonly they are an incidental finding. Here we present a case of a 23-year-old ‘male’ with the complaint of epigastric pain that responded to acetaminophen. Ultrasound (US) and CT raised the suspicion of cystic lymphangioma, and endoscopic ultrasound fine needle aspiration (EUS FNA) showed pathognomic lab findings in the aspirated fluid. A definitive diagnosis can be made based on histology. In asymptomatic patients, conservative treatment is preferred, while in patients with symptoms and compression of adjoining structures due to size, en-bloc resection is curative with an excellent prognosis.