Nabhan Ayman I, Sabouni Rami H E, Khaddour Majd S, Mohamad Ahmad N, Mohamad Meram N, Srour Ahmad F, Almahasna Souheb
Faculty of Medicine, Al Andalus University for Medical Sciences, Tartus.
Faculty of Medicine.
Ann Med Surg (Lond). 2023 Apr 6;85(5):2073-2076. doi: 10.1097/MS9.0000000000000538. eCollection 2023 May.
Retroperitoneal cystic lymphangioma (CL) is a rare condition and accounts for 1% of all CL. It can be congenital in children associated with genetic disorders or acquired in adults with chronic diseases.
In the present case, the girl complained of abdominal pain and dysuria. Clinical examinations showed a palpitated mass in her left pelvis; a radiology exam revealed a cystic mass infiltrating the spleen and pancreatic tail, reaching the pelvis. The mass, including the spleen and pancreatic tail, among the cystic compound was removed. The final diagnosis of benign CL was done based on a histopathology exam. A one-year follow-up showed no signs of recurrence.
CL is usually asymptomatic. The retroperitoneal location of the mass delayed the diagnosis and allowed the mass to grow to a large size and compress nearby structures. The typical presentation of CL is usually a substantial, multichambers cystic mass. However, it could be easily misdiagnosed with other cystic tumors of the pancreas. Age-based differential diagnosis should be taken into consideration in children as abdominal mass can originate from gastrointestinal or genitourinary systems.
The imaging features of CL are insufficient, and the final diagnosis depends on the histopathology exam. Furthermore, CL can mimic pancreatic cysts in its presentation and cite; therefore, it must be included in the diagnosing strategy whenever a retroperitoneal cyst is being investigated, as imaging features can be misleading. Surgical treatment of CL should be associated with long-term ultrasound follow-up to identify and manage recurrence early.
腹膜后囊性淋巴管瘤（CL）是一种罕见疾病，占所有CL的1%。它在儿童中可能是先天性的，与遗传疾病有关，在成人中则可能是后天性的，与慢性疾病有关。
在本病例中，女孩主诉腹痛和排尿困难。临床检查发现其左盆腔有一个可触及的肿块；影像学检查显示一个囊性肿块浸润脾脏和胰尾，延伸至盆腔。切除了包括脾脏和胰尾在内的囊性肿块中的肿块。根据组织病理学检查做出了良性CL的最终诊断。一年的随访显示没有复发迹象。
CL通常无症状。肿块位于腹膜后导致诊断延迟，使肿块得以生长到较大尺寸并压迫附近结构。CL的典型表现通常是一个巨大的、多房性囊性肿块。然而，它很容易与胰腺的其他囊性肿瘤误诊。在儿童中应考虑基于年龄的鉴别诊断，因为腹部肿块可能起源于胃肠道或泌尿生殖系统。
CL的影像学特征不足，最终诊断取决于组织病理学检查。此外，CL在表现和部位上可类似胰腺囊肿；因此，在对腹膜后囊肿进行检查时，无论何时都必须将其纳入诊断策略，因为影像学特征可能会产生误导。CL的手术治疗应结合长期超声随访，以便早期发现和处理复发情况。
