Peripancreatic cystic lymphangioma diagnosed by endoscopic ultrasound/fine-needle aspiration: a rare mesenchymal tumour

Abstract

A 73-year-old man presented with a 5-month history of intermittent nausea, vomiting, central abdominal discomfort and a 17-pound weight loss over the past year. Laboratory testing, including a complete blood count with differential, liver function testing, amylase and lipase studies were normal. A CT scan showed a bilobed cystic lesion inferior to the body of the pancreas. An endoscopic ultrasound revealed a 5.3×3.9 cm, anechoic, bilobed cystic lesion, extrinsic to the body of the pancreas with a 1-2 mm septation and a normal pancreas. Fine-needle aspiration revealed a milky-white aspirate with negative cytology. Laboratory assessment of the cystic aspirant revealed carcinoembryonic antigen 1.7 ng/mL, amylase 148 units/L, cholesterol 300 mg/dL, and carbohydrate antigen 19-9 3 units/mL. He underwent resection of the mass, with the histopathology confirming a diagnosis of peripancreatic lymphangioma. He did well after the surgery with interval resolution of his symptoms.

Figure 1

CT scan of bilobed cystic lesion adjacent to the pancreas.

Figure 2

MRI revealed an extrinsic bilobed cystic lesion with a normal pancreas.

Figure 3

Endoscopic ultrasound revealed a multicystic lesion in the peripancreatic lesion.

Figure 4

Fine needle aspiration of the cyst revealed a milky aspirate.

Figure 5

In apposition to the thin-walled cavernous vascular structures are lymphoid follicles, characteristic of lymphangioma (H&E, low magnification).

Figure 6

(A) Vascular spaces are lined by a single layer of cytologically bland endothelial cells (H&E, high magnification.) (B) Immunostain for podoplanin (D2-40), immunoreactive for D2-40, a lymphatic endothelial marker (high magnification).