Giant Pancreatic Lymphangioma Herniating Above the Diaphragm.

Lymphangiomas of pancreatic origin are rare and can often be found with abdominal symptoms or incidentally on imaging. A 46-years-old female presented with epigastric abdominal pain and vomiting, and twenty-pound weight loss over 3 months. Computed tomography of the abdomen showed a septated mass of the distal pancreas measuring 25.4 cm in largest diameter and extending superiorly into the mediastinum via a hiatal hernia. Endoscopic ultrasound demonstrated abutment but no invasion of the esophagus and stomach. She underwent an exploratory laparotomy with retroperitoneal mass excision, distal pancreatectomy, splenectomy, and hiatal hernia repair with Dor fundoplication. Pathology was consistent with a cystic lymphangioma. Patient was discharged on postoperative day 3 and remained recurrence free for over a year.

Transvaginal Resection of a Gastrointestinal Stromal Tumor (GIST) of the Rectum.

Gastrointestinal stromal tumors (GISTs) are connective tissue tumors representing a minority of gastrointestinal tumors. A 49-year-old woman was found to have a rectal mass in addition to uterine fibroids during work-up for abnormal uterine bleeding. A peri-rectal mass was again seen during hysterectomy, but definitive resection was deferred. A pelvic MRI suggested a posterior vaginal wall mass. A transvaginal approach was chosen for excision of a solid multi-lobulated mass from the rectovaginal septum space. Frozen section reported uterine leiomyoma, but final pathology confirmed a 10-cm high-risk GIST arising from the rectal muscularis propria, with microscopically positive margins. Patient was started on imatinib therapy. Abdominopelvic resection was offered to decrease the risk of recurrence but was declined. Repeat imaging has shown no obvious distant metastases or residual rectovaginal region mass. The simultaneous and similar presentation of uterine leiomyoma and rectal GIST draws attention to this case.