Cystic lymphangioma of the hepatoduodenal ligament: a rare intra-abdominal tumor mimicking hematoma
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CASE REPORT
Cystic lymphangioma of the hepatoduodenal ligament: a rare intra‑abdominal tumor mimicking hematoma Aiji Hattori1 · Hiroyuki Inoue1 · Kazunari Kurata1 · Junya Tsuboi2 · Reiko Yamada1 · Yasuhiko Hamada1 · Masaki Katsurahara2 · Kyosuke Tanaka2 · Noriyuki Horiki2 · Yoshiyuki Takei1 Received: 6 July 2020 / Accepted: 15 September 2020 © Japanese Society of Gastroenterology 2020
Abstract A 22-year-old man was referred for upper abdominal pain. Unenhanced computed tomography (CT) revealed a lesion of heterogeneous hypoattenuation, part of which showed slightly high-density in the porta hepatis. On magnetic resonance imaging (MRI), T1-weighted images showed a multiloculated hyperintense mass and part of the mass was hyperintense in T2-weighted images. Abdominal ultrasonography showed a 40 mm multilocular mass with septa, containing solid and small cystic components. In sonazoid-enhanced ultrasonography, the septa were enhanced but the solid components were not. Because of the location of tumor and the findings of CT/MRI, we suspected the lesion as hematoma of the liver. We could not exclude neoplastic disease, such as biliary cystadenoma or cystadenocarcinoma of the liver, so surgical resection was performed. The mass was a multilocular cyst arising from the hepatoduodenal ligament. Pathological examination revealed aggregation of lymph vessels and endothelial-like cells with no atypia, which were positive for the specific markers D2–40 and CD31. The histological diagnosis was abdominal lymphangioma. Intra-abdominal lymphangiomas, which originate from the hepatoduodenal ligament, are extremely rare, benign tumors. We are mindful that lymphangioma should be considered in the differential diagnosis of tumors in the abdominal cavity, mimicking a hematoma of the liver and with a cystic appearance. Keywords Lymphangioma · Hepatoduodenal ligament · Hematoma
Introduction
Case report
Lymphangiomas are rare benign tumors, mainly occurring in children and rarely in adulthood. They usually occur in the neck, head, and axillary region [1]. Intra-abdominal lymphangiomas are rare, accounting for less than 5% of cases (mesentery 70%, omentum 15%, mesocolon 10%, retroperitoneum 5%) [2]. Preoperative diagnosis of lymphangiomas is usually difficult, with only a few reports in which an accurate preoperative diagnosis was made [3]. Herein, we describe a rare adult case of lymphangioma with a cystic appearance, in the abdominal cavity and arising from the hepatoduodenal ligament, mimicking hematoma.
A 22-year-old man was referred for 1 month’s persistent upper abdominal pain with a cystic liver mass. He had a history of asthma and eosinophilic gastroenteritis, but no history of abdominal trauma or abdominal surgery. On admission, physical examination showed normal vital signs. Abdominal examination revealed upper abdominal pain, without rebound tenderness and a huge palpable mass. Laboratory examination revealed no abnormality. Unenhanced abdominal computed tomography (CT) revealed a lesion of heterogeneous hypoattenuation
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