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Ray R, Baruah TD, Mahobia HS, Borkar A. Pancreatic Lymphangioma: An Unusual Cause of Abdominal Lump. Cureus 2021; 13:e19452. [PMID: 34926026 PMCID: PMC8654082 DOI: 10.7759/cureus.19452] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/10/2021] [Indexed: 11/11/2022] Open
Abstract
Lymphangiomas are uncommon benign malformations that can occur anywhere in the body. These are hamartomatous malformations with lymphatic differentiation, which uncommonly involve the abdomen and rarely the pancreas. The size of the cysts in pancreatic lymphangioma directly correlates with the clinical manifestations; however, most of them are non-specific. Preoperative diagnosis is challenging because conventional imaging examinations like an abdominal ultrasonogram (USG), computed tomography, or magnetic resonance imaging cannot distinguish pseudocyst, mucinous cyst neoplasms, simple cyst, intraductal papillary mucinous neoplasms, and serous cystadenoma. We are presenting a rare case of pancreatic lymphangioma where the definitive diagnosis was made postoperatively in histopathological examination. A female patient aged 27 years presented to the Surgery outpatient department with a slow-growing abdominal lump of 9 months duration. Clinical examination revealed large, non-tender, soft cystic swelling occupying the entire upper abdomen. Radiological imaging showed a large multiseptated cystic lesion occupying almost the entire abdomen and adhered to the pancreas with mass effect. USG-guided fine-needle aspiration revealed straw-colored aspirate with mature lymphocytes. On exploration, there was a large multiloculated cyst occupying the whole abdomen. Cysts were decompressed, and the entire lesion was excised. Final histopathological examination showed unremarkable pancreatic tissue with attached lesion consisting of dilated lymphatic spaces with lymphatic follicles.
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Affiliation(s)
- Rubik Ray
- General Surgery, All India Institute of Medical Sciences, Raipur, IND
| | | | | | - Akshay Borkar
- General Surgery, All India Institute of Medical Sciences, Raipur, IND
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Bellido Luque JA, García Reyes A, Nogales Muñoz Á. Giant pancreatic cystic lymphangioma. REVISTA ESPANOLA DE ENFERMEDADES DIGESTIVAS 2020; 113:75-76. [PMID: 33207886 DOI: 10.17235/reed.2020.7003/2020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
A giant cystic lymphangioma in the pancreatic body-tail was diagnosed as an incidental ultrasound mass in a 41-year-old patient, with a progressive size that had increased in the last year by about 20 cm size. An ultrasound guided fine needle puncture was performed and the result was a benign cystic lesion. Given the increase in size, a surgical intervention was decided. A retroperitoneal cystic tumor dependent on the posterior pancreatic wall was identified and a full laparoscopic resection with pancreas and spleen preservation was performed. The pathological report confirmed the diagnosis of benign cystic lymphangioma. The patient was discharged on the fifth postoperative day without any remarkable complications. After one year of follow-up, the patient remains asymptomatic.
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Affiliation(s)
| | - Alberto García Reyes
- Cirugia General y del Aparato Digestivo, Hospital Universitario Virgen Macarena, España
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Yang F, Liu E, Sun S. Rapid on-site evaluation (ROSE) with EUS-FNA: The ROSE looks beautiful. Endosc Ultrasound 2019; 8:283-287. [PMID: 31603143 PMCID: PMC6791107 DOI: 10.4103/eus.eus_65_19] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2019] [Accepted: 09/22/2019] [Indexed: 02/06/2023] Open
Affiliation(s)
- Fei Yang
- Endoscopy Center, Shengjing Hospital of China Medical University, Shenyang, Liaoning Province, China
| | - Enshuo Liu
- Endoscopy Center, Shengjing Hospital of China Medical University, Shenyang, Liaoning Province, China
| | - Siyu Sun
- Endoscopy Center, Shengjing Hospital of China Medical University, Shenyang, Liaoning Province, China
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Wang S, Zhang K, Hu JL, Wu WC, Liu X, Ge N, Guo JT, Wang GX, Sun SY. Endoscopic resection of the pancreatic tail and subsequent wound healing mechanisms in a porcine model. World J Gastroenterol 2019; 25:2623-2635. [PMID: 31210714 PMCID: PMC6558443 DOI: 10.3748/wjg.v25.i21.2623] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2019] [Revised: 05/06/2019] [Accepted: 05/08/2019] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Laparoscopic resection of the pancreatic body and tail is the predominant methodology to remove lesions in these locations; its safety and surgical planning are relatively mature, but it remains a complex and high-precision surgical operation, requiring abundant experience and skills in laparoscopic surgery, with a 10% rate of complications. AIM To verify the feasibility and safety, as well as to examine the complications of endoscopic pancreatectomy and healing mechanisms of pancreatic wounds after endoscopic resection. METHODS Transgastric endoscopic resections of varying sizes of pancreases were performed in 15 healthy Bama miniature pigs. The technical success rate, the incidence of serious complications, and the survival of the animals were studied. The healing of the wounds was evaluated by sacrificing the animals at various time points. Finally, the expression of transforming growth factor-β1 and Smad3/Smad7 in the surgical site was examined by immunohistochemistry to explore the role of these factors in wound healing of the pancreas. RESULTS Partial and total resections were successfully performed in two groups of animals, respectively. The technical success rate and the survival rate of the pigs were both 100%. We obtained 12 pancreatic tissue samples by endoscopic resection. The pancreatic wounds were closed with metal clips in one group and the wounds healed well by forming scars. There was a small amount of pancreatic leakage in the other group, but it can be fully encapsulated. The level of transforming growth factor-β1 (TGF-β1) in the wounds increased during the inflammatory and fibrous hyperplasia phases, and decreased in the scar phase. The expression of Smad3 paralleled that of TGF-β1, while the expression of Smad7 had an inverse relationship with the expression of TGF-β1. CONCLUSION Purely transgastric endoscopic resection of the pancreas is a safe, effective, and feasible procedure, but the incidence of pancreatic leakage in total pancreatic tail resection is high. The expression of TGF-β1 and Smad3/Samd7 is related to the progression of pancreatic wound healing.
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Affiliation(s)
- Sheng Wang
- Endoscopy Center, Shengjing Hospital of China Medical University, Shenyang 110001, Liaoning Province, China
| | - Kai Zhang
- Endoscopy Center, Shengjing Hospital of China Medical University, Shenyang 110001, Liaoning Province, China
| | - Jin-Long Hu
- Endoscopy Center, Shengjing Hospital of China Medical University, Shenyang 110001, Liaoning Province, China
| | - Wei-Chao Wu
- Endoscopy Center, Shengjing Hospital of China Medical University, Shenyang 110001, Liaoning Province, China
| | - Xiang Liu
- Endoscopy Center, Shengjing Hospital of China Medical University, Shenyang 110001, Liaoning Province, China
| | - Nan Ge
- Endoscopy Center, Shengjing Hospital of China Medical University, Shenyang 110001, Liaoning Province, China
| | - Jin-Tao Guo
- Endoscopy Center, Shengjing Hospital of China Medical University, Shenyang 110001, Liaoning Province, China
| | - Guo-Xin Wang
- Endoscopy Center, Shengjing Hospital of China Medical University, Shenyang 110001, Liaoning Province, China
| | - Si-Yu Sun
- Endoscopy Center, Shengjing Hospital of China Medical University, Shenyang 110001, Liaoning Province, China
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Viscosi F, Fleres F, Mazzeo C, Vulcano I, Cucinotta E. Cystic lymphangioma of the pancreas: a hard diagnostic challenge between pancreatic cystic lesions-review of recent literature. Gland Surg 2018; 7:487-492. [PMID: 30505770 PMCID: PMC6234244 DOI: 10.21037/gs.2018.04.02] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2018] [Accepted: 04/02/2018] [Indexed: 01/27/2023]
Abstract
Lymphangiomas are rare congenital benign tumors arising from the lymphatic system. The incidence of this disease in the pancreas is extremely rare, accounting for less than 1% of these tumors. Before introducing the review we reported a case of a 67-year-old woman with cystic lymphangioma of the pancreas. We reported the radiological investigations carried out preoperatively and the treatment performed. The review tries to identify the features described in literature of the pancreatic lymphangioma. We have performed a PubMed research of the world literature between January 1st 2000, to November 31st 2017, using the keywords [Lymphangioma pancreas], [diagnosis], [CT lymphangioma] and [MRI lymphangioma]. We have found 158 articles, of which about 100 were case reports. Based on our search criteria, we have identified 31 pancreatic lymphangioma in literature reporting their imaging characteristics. According to our report and to several authors in literature the diagnosis of cystic pancreatic lymphangioma should be considered as a differential diagnosis of pancreatic cystic lesions (PCLs). The role of imaging exams (CT and MRI) can help to identify and suspect this possibility of diagnosis. The endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) can have a potential role to reach the correct diagnosis.
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Affiliation(s)
- Francesca Viscosi
- Department of Human Pathology of the Adult and Evolutive Age "Gaetano Barresi", Section of General Surgery, University of Messina, Messina, Italy
| | - Francesco Fleres
- Department of Human Pathology of the Adult and Evolutive Age "Gaetano Barresi", Section of General Surgery, University of Messina, Messina, Italy
| | - Carmelo Mazzeo
- Department of Human Pathology of the Adult and Evolutive Age "Gaetano Barresi", Section of General Surgery, University of Messina, Messina, Italy
| | - Ignazio Vulcano
- Department of Human Pathology of the Adult and Evolutive Age "Gaetano Barresi", Section of General Surgery, University of Messina, Messina, Italy
| | - Eugenio Cucinotta
- Department of Human Pathology of the Adult and Evolutive Age "Gaetano Barresi", Section of General Surgery, University of Messina, Messina, Italy
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Capurso G, Vanella G, Arcidiacono PG. Pancreatic cystic neoplasms in 2018: The final cut. Endosc Ultrasound 2018; 7:289-292. [PMID: 30323154 PMCID: PMC6199915 DOI: 10.4103/eus.eus_48_18] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2018] [Accepted: 07/27/2018] [Indexed: 02/06/2023] Open
Affiliation(s)
- Gabriele Capurso
- Digestive and Liver Disease Unit, S. Andrea Hospital, Rome, Italy
- Pancreato-Biliary Endoscopy and Endosonography Division, Pancreas Translational and Clinical Research Center, IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
| | - Giuseppe Vanella
- Digestive and Liver Disease Unit, S. Andrea Hospital, Rome, Italy
| | - Paolo Giorgio Arcidiacono
- Pancreato-Biliary Endoscopy and Endosonography Division, Pancreas Translational and Clinical Research Center, IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
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Abstract
Pancreatic cystic lymphangioma is an extremely rare tumor. The characteristic imaging findings are poorly defined, and distinguishing between this disease and other pancreatic cyst-related tumors is very difficult. We herein report a case of a Japanese woman in her 50s with this lesion, located in the tail of the pancreas. Pancreatic cystic lymphangioma should therefore be considered in the differential diagnosis of pancreatic cystic lesions. Laparoscopic resection can be a useful, minimally invasive surgical approach for treating these cysts as well as for the treatment of benign or low-grade malignant tumors located in the pancreatic body or tail.
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Affiliation(s)
- Masakuni Fujii
- Department of Internal Medicine, Okayama Saiseikai General Hospital, Japan
| | - Hiroaki Saito
- Department of Internal Medicine, Okayama Saiseikai General Hospital, Japan
| | - Masao Yoshioka
- Department of Internal Medicine, Okayama Saiseikai General Hospital, Japan
| | - Junji Shiode
- Department of Internal Medicine, Okayama Saiseikai General Hospital, Japan
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Krylov NN, Pyatenko EA, Alekberzade AV, Kupriyanov IE. [Pancreatic tuberculosis]. Khirurgiia (Mosk) 2018:122-125. [PMID: 30560858 DOI: 10.17116/hirurgia2018121122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Prevalence, risk factors of primary pancreatic tuberculosis, clinical symptoms and data of instrumental and laboratory diagnosis are reviewed in the article. The authors emphasized the peculiarities of differential diagnosis with pancreatic malignancies and advisability of the most informative methods - endoscopy and fine-needle aspiration procedure.
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Affiliation(s)
- N N Krylov
- Sechenov First Moscow State Medical University, Moscow, Russia, Moscow, Russia
| | - E A Pyatenko
- Sechenov First Moscow State Medical University, Moscow, Russia, Moscow, Russia
| | - A V Alekberzade
- Sechenov First Moscow State Medical University, Moscow, Russia, Moscow, Russia
| | - I E Kupriyanov
- Department of human anatomy of Sechenov First Moscow State Medical University, Moscow, Russia
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