Case Report: Giant mesenteric hemolymphangioma enveloping the ileum

Abstract

Hemolymphangiomas are rare, benign tumors arising from lymphatic and vascular tissues, most commonly found in subcutaneous and soft tissues, with their occurrence in the gastrointestinal tract, especially the mesentery, being uncommon. Due to their heterogeneous imaging features, these tumors are often misdiagnosed as malignancies, particularly when located in the abdominal cavity. We report a case of a 16-year-old male presenting with abdominal pain, vomiting, and diarrhea for 7 days. Imaging revealed a large, heterogeneous mass in the right lower abdomen, initially suspected to be a malignant mesenteric tumor. An ultrasound-guided biopsy and immunohistochemistry confirmed the diagnosis of hemolymphangioma. The patient underwent a combined laparoscopic and open surgical approach, including en bloc resection of the tumor, along with a segment of the ileum and surrounding mesentery. Histopathological examination verified the presence of lymphatic and vascular components consistent with hemolymphangioma. The patient recovered uneventfully and showed no recurrence at a 3-month follow-up. Hemolymphangiomas, although rare, should be considered in the differential diagnosis of mesenteric tumors.

Keywords: abdominal mass; case report; gastrointestinal involvement; hemolymphangioma; laparoscopic surgery.

Figure 1

Contrast-enhanced CT and 3D reconstruction: (A) Coronal view showing a right lower abdominal mass originating from the mesentery. (B) Coronal 3D vascular reconstruction showing the tumor’s blood supply from the superior mesenteric artery. (C) Axial view showing the tumor encasing and invading the ileum. (D) Axial 3D reconstruction showing ileal involvement.

Figure 2

PET/CT imaging showing an irregular soft tissue mass in the mesenteric region of the right lower abdomen and pelvis. The lesion exhibits well-defined margins with mildly increased FDG uptake.

Figure 3

(A) Intraoperative exposure of the tumor during open surgery. (B) The completely resected tumor measuring 18 × 10 × 8 cm.

Figure 4

Histopathological examination and immunohistochemistry: (a) Hematoxylin and eosin staining (50×) showing predominantly lymphatic channels (green arrow) with vascular components (red arrow). (b) Hematoxylin and eosin staining (100×) revealing prominent vascular hemorrhage (red arrow). (c) Immunohistochemical staining(100×) demonstrating lymphatic channels positive for D2-40. (d) Immunohistochemical staining (100×) demonstrating vascular structures positive for CD34.