Pleural-Based Intrathoracic Cystic Lymphangioma in an Infant Mimicking a Pneumonia

Abstract

Cystic lymphangioma is an uncommon benign tumor that occurs primarily in children in the cervical region. We report the first case of a pleural-based cystic lymphangioma in an infant. The patient was admitted for RUL pneumonia. Because of the persistence of the radiographic findings despite clinical improvement, a computed tomography (CT) and a magnetic resonance imaging (MRI) scan were performed. They showed a multiloculated cystic lesion in the superior posterior right hemithorax. A surgical procedure was performed with complete resection of the tumor. Histopathological examination showed a pleural-based intrathoracic multicystic lymphangioma. One year after the surgery, the patient feels well without any sign of recurrence.

Figure 1

Chest X-ray: RUL infiltration and enlarged intercostal space in level T6-T7 on the same side.

Figure 2

Contrast enhanced computed tomography (CT): a large multicystic lesion in the right hemithorax with mediastinal shifting. The bronchus and azygous are not affected.

Figure 3

Magnetic resonance imaging (MRI): insinuating multiloculated cystic lesion. (a) Small extrapleural extensions of the cystic mass superiorly and laterally. (b) The mass bulges in the posterior intercostal spaces, without neuroforaminal involvement. (c) Posterior intercostal bulging, with no neuroforaminal involvement, and hilar structures are not compressed.

Figure 4

Perioperative picture showing intrathoracic cystic lymphangioma.

Figure 5

Microscopic features of the cyst (H&E staining). (a) Panoramic view of the multicystic tumor (original magnification ×12.5). (b) Proteinatious fluid and small lymphocytes in the lumen (original magnification ×40).

Figure 6

Immunohistochemical findings. (a) The cells lining the inner surface of the cystic lesion are positive for D2-40 staining, expressed in lymphatic endothelium (original magnification ×12.5). (b) The cells lining the outer surface of the cystic lesion are positive for calretinin staining, expressed in mesothelial cells (original magnification ×12.5).