Giant cystic lymphangioma originating from the lesser curvature of the stomach

Abstract

Cystic lymphangiomas are rare benign tumors. Most frequently occurring in children and involving the neck or axilla, these tumors are much less common in adults and very rarely involve the abdomen. The known congenital and acquired (traumatic) etiologies result in failure of the lymphatic channels and consequent proliferation of lymphatic spaces. This case report describes a very rare case of a giant mesenteric cystic lymphangioma in an adult male with no clear etiology and successful resolution by standard radical resection. A previously healthy 44-year-old male presented with a 6-wk history of progressive upper abdominal pain, vomiting, anorexia and unintentional weight loss accompanied by rapid abdominal distension. A palpable mass was detected upon physical examination of the distended abdomen and abdominal computed tomography scan showed a giant multilobulated cystic process, measuring 40 cm in diameter. Exploratory laparotomy revealed an enormous cystic mass containing 6 L of serous fluid. The process appeared to originate from the lesser omentum and the lesser curvature of the stomach. Radical resection of the tumor was performed along with a partial gastrectomy to address potential invasion into the adjacent tissues. Histological analysis confirmed the diagnosis of a multicystic lymphangioma. The postoperative recovery was uneventful and the patient was discharged after 6 d. At 3-mo follow-up, the patient was in good health with no signs of recurrence.

Keywords: Abdominal distension; Abdominal pain; Cystic process; Mesentery; Multicystic lymphangioma.

Figure 1

Abdominal computed tomography-scan revealing an enormous cystic process.

Figure 2

First view after midline incision.

Figure 3

Status after radical resection with partial gastrectomy.

Figure 4

Resected cystic process with near complete fluid drainage.

Figure 5

Microscopic view of specimen, depicting various lymphatic spaces (hematoxylin-eosin stain, x 100).

Figure 6

Endothelial lining of cysts (CD31 immunostain, x 400).