Imaging diagnosis of mesenteric cystic lymphangioma: a case report in a newborn

Autor: J. C. Valladares Mendías, F. Ramírez-Garrido, J. D. López-González Garrido, C. López-González Garrido, M. A. Mingorance, J. L. Marín Aznar
Rok vydání: 1999
Předmět:
Zdroj: European Radiology. 9:754-754
ISSN: 1432-1084
0938-7994
DOI: 10.1007/s003300050752
Popis: Sir, It is well known that lymphangioma is a congenital cystic tumor of the endothelium which affects development of the vessels of the lymphatic system. The nature of its incidence is not well known, but the head and neck are the locations usually affected ( > 50% of cases), followed by the extremities, trunk, and abdomen [1, 2]; less than 5% are located within the mesentery [3]. We studied a case of a mesenteric cystic lymphangioma observed in the last weeks of gestation. Physical examination revealed palpable abdominal mass in the left flank without abdominal pain. Blood and urine tests did not show abnormalities except for a discrete decrease in creatinine in blood, 0.4 mg/dL (normal: 0.6±1.2 mg/dL), and in the total proteins, 5.7 g/dL (normal: 6.0±8.0 g/dL). From an abdominal US examination a complex cystic hypoechoic subsplenic mass was detected (6 5 cm), anterior to the left kidney, with thin wall and multiple internal septations and lobulations (Fig.1). A CT scan performed without intravenous contrast (the parents did not authorize the intravenous contrast) demonstrated a lobulated cystic lesion with a size of 6 5 6 cm which occupied the left splenorenal space, descending down to the main portion of the left flank. We did not visualize the septa observed on ultrasound (Fig. 2). No solid components or calcification were identified. Surgical removal of the cyst was accomplished at 2 months of age by means of a supraand infraumbilical mean laparotomy, with subsequent histopathologic study. Gross examination of the specimen obtained by surgery revealed an intraperitoneal multicystic gray mass measuring 7 ” 7 ” 5 cm, which presented a whitish serous content that seemed to have originated in the mesentery, to which it was united by means of a pediculum. This multicystic lesion was partially adhered to the tail of the pancreas. In its wall there was an enlargement of 1 cm in diameter, dark-gray coloration, and 3 mm of thickness. Microscopic section of the mass showed a mesenteric multicystic benign lesion of lymphatic origin, with dilated vessels. The spaces of the multicystic lesion are sometimes tapestried by fine endothelium (feebly positive for the factor VIII) on a slightly fibrous wall. The postoperative course elapsed without incident. Twelve hours after the surgical intervention, oral nourishment was restored, which was perfectly tolerated. During this time no feverish episodes were observed, and after 6 months the evolution has been satisfactory. This indicates that the therapy decisions elected, which consisted of the complete surgical resection of the tumoral mass, were satisfactory, although in cases where adhesions are present and the extirpation is difficult to complete, the recurrence index is very low [1].
Databáze: OpenAIRE
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