Diagnosis Of Lymphangioma Research Articles

Gallbladder fossa lymphangioma encasing the common bile duct: a case report and review of the literature

Introduction: Lymphangiomas are rare low-flow lymphatic vessel malformations mostly diagnosed in childhood. Among the abdominal lymphangiomas, the gallbladder lymphangioma is a rare presentation, and only a few cases have been reported till date, of which majority were cystic lymphangiomas. Case presentation: The authors present a case of a 48-year-old female with abdominal pain and normal physical examination and laboratory findings. On the performed imaging, a multiloculated cystic lesion, located in the gallbladder fossa, was found. The patient underwent open cholecystectomy, and surprisingly, the cyst extended to the common bile duct, which was separated cautiously. The cyst was resected, and the histopathological findings confirmed cystic lymphangioma. Conclusion: The cystic lymphangioma of the gallbladder can be asymptomatic, although most of the literature has reported abdominal pain. The diagnosis of lymphangioma is complicated, especially when intra-cystic hemorrhage happens. Ultrasonography, computed tomography, and magnetic resonance imaging are usually performed. The surgical excision of the cyst and the gallbladder is the treatment of choice. Although bile duct involvement is extremely rare, it should be considered during the surgery.

Lymphangioma in nasal tip and vestibulum: Case report

A ‘Pinocchio’ or ‘Cyrano’ nose is a condition with a deformity at the tip of the nose caused by an underlying soft tissue tumor. The deformity of the nose with secondary involvement in the form of lymphangioma is a sporadic case, and few studies have reported it. Lymphangioma itself is a benign tumor that originates from the lymph vessels. The diagnosis of lymphangiomas can be made based on the clinical picture and computed tomography (CT) or magnetic resonance imaging (MRI) scans. Treatment options for nasal tip lymphangioma and nasal vestibule are radiotherapy, cryotherapy, and sclerosant injection.

Difficulties in Diagnosing Volumetric Formations of the Spleen: an Example of a Clinical Case

Differential diagnosis of bulk splenic neoplasms, despite proper visualization in ultrasound, computed tomography and magnetic resonance imaging of the abdominal cavity, is challenging due to the lack of a unified classification, the extremely rare occurrence of some tumors and difficulty of preoperative morphological identification. The paper discusses a case of making an erroneous preoperative diagnosis in a spleen mass: the instrumental study findings determined the presence of multiple cysts. The latter among all the neoplasms of this organ are the most common and are represented by a variety of forms, subdivided by origin, histogenesis and content features. According to some classifications, cysts are classified as tumors or tumor-like diseases, other sources classify them as non-tumor formations of the spleen. It is not often possible to fully exclude the parasitic origin of the cyst before the morphological study of the removed organ. Surgeons of the Voronezh Regional Clinical Hospital No. 1 encountered this problem during the treatment of a 34-year-old patient with the spleen neoplasm. A diagnosis of lymphangioma was made based on surgical treatment and pathomorphological findings. The analysis of this clinical case demonstrates relevance of splenectomy both as a method of final diagnosis and as the final stage of treatment for benign tumors; it allows avoiding misdiagnosis in case of a malignant tumor.

Intra-abdominal Cystic Lymphangiomas: The Vanderbilt Experience

IntroductionLymphangiomas are rare, cystic tumors that represent congenital malformation of the lymphatic vessels. We reviewed our institution's experience treating abdominal lymphangiomas with the purpose of describing the clinical features, management, and outcomes of this rare pathology. MethodsThis is a single-institution, institutional review board-approved retrospective review of abdominal lymphangiomas presenting between January 2010 and February 2021. The diagnosis of lymphangioma was made on histopathology from either endoscopic or excisional biopsy of the lesion. Demographics, diagnostic imaging, histopathologic characteristics, and outcomes were analyzed. ResultsWe identified 48 patients, of whom 29 (60%) were female, >18 y (38; 79%), with a mean age of 43 y at the time of diagnosis (range, 4 d-87 y). Tumors ranged in size from <1 cm to 30 cm. Only 1/3 were symptomatic, most commonly with abdominal pain (9; 19%) On preoperative imaging, mural nodules or thickened walls were present in one case, in which pathology was consistent with benign lymphangioma. The majority of lymphangiomas were associated with the small bowel or its mesentery (31; 65%), followed by the colon/omentum (7; 15%). Most patients underwent surgical excision (29; 60%) with incomplete excision in one patient due to extensive local invasion, and three (10%) patients required multivisceral resection. The median duration of the follow-up was 13 mo (range, 1-105 mo), during which time, none of the patients developed malignancy. ConclusionsMost abdominal lymphangiomas arise from the small bowel and are found incidentally and have a favorable prognosis. Resection should be reserved for symptomatic lesions or when there is a diagnostic uncertainty.

S1994 Cecal Lymphangioma During Routine Colonoscopy

Introduction: Abdominal lymphangioma is a rare finding. Most of them arise from the mesentery or omentum, and those arising from the GI tract is extremely rare. Lymphangioma involving the colon is usually asymptomatic and can be encountered during screening colonoscopy. It is characterized by a soft, cystic appearing lesion that contains dilated lymphatic channels. Cecal lesions should be differentiated from appendiceal neoplasms including mucocele and carcinoid tumors. Case Description/Methods: A 61-year-old male underwent a screening colonoscopy which revealed a soft cystic lesion in the cecum measuring about 20 mm wide, with a positive cushion sign. Appendiceal orifice and the ileocecal valve appeared normal. CT of the abdomen showed a low-density cystic lesion arising from the wall of the cecum and separate from the appendix. Endoscopic ultrasound (EUS) exam using a mini ultrasound probe revealed a cystic anechoic subepithelial lesion measuring (18 x 17 mm) with septations arising from the submucosa (Figure). Discussion: Lymphangioma of the colon is a rare asymptomatic finding often encountered during screening colonoscopy. It is characterized by a soft, cystic appearing lesion that contains dilated lymphatic channels. It is often solitary and is usually benign in nature. Cecal lesions, especially if in proximity to the appendiceal orifice should be differentiated from appendiceal neoplasms including mucocele and carcinoid tumors. Lymphangioma may be difficult to be differentiated from a lipoma on endoscopic appearance. Signal characteristics on CT imaging differ between the 2; Lipomas have characteristics similar to subcutaneous fat and usually have Hounsfield unit measurements between -65 and -120; Lymphangiomas on the other hand are cystic appearing with Hounsefield units corresponding to the fluid density and the average Hounsefield unit of the lesion in our patient was 17. Similarly, endosonographic features vary between the 2. Lipomas are hyperechoic lesions arising from the submucosa, whereas lymphangiomas are anechoic. Endoscopic appearance of a cystic lesion often with a bluish hue and a positive cushion/ pillow sign and ultrasonographic features (anechoic subepithelial lesion often with septations and without solid component) aid towards the diagnosis of lymphangioma without the need for invasive tissue diagnosis. Rare cases of intussusception from large cecal lymphangioma have been reported. Given the benignity, surgical intervention is not needed in asymptomatic patients.Figure 1.: positive cushion sign.

ORAL LYMPHANGIOMA IN MIDDLE CHILDHOOD: A CASE REPORT

A 9-year-old boy complained of a persistent lesion on the tongue with a 2-year history. His parents reported that the child eventually chewed the lesion and the mass enlarged and presented purple in color. Whenever injury ceased, the lesion slowly decreased in volume and was clear with a pink color but never disappeared. Extraoral examination was not significant. Intraoral examination showed a well-defined mass on the left middle border of the tongue with an approximate size of 2.0 × 1.5 cm. Multifocal and translucent superficial vesicles were present and the color of the lesion ranged from pink to dark red. The clinical differential diagnosis included lymphohemangioma and lymphangioma. An incisional biopsy was performed, and microscopic examination showed dilated lymph vessels in the subepithelial lamina propria. The diagnosis of lymphangioma was established. The lesion was totally excised. After 3-month follow-up, satisfactory wound healing was observed and no recurrence was detected. A 9-year-old boy complained of a persistent lesion on the tongue with a 2-year history. His parents reported that the child eventually chewed the lesion and the mass enlarged and presented purple in color. Whenever injury ceased, the lesion slowly decreased in volume and was clear with a pink color but never disappeared. Extraoral examination was not significant. Intraoral examination showed a well-defined mass on the left middle border of the tongue with an approximate size of 2.0 × 1.5 cm. Multifocal and translucent superficial vesicles were present and the color of the lesion ranged from pink to dark red. The clinical differential diagnosis included lymphohemangioma and lymphangioma. An incisional biopsy was performed, and microscopic examination showed dilated lymph vessels in the subepithelial lamina propria. The diagnosis of lymphangioma was established. The lesion was totally excised. After 3-month follow-up, satisfactory wound healing was observed and no recurrence was detected.

Cervical lymphangioma with myxoid degeneration: a rare case report and literature review

BackgroundLymphangioma is a multi-systemic disease mostly affecting the mesentery, omentum, mesocolon and retroperitoneum and rarely involving bone, with fewer than 30 cases reported so far. Lymphangioma usually has no specific clinical manifestation and could be easily misdiagnosed. Lymphangioma with myxoid degeneration was not reported. We report a histopathologically proved case of lymphangioma of 6th and 7th cervical vertebra (C6–7) with myxoid degeneration.Case presentationA 45-year-old male who suffered from pain in the right shoulder for 1 month, aggravated with numbness in the right little finger and ring finger and radiating pain for half a month. CT showed multiple cystic bone destruction areas in C6–7 vertebral right part and appendage with marginal osteosclerosis and surrounded by soft tissue density. The size of the lesion was about 36 mm × 41 mm . MRI: the margin of the lesion appears lobulated. Lesion showed slightly hypointense on T1WI, slightly hyperintense on T2WI and STIR. Multiple patchy T1WI hypointense and T2WI hyperintense shadows were seen within the lesion. No enhancement was observed in the lesion after injection of contrast, and there was no abnormal signal in surrounding soft tissue and bone. The histopathological examination confirmed the diagnosis of lymphangioma with myxoid degeneration after surgical resection. After over 2 years of follow-up, there were no signs of disease recurrence and progression.ConclusionsTo the best of our knowledge, this is the first case reported in English language literature of lymphangioma with myxoid degeneration.

Lymphangioma of popliteal fossa masquerading as Baker\u2019s cyst

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.

Novel treatment of recurrent abdominal lymphatic malformations in a dog

AbstractAn 8‐month‐old neutered male border collie mix was presented for abdominal distension, lethargy and vomiting. Computed tomography revealed a large, lobulated, fluid‐filled cystic mass within the abdomen. Following subtotal surgical resection and histopathology, a diagnosis of lymphangioma (lymphatic malformation) was made. Five months postoperatively, a recurrence of the lymphatic malformation was diagnosed. Multimodal therapy was instituted consisting of subtotal surgical resection, electrochemotherapy, sclerotherapy and radiation therapy. Ten months postoperatively and 7 months post‐radiation therapy, the dog remained without recurrence of clinical signs, and the lymphatic malformation was reduced in size. The combination of surgical resection, electrochemotherapy, sclerotherapy and radiation therapy seemed to be safe therapeutic options for abdominal lymphangiomas and may aid in medium‐term disease control.

Successful laparoscopic resection of gastric lymphangioma under the intraoperative guidance of indocyanine green fluorescence imaging: A case report

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.

Primary Nodal Lymphangioma: A Rare Case Report and Literature Review

Abstract Introduction/Objective Lymphangiomas are benign nodal vascular tumors commonly seen in the skin, mucosa, and soft tissue; however, its occurrence in lymph nodes is extremely rare, with only a few cases reported in English literature. Methods We report a case of a 20-year-old female who presented with a 6 cm right upper thigh mass below the inguinal region that has been gradually increasing in size over the past three months. Ultrasound showed a cystic appearance. An excisional biopsy was performed to yield a thin-walled cystic mass filled with clear fluid. The mass appeared to be connected to a regional lymph node. Histologic examination revealed a multiloculated thin-wall cyst involving the hilum of the lymph node. The cyst is lined by flat lymphatic endothelial cells with focally disorganized smooth muscle at the wall of large channels and peripheral lymphoid aggregates. The rest of the lymph node shows reactive change with vascular proliferation and congestion. Results Lymphangiomas are soft, relatively well-circumscribed hamartomatous malformations due to the failure of the lymphatic system to communicate with the venous system. This leads to abnormal rests of lymphatic tissue that proliferate and accumulate fluid, causing their cystic morphology. Lymphangiomas are classified as capillary, cavernous, and cystic forms. Imaging techniques such as ultrasonography, mammography, and magnetic resonance imaging may aid in clinical diagnosis and follow-up. Histologically, cavernous lymphangiomas show numerous narrow cavernous spaces lined by a single layer of attenuated endothelial cells, and containing amorphous eosinophilic fluid with few lymphocytes. These spaces may contain blood resulting in misdiagnosis of this lesion as cavernous hemangioma; however, increased lymphoid cells in the stroma, more irregular cavernous spaces, support the diagnosis of lymphangioma. Conclusion Lymphangiomas are slowly progressive painless lesions that frequently recur in cases of incomplete excision. It is important to identify this primary nodal lymphangioma to avoid misdiagnosis of benign vascular proliferation, benign vascular tumor, or malignant vascular tumor.

LYMPHANGIOMA: A CASE REPORT

The lymphangiomas are benign hamartomatous tumors that result from congenital or acquired abnormalities of the lymphatic system. They are rare in adults and frequently localized in the head and neck regions. When they occur in the oral cavity the most common location is dorsum of the tongue. The goal of this case report is to present the diagnostic methods based on clinical and histopathologic criteria as well the surgical treatment of choice. A 56-year-old female patient presented with a white painless vesiculobullous lesion on her lower lip for at least 8 years according to the patient’s report. The excisional biopsy was performed as surgical treatment, and the diagnosis of lymphangioma was confirmed by histopathologic examination. Although it is a rare condition, it is extremely relevant to perform the diagnosis of this condition and the adequate treatment. The lymphangiomas are benign hamartomatous tumors that result from congenital or acquired abnormalities of the lymphatic system. They are rare in adults and frequently localized in the head and neck regions. When they occur in the oral cavity the most common location is dorsum of the tongue. The goal of this case report is to present the diagnostic methods based on clinical and histopathologic criteria as well the surgical treatment of choice. A 56-year-old female patient presented with a white painless vesiculobullous lesion on her lower lip for at least 8 years according to the patient’s report. The excisional biopsy was performed as surgical treatment, and the diagnosis of lymphangioma was confirmed by histopathologic examination. Although it is a rare condition, it is extremely relevant to perform the diagnosis of this condition and the adequate treatment.

INTRALESIONAL SCLEROTHERAPY WITH POLIDOCANOL 1% AS AN ALTERNATIVE TREATMENT OF LYMPHANGIOMA: A REPORT OF 2 CASES

Lymphangioma is a benign congenital malformation of the lymph nodes and rarely affects the oral cavity. Usually, the treatment chosen is surgical excision; however, depending on the lesion size, the treatment may be compromised because of its high recurrence rate. Consequently, sclerotherapy has arisen as an additive treatment of lymphangioma once neither sclerotherapy nor surgical excision alone have showed encouraging results in treating lymphangioma. Polidocanol 1% has been used to cause regression of the lesion before the surgery is performed, hence improving the treatment of these malformations. A 7-year-old boy and 16-year-old girl presented with a nodule on the tongue and upper lip tumefaction, respectively. After incisional biopsy and diagnosis of lymphangioma, treatment consisted of 5 sessions of intralesional sclerotherapy with 1 mL of polidocanol 1% with a 2-week interval in between sessions. Surgical excision was performed, both patients displayed improvement, and no recurrence was noted after a 7-month follow-up.

Cervical cystic lymphangioma

Our work is about a 34-year-old woman with no particular history who was admitted for a cervical mass which showed a substantial increase in size in the last 8 months. Physical examination revealed a fluctuant and painless mass in the right posterior triangle which was tender on palpation. CT scan of the neck showed a multi-loculated homogeneous cystic lesion located primarily in the right posterior cervical triangle, and extending to the right deep cervical spaces, underneath an elevated sternocleidomastoid muscle. The right jugular vein, while relatively compressed, was still patent. There was no contrast enhancement after intravenous injection. The patient underwent complete surgical excision by transverse neck incision and the diagnosis of lymphangioma was confirmed on histological examination.

Orbital Lymphangioma Confined to an Extraocular Muscle

A 48-year-old woman presented with a 1-year history of an enlarging, nontender right lateral intrapalpebral mass overlying the insertion of the right lateral rectus muscle, associated with a 3-month history of worsening right orbital pain and retrobulbar headaches. MR imaging revealed an isointense right orbital mass contained entirely within the right lateral rectus muscle and indistinguishable from it. Transconjunctival biopsy established the diagnosis of lymphangioma. To the authors' knowledge, this case represents the first reported orbital lymphangioma contained entirely within an extraocular muscle.

Esophageal lymphangioma: a case report and review of literature

BackgroundLymphangioma of the esophagus is an exceedingly rare benign tumor. Herein, we reported a case of lymphangioma in the thoracic esophagus.Case presentationThe patient was a 48-year-old woman who presented to our hospital with a one-month history of dysphagia. Upper endoscopy revealed an esophageal submucosal lesion that was completely removed by endoscopic submucosal dissection. Pathologic examination of the resected specimen secured the diagnosis of lymphangioma. A review of the PUBMED indexed literature in English with the key words of esophagus and lymphangioma was carried out and the results were discussed.ConclusionEsophageal lymphangioma is a rare submucosal tumor and should be included in the differential diagnosis of esophageal submucosal tumors.

LYMPHANGIOMA AS A CAUSE OF ILEUS

Introduction. Lymphangiomas are mature benign tumors emanating from the lymphatic vessels making up 9-10% of all benign neoplasms in pediatric oncology. In our practice, we have encountered a rare complication of the lymphangioma of the abdominal cavity - an ileus Objective: To present a clinical picture, diagnostic and surgical tactics in a rare clinical observation of mesenteric lymphangioma, complicated by ileus. Material and methods. Boy aged of 6 years 4 months. He was taken to the emergency department of the Research Institute of NDHiT by an ambulance team (SMP) with suspected acute appendicitis 6 hours after the onset of the disease. Results. According to the results of clinical, laboratory and echographic examination, a child with a clinical picture of “acute abdomen” was suspected of an abdominal lymphangioma. For the purpose of the differential diagnosis of a complicated course of the lymphangioma of the abdominal cavity with complicated destructive appendicitis, 2 hours after hospitalization, laparoscopy was performed and there was confirmed lymphangioma of the ileum mesentery, complicated by the twisting of the latter. After elimination of the torsion, a section of the ileum with a tumor was resected with an end-to-end anastomosis. Histologically, the diagnosis of lymphangioma was confirmed. Conclusion. The cause of “acute abdomen” may be the development of complications of the mesenteric lymphangioma. Timely hospitalization of the child in a specialized hospital allows making a diagnosis in a timely manner, select the optimal surgical tactics and prevent life-giving complications

SURGICAL TREATMENT OF ORAL LYMPHANGIOMA IN CHILDREN

A 9-year-old male patient presented a soft well-defined mass in the left border of the tongue, dark red colored, measuring 2.0 x 1.5 cm, with 2 years of evolution. The lesion showed translucent superficial vesicles, creating the appearance of frog eggs. Repeated trauma in the region and aesthetic complaints were reported. The differential diagnoses included lymphangioma and lymphohemangioma. An incisional biopsy was performed and the histopathologic examination showed oral mucosa with numerous subepithelial dilated lymphatic vessels filled with homogeneous eosinophilic material. The diagnosis of lymphangioma was established and the lesion was completely removed surgically with satisfactory healing. After 11 months follow-up, a 1.0 x 0.5 cm nodule with superficial vesicles appeared at the same location. The hypothesis of lymphangioma recurrence was proposed and excisional biopsy was performed. The diagnosis was confirmed by histopathology and the patient is under follow-up, without signs of recurrence after 4 months.

An adult case of lymphangioma of the hepatoduodenal ligament mimicking a hepatic cyst

BackgroundIntra-abdominal lymphangiomas are rare, benign tumors in adults. This report is the third documented case of a lymphangioma originating in the hepatoduodenal ligament that mimicked a simple liver cyst.Case presentationA 50-year-old woman was admitted with a cystic tumor in the right lobe of her liver and underwent laparoscopic excision of the cyst. Operative findings revealed that the cyst had developed in the hepatoduodenal ligament, not in the liver. A small part of the cystic wall remained on the dorsal surface of the hepatoduodenal ligament. Immunohistochemically, the tumor cells stained positive only for D2-40, leading to a diagnosis of lymphangioma (cystic type). Six months later, a cystic tumor recurred and was completely excised via laparotomy. No recurrence was observed after the second operation.ConclusionsThe incomplete excision of the cystic tumor led us to re-operate 6 months after the first operation for the local disease recurrence.

An Interesting Association of Cystic Hygroma of the Neck and Lymphangioma Causing a Paediatric Swollen Tongue.

Up to 75% of lymphatic malformations occur in the head and neck region. Of these, cystic hygromas and lymphangiomas have been widely reported; however they rarely occur in the same patient. We report the case of a 5-year-old girl who presented to the Department of Paediatrics of a district general hospital with a short history of recurrent, painful swelling of the anterior one-third of her tongue. She was reviewed under the joint care of the Oral and Maxillofacial Surgery and Otolaryngology Teams. Relevant past medical history included a previously excised cystic hygroma from her right neck when she was aged 2 years. Diagnosis of lymphangioma was made and of the potential management options available active monitoring was favoured due to the patient's age. To our knowledge the occurrence of both tongue lymphangioma and cystic hygroma has not been previously reported in a paediatric patient. This case report therefore shows a rare association between a cystic hygroma of the neck and lymphangioma of the tongue.