Abstract
Gastric lymphangioma (GLA) is an extremely rare tumor without an established therapeutic strategy. Surgical resection is considered the mainstay of treatment, although there is a high risk of local recurrence if negative margins are not achieved. A 51-year-old man underwent routine abdominal ultrasonography, which incidentally detected a 20-mm tumor adjacent to the lesser curvature of the stomach. GLA was suspected based on its polycystic appearance. After a 16-month monitoring period, laparoscopic resection was performed because of tumor growth and involvement of the left gastric artery. Intraoperative indocyanine green (ICG) navigation system revealed lymphatic drainage from the tumor, which we used to help determine the optimal excision line and minimize the loss of gastric volume. Pathological examination confirmed complete resection with negative margins and supported a diagnosis of lymphangioma. We performed laparoscopic radical resection of GLA under guidance from intraoperative ICG fluorescence imaging, which allowed us to maximize residual gastric volume.
Highlights
Gastric lymphangioma (GLA) is an extremely rare tumor without an established therapeutic strategy
Gastric lymphangioma (GLA) is a very rare tumor and we are only aware of approximately 100 reported cases of GLA [1, 2]
Surgical resection is the mainstay of radical treatment for GLA [3], previous authors have suggested that margin-free resection is difficult because the tumor tends to invade the surrounding tissues with ambiguous boundaries, which produces a high rate of local recurrence [4, 5]
Summary
We encountered a lymphangioma that arose from the lesser curvature of the stomach, and successfully resected the lesion under guidance from ICG fluorescence imaging. This innovative technique helped us achieve complete resection of the tumor with limited loss of gastric volume. While this procedure may provide significant benefits to patients who are undergoing resection of GLA, additional cases should be accumulated to validate our findings. SH supervised the writing of the manuscript. All authors commented on previous versions and approved the final manuscript
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