Lymphangioma of the small bowel mesentery: A case report and review of the literature

Figure 1 Radiologic study. A, B: Plain abdominal radiography in supine (A) and upright (B) positions showed small-bowel dilatation with multiple air-fluid levels in the upright position (B); C: Coronal view of the abdominal computed tomography (CT) scan revealed twist of the mesentery and its vessels (arrows) with a fluid-filled multiloculated mass in the right lower quadrant (between arrowheads); D: Axial view of the abdominal CT scan showed a twist of the mesenteric fat and its vessels (arrow) with small-bowel dilatation.

Figure 2 Gross pathology. A, B: Intraoperative photographs show a lobulated cystic yellowish pink mass that originated from the small-bowel mesentery (arrow in A) with small bowel dilatation. The mass shows vascular streaks (B); C, D: The formalin-fixed specimen reveals a partially collapsed, cystic, lobulated, pale tan mesenteric mass with vascular streaks (C). The cut surface reveals thin-wall multicystic spaces with thickened white appearance in some cystic walls (D). The inset shows milky white fluid. The small-bowel mucosa is not remarkable.

Figure 3 Histopathology. A: Cystic spaces (asterisks) with smooth muscle in their walls (hematoxyin and eosin, 40 ×); B: Flat lining cells of the cystic spaces with smooth muscle below them (hematoxyin and eosin, 400 ×); C: Lymphatic spaces in the stroma containing lymphoid cells (arrow) and pale eosinophilic fluid, suggestive of lymph (asterisks) (hematoxyin and eosin, 200 ×); D: Subendothelial lymphoid follicle (hematoxyin and eosin, 200 ×); E-G: Immunohistochemical study of the lining cells of the cystic wall shows strong cytoplasmic immunoreactivity for factor VIII-related antigen (E, 600 ×) and focal reactivity with D2-40 (F, 1000 ×, arrows) but not for calretinin (G, 600 ×); H: Immunohistochemical study for human melanoma black-45 shows negative result in the smooth muscle of the lymphatic wall (100 ×).