Asymptomatic lymphangioma involving the spleen and retroperitoneum in adults

Abstract

Lymphangioma, a benign neoplasm of the lymphatic system, is common in children but rare in adults. Its clinical manifestations include abdominal pain, nausea, vomiting and a palpable mass. However, abdominal sonography or abdominal computed tomography (CT) scan can also incidentally reveal lymphangioma. A larger or symptomatic lymphangioma is treated with total resection to prevent recurrence, infection, torsion and enlargement. Although lymphangioma rarely becomes malignant, its prognosis is generally good. We report a cystic lymphangioma of the spleen and retroperitoneum, which was incidentally found in a 56-year-old man who was hospitalized due to a colon mass. Physical examination showed no specific findings. Abdominal CT revealed a 5.7 cm, non-enhanced multilobulated cystic mass with multiple septa in the spleen and a 10 cm lobulated cystic mass in the paraaortic area. Splenectomy and retroperitoneal resection of the cystic mass were conducted. The endothelium of splenic and retroperitoneal cyst was immunohistochemically stained with D2-40 antibody. The patient was finally diagnosed with splenic cystic and retroperitoneal cavernous lymphangioma.

Figure 1

Enhanced abdominal CT and F-18 FDG Torso PET CT images of lymphangioma. A: A 5.7 cm lobulated & septated mass without enhancement in the spleen (white arrow); B: A 10 cm lobulated cystic mass in the paraaortic area (white arrow); C: A hypermetabolic lesion in the sigmoid colon mass (white arrow) and maxSUV 23 but no hypermetabolic lesion in the spleen and retroperitoneum.

Figure 2

Gross and microscopic images of splenic lymphangioma. A: A 4.5 cm × 3.5 cm bulging cystic mass in lower pole; B: HE staining of splenic lymphangioma, × 20; C: Immunostaining with D2-40 antibody (× 200) for cystic lining cells.

Figure 3

Gross and microscopic images of retroperitoneal lymphangioma. A: A 4.5 cm × 4.5 cm × 2.5 cm retroperitoneal mass; B: HE staining of retroperitoneal lymphangioma, × 20; C: Immunostaining with D2-40 antibody (× 200) for cystic lining cells.