Giant mesenteric cystic lymphangioma presenting with abdominal pain and masquerading as a gynecologic malignancy

Abstract

Lymphangiomas are congenital malformations of the lymphatic system that account for about 5% of all benign tumors in infants and children.(1) The most common sites are the neck and axilla, which account for 95% of cases.(2) Abdominal cystic lymphangiomas are quite rare, and can arise from either the retroperitoneum, gastrointestinal tract, or the mesentery of the abdominal viscera.(3) The presenting symptoms are painless abdominal distension, a palpable mass, or secondary complications in the abdomen such as intestinal obstruction, volvulus, intestinal infarction, or bleeding.(4) Typically diagnosed during childhood, these tumors prompt surgical intervention. We describe an atypical case of an abdominal cystic lymphangioma, which did not manifest until adulthood, with atypical symptoms of a rapidly expanding and symptomatic mass.

Keywords: cystic lymphangioma; mesenteric lymphangioma; retroperitoneal lymphangioma..

Figure 1

Magnetic resonance image demonstrating the mesenteric cystic lymphangioma. (A) Axial T2-weighted image. White arrow points to the sigmoid colon engulfed by the tumor mass. (B) Sagittal view. White arrow points to the engulfed sigmoid colon.

Figure 2

Gross specimen of resected lymphangioma and adjacent sigmoid colon en bloc.

Figure 3

Immunohistochemical staining of a representative section of the resected specimen using the D2-40 antibody (a marker of lymphatic endothelium).