Retroperitoneal lymphangioma with a duodenal lesion in an adult

Abstract

A multilocular-cystic and cavernous, retroperitoneal tumor was found in a 40-year-old man whose past medical history was unremarkable. On admission, he complained of a large and still growing intra-abdominal mass associated with dull pain and a low-grade fever. Laboratory findings revealed leukocytosis and C-reactive protein elevation, compatible with inflammation of the tumor. Percutaneous aspiration of the tumor was performed under transabdominal ultrasonographic guidance, and continuous drainage of fluid from within the tumor ameliorated his symptoms. From preoperative examinations, including radiological imaging, fluid aspiration, and endoscopy with biopsy, a diagnosis of retroperitoneal lymphangioma was made. Laparotomy revealed extensive adhesions between the tumor and both the duodenum and the pancreatic head. A pancreaticoduodenectomy was therefore performed. At 3-year follow-up, there was no sign of recurrence. Retroperitoneal lymphangioma is an uncommon disorder, and the cavernous type is extremely rare. The duodenal lesion was an important feature of the present case, and endoscopic biopsy of this lesion facilitated precise preoperative diagnosis of retroperitoneal lymphangioma.

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

“…White-colored spots on the surface have been reported in previous case reports [4, 5, 6] as well as in our case. In the present case, white liquid material flowed from the tumor when the white spots were grasped by biopsy forceps.…”

“…Macroscopically, duodenal lymphangiomas appear as submucosal tumors [4, 5, 6, 7, 8]. White-colored spots on the surface have been reported in previous case reports [4, 5, 6] as well as in our case.…”

“…Most lymphangiomas arise in the neck and axilla; the gastrointestinal tract is relatively infrequently affected [1, 2, 3]. Although the macroscopic features of duodenal lymphangioma are known as submucosal tumors with white-colored spots [4, 5, 6, 7, 8], magnifying endoscopic images have never been reported. In this paper, we describe a case of duodenal lymphangioma observed by a magnifying endoscope with a narrow-band imaging system.…”

Single-Centre Results of Treatment of Retroperitoneal and Mesenteric Cystic Lymphangiomas

“…Retroperitoneal cystic lymphangiomas sometimes had a close relationship to visceral organs. Fujishiro et al [13] reported a patient with a retroperitoneal lymphangioma with dense duodenal adhesion which necessitated pancreaticoduodenectomy. However, the patients in our study showed no retroperitoneal visceral organ invasion.…”

Colonic lymphangiomatosis associated with anemia

“…Lymphangioma, a benign tumor of lymphatics, rarely occurs in the abdomin, and most of them arise in the mesentery, omentum, mesocolon and retroperitoneum [6][7][8][9] . The incidence of lymphangioma in the intestinal wall is very low, and few cases of multiple colonic lymphangioma have been reported [1][2][3][4] .…”