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Na, Lee, Lee, Kim, Chae, Kim, Kim, Kim, Im, Huh, Choi, and Kang: Clinical Aspects of Intraabdominal Cystic Lymphangioma in Korea
Original Article

Korean J Gastroenterol 2010;56(6):353-358.

Published online: 21 February 2010

DOI: https://doi.org/10.4166/kjg.2010.56.6.353

Clinical Aspects of Intraabdominal Cystic Lymphangioma in Korea

Woon-Tae Na, M.D., Tae-Hee Lee, M.D., Byung-Seok Lee, M.D.∗, Seok-Hyun Kim, M.D.∗, Hee-Bok Chae, M.D.†, Seok Bae Kim, M.D.‡, Yong-Seok Kim, M.D., Sun-Moon Kim, M.D., Euyi-Hyeog Im, M.D., Kyu-Chan Huh, M.D., Young-Woo Choi, M.D., Young-Woo Kang, M.D.

Department of Internal Medicine, Konyang University College of Medicine, Daejeon, Korea

∗Chungnam National University College of Medicine, Daejeon, Korea

†Chungbuk National University College of Medicine, Cheongju, Korea

‡Dankook University College of Medicine, Cheonan, Korea

Correspondence to: Tae-Hee Lee, M.D. Department of Internal Medicine, Konyang University College of Medicine, 685 Gasoowon-dong, Seo-gu, Daejeon 302-718, Korea Tel: +82-42-600-9370, Fax: +82-42-600-9090 E-mail: green740@naver.com

Received 13 July 2010       Accepted 9 September 2010

Copyright © 2010 The Korean Journal of Gastroenterology

Abstract

Background/Aims

Cystic lymphangioma is an uncommon disease, and rarely develops in the intraabdomen. The aim of this article was to discuss about clinical characteristics of intraabdominal cystic lymphangioma developed in Korea.

Methods

Age, sex, symptoms, locations and size of the lesions, diagnostic methods, treatments, complications and recurrence were analyzed in 13 pathologically confirmed cases of intraabdominal cystic lymphangioma and 18 cases of literature consideration reported in Korea.

Results

Intraabdominal cystic lymphangioma commonly developed in adults compared to the other lymphangioma, and frequently located in the mesentery. Abdominal pain was the most common symptom, but it was a non-specific finding. Tenderness and abdominal mass were not significantly associated. The size of mass was diverse. Abdominal ultrasonography and abdominal CT were diagnostic tools most commonly used, but preoperative diagnosis was possible only in 22.6%. All patients were discharged without any complications, and no recurrence was reported.

Conclusions

Preoperative diagnosis of intraabdominal cystic lymphangioma is difficult and symptoms and signs are not specific. Intraabdominal cystic lymphangioma should be suspected in patients with non specific abdominal pain and intraabdominal mass and active diagnostic evaluation is mandatory.

Keywords: Lymphangioma, Cystic, Abdominal cavity

REFERENCES

1. Rieker RJ, Quentmeier A, Weiss C, et al. Cystic lymphangioma of the small-bowel mesentery: case report and a review of the literature. Pathol Oncol Res. 2000; 6:146–148.
2. Roisman I, Manny J, Fields S, Shiloni E. Intraabdominal lymphangioma. Br J Surg. 1989; 76:485–489.
crossref
3. Takiff H, Calabria R, Yin L, Stabile BE. Mesenteric cysts and intraabdominal cystic lymphangiomas. Arch Surg. 1985; 120:1266–1269.
crossref
4. Losanoff JE, Richman BW, El-Sherif A, Rider KD, Jones JW. Mesenteric cystic lymphangioma. J Am Coll Surg. 2003; 196:598–603.
crossref
5. Jun GH, Kim NH, Jun BC, Bae JM, Bae JD, Jung KH. Duodenal lymphangioma. J Korean Surg Soc. 2004; 67:160–162.
6. Hwang DY, Hwang WY, Kim JC, et al. Cystic lymphangioma of the colon. Ulsan Univ Med J. 1992; 1:206–211.
7. Barrand KG, Freeman NV. Massive infiltrating cystic hy-groma of the neck in infancy. Arch Dis Child. 1973; 48:523–531.
crossref
8. Mayer M, Fartab M, Villiger A, Yurtsever H. Cystic lymphangioma of the transverse mesocolon. Chirurg. 1994; 65:561–563.
9. Tsukada H, Takaori K, Ishiguro S, Tsuda T, Ota S, Yamamoto T. Giant cystic lymphangioma of the small bowel mesentery: report of a case. Surg Today. 2002; 32:734–737.
crossref
10. Aneiros J, Pleguezuelos J, Garcia del Moral R, Caballero T, Rodrigo M, Salido E. Lymphangioma of the duodenum: an ultrastructural study. Endoscopy. 1986; 18:245–248.
crossref
11. Koshy A, Tandon RK, Kapur BM, Rao KV, Joshi K. Retroperitoneal lymphangioma. A case report with review of the literature. Am J Gastroenterol. 1978; 69:485–490.
12. Weiss SW, Goldblum JR, Enzinger FM. Enzinger and Weiss's soft tissue tumors. 4th ed.St. Louis: Mosby;2001.
13. Iyer R, Eftekhari F, Varma D, Jaffe N. Cystic retroperitoneal lymphangioma: CT, ultrasound and MR findings. Pediatr Radiol. 1993; 23:305–306.
crossref
14. Vargas-Serrano B, Alegre-Bernal N, Cortina-Moreno B, Rodriguez-Romero R, Sanchez-Ortega F. Abdominal cystic lymphangiomas: US and CT findings. Eur J Radiol. 1995; 19:183–187.
crossref
15. Saba C, Bossi MC, Barletta A. Therapy of subcutaneous cystic lymphangioma with ultrasound-guided puncture and alcoholization. Radiol Med. 1992; 83:270–272.
16. Hancock BJ, St-Vil D, Luks Fl, Di Lorenzo M, Blanchard H. Complications of lymphangiomas in children. J Pediatr Surg. 1992; 27:220–224.
crossref
17. Okada A, Kubota A, Fukuzawa M, Imura K, Kamata S. Injection of bleomycin as a primary therapy of cystic lymphangioma. J Pediatr Surg. 1992; 27:440–443.
crossref
18. Castañó n M, Margarit J, Carrasco R, Vancells M, Albert A, Morales L. Longterm follow-up of nineteen cystic lymphangiomas treated with fibrin sealant. J Pediatr Surg. 1999; 34:1276–1279.
19. Ogita S, Tsuto T, Nakamura K, Deguchi E, Tokiwa K, Iwai N. OK-432 therapy for lymphangioma in children: why and how does it work? J Pediatr Surg. 1996; 31:477–480.
crossref
20. Choi SO, Park WH, Hong SP. Cystic lymphangioma of the mesentery. J Korean Surg Soc. 1987; 32:489–495.
21. Choi HH, Lim JS, Kim HR, et al. Jejunal lymphangioma with recurrent bleeding in a renal transplant recipient. J Korean Surg Soc. 2006; 70:83–86.
22. Jang YS, Yoo H, Shim CS, Jin SY. A case of cystic lymphangioma of colon. Korean J Gastroenterol. 1992; 24:637–640.
23. Hwang JK, Kim KH, Seo HJ, et al. Splenic lymphangioma of the spleen in an elderly patient. J Korean Surg Soc. 2005; 68:74–77.
24. Ahn SH, Min PC, Park KC, Kim SH, Lee GH, Lee IC. Cystic lymphangioma of the spleen. Korean J Gastroenterol. 1991; 23:282–286.
25. Kim JJ, Lee YS, Lee KH, et al. Cystic lymphangioma of the spleen. J Korean Surg Soc. 2006; 70:158–160.
26. Kim CJ, Yun HR, Choi MG, Noh JH, Sohn TS, Kim S. Lymphangioma of the small intestine with chronic gastrointestinal bleeding. J Korean Surg Soc. 2006; 70:478–481.
27. Kim HA, Min SK, Lee JH. Colonic lymphangiomatosis with normal colonoscopic finding in an adult. J Korean Surg Soc. 2007; 73:514–516.
28. Kim SH, Noh SH, Min JS, Whang YN, Choi KS. A case of duodenal mesenteric cystic lymphangioma. Korean J Gastroenterol. 1988; 20:177–181.
29. Nam-Koong Y, Kim LS, Lee BH, et al. A case of huge cystic lymphangioma of the greater omentum. J Korean Surg Soc. 1997; 53:444–449.
30. Kim YS, Jang SH, Shim BS, Kwon SW, Gu HS. A case of retroperitoneal cystic lymphangioma. Ewha Med J. 1995; 18:153–155.
crossref
31. Kim TY. Lymphangioma of the pancreas. J Soonchunhyang Med Coll. 2004; 10:1589–1692.
32. Kim HC, Yoon C, Kim YW, Yang MH. Submucosal lymphangioma of the stomach. J Korean Surg Soc. 1994; 46:741–744.
33. Lee KJ, Kim SJ, Lee SC, et al. Mesenteric cystic lymphangioma with traumatic hemorrhage. J Korean Surg Soc. 2008; 74:146–149.
34. Park HS, Lee H, Moon WS, Lee SC, Choi WB, Choi HW. Intussusception secondary to jejunal lymphangioma in a 13-year-old girl. Korean J Gastroenterol. 2007; 49:256–259.

Fig. 1.
Schematic diagrammatic drawing depicting four types of mesenteric cystic lymphangiomas (MCL) (Adopted from reference 4). 1) Type 1 is a pedicled MCL. 2) Type 2 is a sessile MCL located in the mesenteric boundaries. 3) Type 3 is an MCL with retroperitoneal extension. 4) Type 4 describes multi-centric MCLs.
kjg-56-353f1.tif
Table 1.
Summary of 13 Cases
No. Age/Sex Symptom Preoperative diagnosis Site of lesion Size (cm)
1 4/M Abdominal discomfort Neuroblastoma Omentum 15
2 5/M Abdominal pain Omental cyst Omentum 8
3 6/F Abdominal pain Mesenteric cyst Mesentery 16
4 7/F Abdominal pain Intabdominal cyst Omentum 6.5
5 8/M Abdominal pain Mesenteric cyst Mesentery 12
6 28/F Indigestion Retroperitoneal lymphangioma Mesentery 5
7 30/F Abdominal pain Small bowel volvulus Mesentery 9
8 46/M No Lymphangioma Omentum 10
9 53/F Abdominal pain Omental cyst Omentum 12
10 57/M No Mesenteric cystic lymphangioma Mesentery 1.5
11 63/F Abdominal discomfort R/O appendicitis Mesentery 8
12 68/F Abdominal pain Retroperitoneal mass Mesentery 6.5
13 73/M Abdominal pain Lymphangioma Omentum 5
Table 2.
Summary of 18 Cases (Literature Review)
Ref.∗ Age/Sex Symptom Preoperative diagnosis Site of lesion Size (cm)
5 45/F Abdominal discomfort Duodenal mass Duodenum 2
6 69/F Hematochezia Colon adenoma Colon 3
20 0/M Vomiting Intraabdominal cyst Mesentery 3.5
20 5/M Abdominal pain Intraabdominal cyst Mesentery 15
21 53/M Dizziness, anemia SMT in jejunum Jejunum 6
22 42/M Abdominal discomfort SMT in colon Mesentery 2.5
23 65/F Abdominal pain Spleen lymphangioma Spleen 13
24 40/F General weakness Spleen lymphangioma Spleen 13
25 44/F Abdominal discomfort Spleen lymphangioma Spleen 18
26 40/F Anemia UGI bleeding Jejunum 0.3
27 40/F Abdominal pain Abdominal cyst Mesentery 2
28 49/M Abdominal pain Pancreatic cystic tumor Mesentery 7
29 14/M Abdominal discomfort Intraabdominal cyst Omentum 19
30 42/F Abdominal pain Retroperitoneal cyst Retroperitoneum 10
31 48/F Abdominal discomfort Abdominal mass Pancreas tail 20
32 63/M Abdominal discomfort SMT in stomach Stomach 5
33 16/M Abdominal pain Mesenteric hematoma Mesentery 8
34 13/F Abdominal pain Intussusceptions Mesentery 3

  Ref., reference; SMT, submucosal tumor; UGI, upper gastrointestinal.

∗ Reference number.

Table 3.
Site of Lesion
Site Number (%)
Mesentery 14 (45.2)
Omentum 7 (22.6)
Bowel wall 5 (16.1)
Jejunum 2
Stomach 1
Duodenum 1
Colon 1
Spleen 3 (9.7)
Retroperitoneum 1 (3.2)
Pancreas 1 (3.2)
Total 31 (100)
Table 4.
Diagnostic Modalities
Method Number (%)
Ultrasonography 20 (64.5)
Computed tomography 24 (77.4)
Endoscopy 2 (6.5)
Magnetic resonance imaging 1 (3.2)
Table 5.
Type of Mesentery Origin Cystic Lymphangioma
Type Number (%)
Type 1 (Pedicled) 2 (28.5)
Type 2 (Sessile) 1 (14.3)
Type 3 (Retroperitoneal extension) 3 (42.9)
Type 4 (Multicentric) 1 (14.3)
Total 7 (100)
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