Lymphangioma of the pancreas and the duodenal wall: MR imaging findings

Abstract

Pancreatic lymphangiomas are rare benign tumours with a histogenesis not yet completely understood. Predominantly the cystic aspect of this lesion can complicate the differentiation from other neoplastic and non-neoplastic cystic tumours of the pancreas. We present a case of a middle-aged woman with a lymphangioma involving the duodenal wall and the pancreatic head. With special regard to MR imaging findings differential diagnosis is discussed.

Retroperitoneal lymphangioma: A report of 2 cases and a review of the literature regarding the differential diagnoses of retroperitoneal cystic masses

“…According to the most popular theory, these lymphangiomas develops from a congenital malformation of the lymphatic channels that dilates, resulting in the formation of uni-or multi-cystic masses. The malformation appears to arise from sequestration of lymphatic tissue that fails to communicate with lymphatic flow, or from developmental defects during the embryological life stage of the patient, which results from the abnormal budding of the lymphatic endothelium (7,8). However, a pathogenesis associated with abdominal trauma, inflammation due to obstruction of the lymphatic system and radiation therapy have also been suggested as promoting the secondary development of these tumors (9).…”

Cystic lymphangioma of the pancreas

“…Differential diagnoses include pancreatic pseudocysts, mucinous and serous cystadenomas, other congenital cysts and pancreatic ductal carcinoma with cystic degeneration [1,13,14] . The final diagnosis is histological [1] , with the endothelial cells showing immunohistochemical reactivity to factor VIII/R antigen, CD 31 (+) positivity [6,8] and CD 34 (-) negativity [6] , as seen in our patient.…”

Complex pancreatic vascular anomalies in children

“…Resection is also indicated when malignancy cannot be excluded. In some cases, the malformation can invade surrounding structures (ie, duodenum, stomach, spleen, and kidney) necessitating a larger operation [8,9,29]. Intralesional sclerotherapy with agents such as ethanol, OK-432, and doxycycline can be performed for macrocystic lesions near the pancreas, although caution must be exercised in treating lesions within the gland.…”

“…Patients present with a smattering of symptoms including abdominal pain (acute or chronic), biliary obstruction, intestinal obstruction, and gastrointestinal bleeding (from pressure necrosis of the duodenum, duodenal ulceration, hemobilia, or intraductal hemorrhage) [4][5][6][7][8][9][10][11]. Signs and symptoms of portal hypertension may also be evident [12].…”