Abdominal Lymphangiomas: Imaging Features with Pathologic Correlation
Angela D. Levy1,2,
Vito Cantisani3 and
Markku Miettinen4
1 Department of Radiologic Pathology, Armed Forces Institute of Pathology, 6825
16th St., NW, Washington, DC 20306-6000.
2 Department of Radiology and Nuclear Medicine, Uniformed Services University of
the Health Sciences, Bethesda, MD 20814.
3 Institute of Radiologic Sciences, University "La Sapienza," Viale
Regina Elena, 324, Rome 00161, Italy.
4 Department of Soft Tissue Pathology, Armed Forces Institute of Pathology,
Washington, DC 20306.
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Fig. 1. —Photomicrograph of histopathologic specimen of mesenteric
lymphangioma from 1-year-old girl shows thin-walled cystic spaces
(asterisk) filled with proteinaceous fluid. Cysts are lined with
attenuated endothelia (arrow). Cyst walls contain irregular
smooth-muscle elements, and foci of lymphocyte clusters appear inside and
between some cystic spaces. (H and E, x40)
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Fig. 2A. —10-year-old girl with 3-day history of epigastric pain and
bilious vomiting caused by small-bowel volvulus secondary to mesenteric
lymphangioma. IV contrast–enhanced CT scan shows circular arrangement of
mesenteric vessels with surrounding small bowel (arrows). Note
fluid-containing mass (asterisk) to right of small-bowel
volvulus.
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Fig. 2B. —10-year-old girl with 3-day history of epigastric pain and
bilious vomiting caused by small-bowel volvulus secondary to mesenteric
lymphangioma. CT scan obtained through lower abdomen shows multilocular cystic
mass (asterisk). Ascites is present in right paracolic gutter.
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Fig. 2C. —10-year-old girl with 3-day history of epigastric pain and
bilious vomiting caused by small-bowel volvulus secondary to mesenteric
lymphangioma. Photograph of cut surface of resected surgical specimen shows
opened small bowel (sb) and multiloculated cystic lymphangioma
(arrows) arising from adjacent small-bowel mesentery.
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Fig. 3. —Longitudinal sonogram of right upper quadrant in 58-year-old
woman with retroperitoneal lymphangioma shows anechoic cyst with multiple thin
septa (arrows) posterior to gallbladder.
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Fig. 4. —Transverse sonogram of abdomen in 32-year-old man with
mesenteric lymphangioma shows complex multiloculated cyst containing internal
echoes.
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Fig. 5A. —Retroperitoneal lymphangioma in 32-year-old woman with
increasing abdominal girth. IV and oral contrast–enhanced CT scan shows
large multiseptate cystic mass with enhancing septa arising from anterior
pararenal space.
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Fig. 5B. —Retroperitoneal lymphangioma in 32-year-old woman with
increasing abdominal girth. Photograph of cut surface of resected surgical
specimen shows that some locules contain milky chylous fluid.
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Fig. 6A. —Mesenteric lymphangioma in 42-year-old woman with chronic
abdominal pain. IV and oral contrast–enhanced CT scan shows well-defined
cystic mass in small-bowel mesentery that insinuates around mesenteric
vessels. Note punctate calcifications in cyst.
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Fig. 6B. —Mesenteric lymphangioma in 42-year-old woman with chronic
abdominal pain. Axial T2-weighted MR image shows high-signal-intensity fluid
in cyst and low-signal-intensity septa.
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Fig. 7A. —Mesenteric lymphangioma in 70-year-old woman with painless
abdominal distension. IV and oral contrast–enhanced CT scan shows
complex mixed-attenuation mass arising from small-bowel mesentery. Foci of
high attenuation in mass (arrow) correspond to areas of hemorrhage in
resected surgical specimen.
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Fig. 7B. —Mesenteric lymphangioma in 70-year-old woman with painless
abdominal distension. Photograph of cut surface of resected specimen shows
well-circumscribed mass composed of numerous small locules. Some locules
(arrows) contain hemorrhagic fluid.
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Fig. 8. —Lymphangioma arising from greater omentum in 16-month-old boy
with abdominal distention. Oral and IV contrast–enhanced CT scan shows
lobular fluid-filled mass following anterior surfaces of intestine.
Lymphangioma compresses all intraabdominal organs. Unlike ascites,
lymphangioma does not pool in recesses of small-bowel mesentery and subhepatic
spaces.
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Fig. 9A. —Two colonic lymphangiomas in 43-year-old woman with
pancreatic cancer and no colonic symptoms. Single-contrast enema-enhanced CT
scan shows two well-defined oval filling defects (arrows) in
ascending colon.
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Fig. 9B. —Two colonic lymphangiomas in 43-year-old woman with
pancreatic cancer and no colonic symptoms. Photograph of open resected
surgical specimen shows two masses (arrows) covered with normal
mucosa bulging into lumen of ascending colon. Appendix (a) and ileocecal valve
(ic) appear in lower portion of specimen.
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Fig. 9C. —Two colonic lymphangiomas in 43-year-old woman with
pancreatic cancer and no colonic symptoms. Photomicrograph of histopathologic
specimen shows multiple interconnecting cysts in submucosa. (H and E,
x4)
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Fig. 10A. —Jejunal lymphangioma in 51-year-old woman with anemia. Image
obtained during enteroclysis shows lobular filling defect (arrow) in
proximal jejunum.
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Fig. 10B. —Jejunal lymphangioma in 51-year-old woman with anemia. Oral
and IV contrast–enhanced CT scan shows fluid-attenuation mural mass
(arrow) in proximal jejunum.
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Fig. 11A. —Renal lymphangioma in 8-month-old male infant who presented
with urinary tract infection. IV contrast–enhanced CT scan shows left
renal cyst (arrow) with lobulated contours and mural enhancement.
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Fig. 11B. —Renal lymphangioma in 8-month-old male infant who presented
with urinary tract infection. Photograph of bisected surface of nephrectomy
specimen shows thin-walled lower pole cyst (arrow) containing
septa.
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Fig. 12A. —Splenic lymphangioma in 70-year-old man with asymptomatic
splenomegaly. Unenhanced CT scan shows multiple circumscribed low-attenuation
lesions throughout spleen. Subtle calcification (arrow) is
present.
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Fig. 12B. —Splenic lymphangioma in 70-year-old man with asymptomatic
splenomegaly. Photograph of cut surface of resected spleen shows multiple
thin-walled cystic structures replacing splenic parenchyma.
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Fig. 13A. —Gallbladder lymphangioma in 36-year-old woman with dull
intermittent right upper quadrant pain. Axial T1-weighted MR image shows
high-signal-intensity gallbladder (arrow) surrounded by
low-signal-intensity lymphangioma.
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Fig. 13B. —Gallbladder lymphangioma in 36-year-old woman with dull
intermittent right upper quadrant pain. Axial T2-weighted MR image shows
low-signal-intensity gallbladder (arrow) surrounded by
high-signal-intensity lymphangioma. Altered signal pattern of gallbladder is
caused by inspissated bile.
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Fig. 13C. —Gallbladder lymphangioma in 36-year-old woman with dull
intermittent right upper quadrant pain. Coronal T2-weighted MR
cholangiopancreatograph shows teardrop-shaped high-signal-intensity
lymphangioma (arrow) extending upward toward hepatic hilum and
compressing low-signal-intensity gallbladder.
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Fig. 13D. —Gallbladder lymphangioma in 36-year-old woman with dull
intermittent right upper quadrant pain. Photograph of unopened resected
specimen shows lymphangioma (arrow) encircling bile-colored
gallbladder.
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Fig. 13E. —Gallbladder lymphangioma in 36-year-old woman with dull
intermittent right upper quadrant pain. Photograph of partially opened
surgical specimen shows thin septa in lymphangioma (arrow)
surrounding gallbladder.
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Fig. 14. —Unenhanced CT scan in 33-year-old man with severe back pain
shows large cystic pancreatic lymphangioma mass arising from tail of
pancreas.
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Fig. 15. —IV contrast–enhanced CT scan in asymptomatic
42-year-old man shows lobulated cystic pancreatic lymphangioma mass adjacent
to tail of pancreas.
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Copyright © 2004 by the American Roentgen Ray Society.
