Observation of Lymphangioma of the Duodenum by a Magnifying Endoscope with a Narrow-Band Imaging System

Abstract

Among duodenal tumors, lymphangioma is relatively infrequent. In this case report, we describe the case of a 65-year-old Japanese man with duodenal lymphangioma diagnosed by esophagogastroduodenoscopy. Endoscopically, the tumor appeared as a soft submucosal tumor with white spots. When the white spots were grasped by biopsy forceps, milky liquid exuded from the tumor. Additionally, observation by a magnifying endoscope with narrow-band imaging revealed elongated microvessels on the surface. We speculated that this feature was formed because the duodenal villi were dilated and the microvessels were stretched due to the retention of chyle. These endoscopic findings are key features in the diagnosis of duodenal lymphangioma.

Clinical manifestation and treatment of small intestinal lymphangioma: A single center analysis of 15 cases

“…Exudation of milky fluid after a biopsy of lymphangioma was also observed in theirs and others' reports (10)(11)(12). Consequently, the endoscopic features may be the consequence of the duodenal villi being dilated and the microvessels being stretched due to the retention of chyle (10).…”

“…Most of our series had the above typical endoscopic manifestations. Iwamuro et al (10) performed magnifying endoscopy to observe duodenal lymphangioma, and elongated microvessels were seen on the surface of the white spots. Exudation of milky fluid after a biopsy of lymphangioma was also observed in theirs and others' reports (10)(11)(12).…”

“…Iwamuro et al (10) performed magnifying endoscopy to observe duodenal lymphangioma, and elongated microvessels were seen on the surface of the white spots. Exudation of milky fluid after a biopsy of lymphangioma was also observed in theirs and others' reports (10)(11)(12). Consequently, the endoscopic features may be the consequence of the duodenal villi being dilated and the microvessels being stretched due to the retention of chyle (10).…”

Narrowed-spectrum Technologies in Endoscopic Imaging of The Upper Gastrointestinal Tract

“…98 The use of NBI in the diagnosis of duodenal lymphangioma and small bowel follicular lymphoma has been described in case reports. 100,101 BLI can enhance features associated with duodenal cancer such as vascular and surface patterns and fatty deposits on the tumor surface. 42 A systematic review and metaanalysis did not show improved delineation or detection rate with the use of FICE in small bowel capsule endoscopy.…”

Pseudo-papillary orifice

“…In this case, we could not histologically diagnose that lesion. However, the excretion of milky fluid was reported in a case of lymphangioma 1 2 , but these are rare. A Brunner’s gland hyperplasia 3 , mucus secreting polyp 4 , and ectopic pancreatic tissue 5 have been known to sometimes have an orifice structure.…”