Cystic lymphangioma of the lesser omentum in an adult patient.

INTRODUCTION: Lymphangiomas belong to the group of benign vascular tumors that originate in the lymphatic tissue. Up to 90% of cases manifest in children before the second year of life. In adults, their presence is very rare. In most cases, they are located in the head, neck and axilla. Intra-abdominal lymphangiomas are very rare and represent less than 1% of all cases. CASE REPORT: The authors present the case of a 64-year-old female patient diagnosed with an intra-abdominal cystic lesion following a routine examination. A CT scan of the abdomen confirmed a cystic lesion located in the lesser omentum between the left lobe of the liver and the lesser curvature of the stomach. The patient was scheduled for laparoscopic exstirpation of the lesion. Histological examination confirmed the clinical diagnosis of cystic lymphangioma of the lesser omentum. CONCLUSION: The etiopathogenesis of lymphangiomas remains unclear. Despite the fact that they are benign tumors, lymphangiomas tend to have an infiltrative pattern of growth, invading surrounding structures. The majority of cases are asymptomatic and the diagnosis is incidental. The gold standard in treatment remains complete surgical extirpation with microscopically negative margins.

Abdominal mouse: Floating intra-abdominal cystic lymphatic malformation - An exceedingly rare case report.

INTRODUCTION AND IMPORTANCE: Lymphangiomas are rare benign lymphatic malformations, typically affecting the head, neck, or axillary regions, with abdominal cystic lymphatic malformations (CLM) being particularly uncommon in adults. Abdominal CLM account for less than 5 % of all lymphangiomas and 7 % of all abdominal cystic lesions in adults with a prevalence of approximately 1 in 250,000. These lesions are commonly found by accident during imaging investigations and are asymptomatic. Being free of any attachment, floating in the peritoneal cavity make it unique in its presentation. CASE PRESENTATION: We report a case of 25-year-old female who complaining of right upper abdominal pain. Initial laboratory and imaging studies by abdominal computed tomography (CT) scan showed multiple complex cysts with undetermined origin. Exploration laparoscopy was performed, revealing over 50 variable-sized cysts, some of them were floating freely within the abdominal cavity. Complete resection of all cysts was performed. Postoperative recovery was uneventful, and histopathological examination confirmed the diagnosis of cystic lymphangiomas. CLINICAL DISCUSSION: This case demonstrates the unusual presentation of multiple, floating, and variably sized intra-abdominal cystic lymphangiomas, a rare finding that presents significant diagnostic and management challenges. The absence of attachment to common intra-abdominal structures, such as the mesentery or omentum, further complicates the clinical picture. CONCLUSION: Abdominal CLM must be considered as possible diagnosis especially if the cysts are multiple and complex. Freely floating abdominal CLM may cause the symptoms of a moving lump described by the patient, which must be taken in consideration.

Diverticular disease is associated with benign intra-abdominal cystic disease.

BACKGROUND: Diverticular disease (DD) and hepatic and renal cysts have been linked with defects in collagen and dysfunctional matrix metalloproteinases. METHODS: Consecutive abdominal computed tomography scans between January-July 2015 were prospectively studied to determine a correlation between visceral cysts and DD. Patients with a sigmoid colectomy for pathology other than DD and scans in which DD and/or solid organs were not fully visualized were excluded. A subgroup analysis was performed on youthful DD patients (<55 years of age, n = 32) vs. older controls (>55, n = 213). RESULTS: 238 DD patients (50.8% male) and 369 controls (40.5% male, p = .02) were included. Incidence of visceral cystic disease in DD patients vs. controls was 71.4% vs. 22.5% (p < 0.00001). Renal cysts, present in 53.4% of the DD patients and 18.7% of the controls (p < .00001), were more common than hepatic cysts in both groups. Hepatic cyst prevalence was 8.8 vs. 2.4% (p = .0008). In the subgroup analysis, cystic disease was present in 56.2% of youthful DD patients vs. 29.1% of older controls (p = .004). CONCLUSIONS: A significant association between cystic disease and DD was demonstrated overall and in subgroup analysis inclusive of youthful DD patients and older controls. These findings suggest a global defect in connective tissue integrity in DD patients.