Yin Wenxian, Yu Ruyi, Xia Dong
Department of Clinical Medicine, Southwest Medical University, Luzhou, Sichuan Province, China.
Department of General Surgery, Gastrointestinal Group, Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan Province, China.
Medicine (Baltimore). 2025 May 23;104(21):e42394. doi: 10.1097/MD.0000000000042394.
Lymphangioma (LA) is a benign tumor that predominantly occurs in children, and is characterized by abnormal proliferation of lymphatic vessels. It is commonly present in areas such as the head, neck, and axilla. Mesenteric cystic lymphangioma (MCL) is relatively rare in adults. We reported a case of an elderly patient with a massive cystic LA of the mesentery that exerted pressure on surrounding tissues, resulting in both local and systemic symptoms.
The patient is a 66-year-old male who presented to our hospital with a history of recurrent abdominal pain of unknown origin for over 20 years. In the past month, the abdominal pain has worsened and is accompanied by abdominal distension.
Abdominal computed tomography angiography revealed a large cystic low-density mass in the right middle and lower abdomen, measuring approximately 14.9 cm × 12.8 cm × 14.9 cm. The mass contained septations, with mild enhancement of the cyst wall and septa on contrast-enhanced imaging. Small blood vessels, originating from the superior mesenteric artery, were seen traversing the lesion. Abdominal enhanced magnetic resonance imaging demonstrated a large cystic mass in the right lower abdomen, measuring approximately 17.2 cm × 14.5 cm × 8.1 cm. The mass exerted pressure on the adjacent bowel and bladder, with poorly defined borders between the lesion and the adjacent bowel.
Surgical intervention was undertaken to alleviate the patient's symptoms and get a definitive diagnosis. The postoperative pathological results confirmed the diagnosis of cystic LA of the mesentery of the small intestine.
The patient resumed oral intake on the third day following surgery and was discharged in stable condition on the sixth day following surgery. The patient was followed up for 1 month postoperatively without signs of recurrence.
MCL is a rare entity often presenting with nonspecific early symptoms. As the disease progresses, patients may experience abdominal pain, distension, and other gastrointestinal manifestations, potentially culminating in acute abdominal emergencies. While definitive diagnosis necessitates postoperative histopathology, preoperative imaging plays a crucial role in diagnosis. Therefore, clinicians should consider MCL in the differential diagnosis of unexplained abdominal masses.
淋巴管瘤（LA）是一种主要发生于儿童的良性肿瘤，其特征为淋巴管异常增殖。它常见于头、颈和腋窝等部位。肠系膜囊性淋巴管瘤（MCL）在成人中相对罕见。我们报告了一例老年患者，其肠系膜有巨大囊性LA，对周围组织施加压力，导致局部和全身症状。
该患者为66岁男性，因20多年来历不明的反复腹痛病史前来我院就诊。在过去一个月里，腹痛加重并伴有腹胀。
腹部计算机断层血管造影显示右中下腹有一个大的囊性低密度肿块，大小约为14.9 cm×12.8 cm×14.9 cm。肿块内有分隔，增强扫描时囊壁和分隔轻度强化。可见发自肠系膜上动脉的小血管穿过病变。腹部增强磁共振成像显示右下腹有一个大的囊性肿块，大小约为17.2 cm×14.5 cm×8.1 cm。肿块对相邻肠管和膀胱施加压力，病变与相邻肠管之间边界不清。
采取手术干预以缓解患者症状并获得明确诊断。术后病理结果证实为小肠系膜囊性LA。
患者术后第三天恢复经口进食，术后第六天病情稳定出院。术后随访1个月，无复发迹象。
MCL是一种罕见疾病，早期症状通常不具特异性。随着病情进展，患者可能会出现腹痛、腹胀及其他胃肠道表现，甚至可能发展为急性腹部急症。虽然明确诊断需要术后组织病理学检查，但术前影像学检查在诊断中起着关键作用。因此，临床医生在鉴别诊断不明原因的腹部肿块时应考虑MCL。
