Cystic lymphangioma of the head and tail of the pancreas in a middle-aged Iranian woman: A case report

Abstract

Introduction: Lymphangioma is a benign neoplasm that involves the lymphatic vessels in multiple anatomical regions, including the pancreas, where it is exceptionally rare, with a prevalence of only 0.2 %. These tumors, often found in children, are uncommon in adults and may present with symptoms like abdominal pain, distention, and nausea. Many cases are asymptomatic and discovered incidentally during imaging studies. A definitive diagnosis is achieved through pathological examination following a biopsy. This report details a rare instance of pancreatic lymphangioma in a 58-year-old Iranian woman experiencing acute abdominal symptoms.

Case presentation: A 58-year-old woman presented with acute abdominal pain, nausea, and vomiting, ultimately diagnosed with pancreatic lymphangioma. She underwent exploratory laparotomy, resulting in the successful excision of a cystic mass from the pancreas. Histopathological examination confirmed the diagnosis. This case emphasizes the necessity of considering pancreatic lymphangioma in the differential diagnosis of acute abdominal pain in adults, where it is less frequently encountered. Ultrasonography and CT scans played pivotal roles in the diagnosis, while surgical excision remains the gold standard for both diagnosis and treatment. Physical examination revealed left upper quadrant tenderness and a large palpable mass. Laboratory tests ruled out acute pancreatitis or myocardial infarction.

Discussion: Pancreatic lymphangiomas are exceedingly rare and often asymptomatic. When symptomatic, they can present with acute abdominal pain and other gastrointestinal disturbances. The etiology may relate to congenital malformations or inflammatory processes affecting lymphatic vessels. The case highlights the necessity of including pancreatic lymphangioma in differential diagnoses for abdominal pain in adults, despite its rarity. While ultrasonography remains a primary diagnostic modality, CT and MRI are invaluable for providing comprehensive evaluations of cystic lesions. Magnetic resonance cholangiopancreatography (MRCP) can assist in distinguishing lymphangiomas from other cystic lesions, although it may not always yield definitive results without further invasive procedures like endoscopic ultrasound-guided fine needle aspiration (EUS-FNA).

Conclusion: This case contributes to the limited literature on pancreatic lymphangioma in adults and highlights the need for further research to develop standardized medical approaches for managing this rare condition. The findings suggest that while pancreatic lymphangiomas are benign, they should be included in differential diagnoses for pancreatic cystic lesions, given their potential for causing significant symptoms.

Keywords: Acute abdominal pain; Case report; Cystic lymphangioma; Pancreas; Pancreatic cyst.

Fig. 1

A huge cystic lobulated structure is noted in the pancreas through CT-Scan.

Fig. 2

Cystic Mass Located in The Patient's Pancreas Was Successfully Excised Via an Exploratory Laparotomy Procedure.

Fig. 3

Histopathological examination of the cystic Lymphangioma revealed dilated lymphatic spaces lined by endothelial cells, characteristic of this benign vascular malformation. Additionally, the presence of lymphoid aggregates within the cyst wall supported the diagnosis.