An Unusual Cause of Acute Abdomen in Adults: Giant Cystic Lymphangioma of the Pancreatic Head. A Clinical Case and Literature Review

  • Supriyo Ghatak Division of Surgical Gastroenterology, School of Digestive and Liver Diseases, Institute of Postgraduate Medical Education and Research, SSKM Hospitals. Kolkata, India
  • Sukanta Ray Division of Surgical Gastroenterology, School of Digestive and Liver Diseases, Institute of Postgraduate Medical Education and Research, SSKM Hospitals. Kolkata, India
  • Sumit Sanyal Division of Surgical Gastroenterology, School of Digestive and Liver Diseases, Institute of Postgraduate Medical Education and Research, SSKM Hospitals. Kolkata, India
  • Pankaj Kr Sonar Division of Surgical Gastroenterology, School of Digestive and Liver Diseases, Institute of Postgraduate Medical Education and Research, SSKM Hospitals. Kolkata, India
  • Sujan Khamrui Division of Surgical Gastroenterology, School of Digestive and Liver Diseases, Institute of Postgraduate Medical Education and Research, SSKM Hospitals. Kolkata, India
  • Keya Basu Division of Gastrointestinal Pathology, School of Digestive and Liver Diseases, Institute of Postgraduate Medical Education and Research, SSKM Hospitals. Kolkata, India
  • Sujay Ray Division of Medical Gastroenterology, School of Digestive and Liver Diseases, Institute of Postgraduate Medical Education and Research, SSKM Hospitals. Kolkata, India
  • Kshaunish Das Division of Medical Gastroenterology, School of Digestive and Liver Diseases, Institute of Postgraduate Medical Education and Research, SSKM Hospitals. Kolkata, India
Keywords: Abdomen, Acute, Lymphangioma, Pancreas, Pancreaticoduodenectomy

Abstract

Context Cystic lymphangioma of the pancreas presenting as acute abdomen in adults has not been reported before. Case report We report the case of a young man who presented with severe pain in the upper abdomen and abdominal swelling. On imaging, he was found to have a giant multiseptate cystic lesion occupying almost the entire abdomen anterior to the pancreas. On exploration, a cystic mass involving the head of the pancreas and densely adherent to the antrum, and the second and third parts of the duodenum was found and a classic Whipple pancreaticoduodenectomy was done. Histology revealed a diagnosis of cystic lymphangioma. Conclusion Cystic lymphangioma is a rare benign tumor of the pancreas and this is the first reported case in an adult presenting with acute abdomen. Though rarely diagnosed preoperatively, this entity should also be considered in the differential diagnosis of cystic lesions of the pancreas. Complete surgical excision is curative.

Image: Operative photograph showing the tumor.

Downloads

Download data is not yet available.

References

Casadei R, Minni F, Selva S, Marrano N, Marrano D. Cystic lymphangioma of the pancreas: anatomoclinical, diagnostic and therapeutic considerations regarding three personal observations and review of the literature. Hepatogastroenterology 2003; 50:1681-6. [PMID 14571816]

Colovic RB, Grubor NM, Micev MT, Atkinson HD, Rankovic VI, Jagodic MM. Cystic lymphangioma of the pancreas. World J Gastroenterol 2008; 14:6873-5. [PMID 19058318]

de Perrot M, Rostan O, Morel P, Le Coultre C. Abdominal lymphangioma in adults and children. Br J Surg 1998; 85:395-7. [PMID 9529502]

Goh BK, Tan YM, Ong HS, Chui CH, Ooi LL, Chow PK, et al. Intra-abdominal and retroperitoneal lymphangiomas in pediatric and adult patients. World J Surg 2005; 29:837-40. [PMID 15951926]

Khandelwal M, Lichtenstein GR, Morris JB, Furth EE, Long WB. Abdominal lymphangioma masquerading as a pancreatic cystic neoplasm. J Clin Gastroenterol 1995; 20:142-4. [PMID 7769196]

Kullendorff CM, Malmgren N. Cystic abdominal lymphangioma in children. Case report. Eur J Surg 1993;159: 499-501. [PMID 8274560]

Leung TK, Lee CM, Shen LK, Chen YY. Differential diagnosis of cystic lymphangioma of the pancreas based on imaging features. J Formos Med Assoc 2006; 105: 512-7. [PMID 16801041]

Lyngdoh TS, Konsam R, Th B, Marak B. Giant cystic lymphangioma of pancreas. ANZ Journal of Surgery 2008 ;78:673-4. [PMID 18796026]

Gray G, Fried K, Iraci J. Cystic lymphangioma of the pancreas: CT and pathologic findings. Abdom Imaging 1998; 23: 78-80. [PMID 9437068]

Nobuhara Y, Onoda N, Fukai K, Hosomi N, Ishii M, Wakasa K, et al. TIE2 gain-of-function mutation in a patient with pancreatic lymphangioma associated with blue rubber-bleb nevus syndrome: report of a case. Surg Today 2006; 36:283-6. [PMID 16493543]

Gui L, Bigler SA, Subramony C. Lymphangioma of the pancreas with 'ovarian-like' mesenchymal stroma: a case report with emphasis on histogenesis. Arch Pathol Lab Med 2003; 127:1513-6. [PMID 14567749]

Igarashi A, Maruo Y, Ito T, Ohsawa K, Serizawa A, Yabe M, et al. Huge cystic lymphangioma of the pancreas: Report of a case. Surg Today 2001; 31:743-6. [PMID 11510617]

Fahimi H, Faridi M, Gholamin S, Molanaee S, Khorsandi M. Cystic lymphangioma of the pancreas: diagnostic and therapeutic challenges. JOP. J Pancreas (Online) 2010; 11:617-9. [PMID 21068498]

Paal E, Thompson LD, Heffess CS. A clinicopathologic and immunohistochemical study of ten pancreatic lymphangiomas and a review of the literature. Cancer 1998; 82:2150-8. [PMID 9610694]

Hanelin LG, Schimmel DH. Lymphangioma of the pancreas exhibiting an unusual pattern of calcification. Radiology 1977; 122:636. [PMID 841038]

Shinozaki K, Yoshimitsu K, Honda H, Kuroiwa T, Irie H, Aibe H, et al. Abdominal cystic tumors containing small amount of fat in the septa: report of two cases. Abdom Imaging 2001; 26:315-8. [PMID 11429962]

Ferrozzi F, Zuccoli G, Bova D, Calculli L. Mesenchymal tumors of the pancreas: CT Findings. J Comput Assist Tomogr 2000; 24:622-7. [PMID 10966199]

Schneider G, Seidel R, Altmeyer K, Remberger K, Pistorius G, Kramann B, Uder M. Lymphangioma of the pancreas and the duodenal wall: MR imaging findings. Eur Radiol 2001; 11:2232-5. [PMID 11702164]

Applebaum B, Cunningham JT. Two cases of cystic lymphangioma of the pancreas: a rare finding in endoscopic ultrasonography. Endoscopy 2006; 38(Suppl. 2):E24-5. [PMID 17366391]

Barresi L, Tarantino I, Curcio G, Mocciaro F, Catalano P, Spada M, Traina M. Pancreatic cystic lymphangioma in a 6-year-old girl, diagnosed by endoscopic ultrasound (EUS) fine needle aspiration. Endoscopy 2011; 43(Suppl. 2):E61-2. [PMID 21287455]

Operative photograph showing the tumor
Published
2011-05-06
How to Cite
GhatakS., RayS., SanyalS., SonarP., KhamruiS., BasuK., RayS., & DasK. (2011). An Unusual Cause of Acute Abdomen in Adults: Giant Cystic Lymphangioma of the Pancreatic Head. A Clinical Case and Literature Review. JOP. Journal of the Pancreas, 12(3), 266-270. https://doi.org/10.6092/1590-8577/3295
Section
CASE REPORT