Hemolymphangioma of the transverse mesocolon: a case report and literature review

Abstract

Hemolymphangioma is an extremely rare type of lymphatic and vascular malformation, histologically comprised of both cystic dilated veins and lymphatic vessels. They have been reported to occur in the skin, extremities, pancreas, spleen, mediastinum, as well as in the gastrointestinal tract. A 61-year-old male patient presented with a 2-week history of left lower abdominal and back pain. He had no relevant personal or family past medical history. He denied fever, trauma or weight change, but had noted early satiety with eating. On physical examination, a 10 cm soft, mobile, well-defined, minimally tender mass was palpated in the lower left abdomen. Computed tomography confirmed a large intraperitoneal cystic mass, and resection was advised. The mass was completely excised laparoscopically from the transverse mesocolon. Histopathology verified the diagnosis of hemolymphangioma. The patient recovered uneventfully, and no recurrence was identified at 3 months follow-up. Hemolymphangioma is more common in women and occurs in the fourth to fifth decades of life. The intent of this case report and literature review was to highlight the key aspects of presentation, organ involvement, imaging, histopathological characteristics, and treatment of hemolymphangioma involving the gastrointestinal tract.

Keywords: Case report; hemolymphangioma; transverse mesocolon.

Figure 1

Computed tomography demonstrated a large, cystic, space-occupying lesion (arrow) in the left peritoneal cavity, consistent with a lymphangioma.

Figure 2

Hematoxylin and eosin stained slides of the cystic wall of the hemolymphangioma (H&E staining, ×40). Thin-walled lumens of different sizes were seen in the retinal tissue, which were lined with a single layer of flat epithelium. The lumens contained red blood cells or protein fluid, and lymphocytes. Proliferative lymphatic tissue was seen around some lumens. These findings were consistent with the diagnosis of hemolymphangioma (mesenteric masses).