Mesenteric cystic lymphangioma misdiagnosed as ovarian cyst in a 63-year-old female: A case report and review of literature

Abstract

Introduction: Cystic lymphangioma is rare benign tumor that results from a lymphatic system malformation. The mesenteric location is even more uncommon.

Case report: We report the case of a menopausal 63-year-old woman who presented with a persistent painful well-defined mass of the pelvis. On ultrasound and computed tomography, the mass appeared as thick-walled unilocular homogenous cyst in favor of an ovarian cystadenoma. During laparotomy, the misdiagnosis was confirmed as the tumor was found to be embedded in the mesentery of the ileum. Subsequent histopathological examination confirmed the benign cystic lymphangioma diagnosis.

Discussion: Mesenteric cystic lymphangioma is rare peritoneal tumor of the adult. Clinically, it often masquerades as other abdominopelvic masses like ovarian cysts. Differential diagnosis is often challenging because of the overlapping clinical abdominal presentation and radiological features. Histopathological is the gold standard in diagnosing mesenteric cystic lymphangioma. Surgery is the mainstay treatment, and the recurrence rate is low if negative surgical margins are achieved.

Conclusion: Mesenteric cystic lymphangioma often mimics more frequent and potentially malignant lesions. It is essential for surgeons to remain vigilant for the possibility of this diagnosis when evaluating abdominopelvic cystic masses.

Keywords: Lymphatic malformation; Mesenteric cyst; Ovarian cyst; Surgical resection.

Fig. 1

Ultrasound image showing a purely anechoic, thickened-walled cyst in the left parametrium space, lateral to the uterus (white star), measuring 59x53mm.

Fig. 2

CT scan images at the sagittal (A) and axial (B) planes showing a unilocular cystic formation (white star) above and left to the uterus, rounded with a thick and regular wall, homogeneous.

Fig. 3

Image of the resected mesenteric cystic lymphangioma with the ileum (A), opened (B).