Pancreatic lymphangiomas are benign lesions that are often found incidentally during cross-sectional imaging for another reason.
More common in adults (in contrast to lymphangiomas in the head and neck, which are more common in children). Account for approximately 1% of abdominal lymphangiomas. More common in women
Lymphangiomas are thought to arise from a congenital blockage of regional lymphatic ducts. They can be pancreatic or peripancreatic.
They may contain serous, serosanguinous, or chylous fluid. Cyst walls are lines with endothelial cells (immunoreactive with VIII-R AG, CD31, and D2-40; negative for CD34).
- multilocular and multiseptated (occasionally unilocular)
- homogeneously hypoattenuating, may be fat attenuation
- phleboliths may be present
- they can become quite large
- T1: hypointense
- T2: hyperintense
- multiseptated, lobulated
- multiple hypoechoic or anechoic cysts
- contents may be echogenic
Treatment and prognosis
None usually necessary, but may be excised if locally invasive.
- side branch intraductal papillary mucinous neoplasm (IPMN)
- if a connection to the main duct of the pancreas can be found, this entity becomes much more likely
- a mucinous lesion of the pancreas
- oligocystic serous cystadenoma of the pancreas
acute peripancreatic fluid collection / pseudocyst
- a history of pancreatitis is usually present
- pancreatic neuroendocrine tumor
Endoscopic ultrasound (EUS) with cyst fluid aspiration is probably the best way to confirm a pancreatic lymphangioma (it has an elevated triglyceride level).
A pancreatic lymphangioma should not have any enhancing component. If an enhancing component is present, it is more prudent to consider one of the neoplastic entities on the differential.
Finding fat attenuation in the cystic lesion helps to separate pancreatic lymphangioma from other entities on the differential.
If a lymphangioma becomes secondarily infected, it may be difficult to distinguish it from a more aggressive lesion.
- cystic neoplasm (cystic pancreatic mass differential diagnosis)
- solid neoplasm
- nonepithelial pancreatic neoplasms
pancreatitis (mnemonic for the causes)
- gallstone pancreatitis
- interstitial oedematous pancreatitis
- necrotising pancreatitis
- haemorrhagic pancreatitis
- revised Atlanta classification of acute pancreatitis
- chronic pancreatitis
- Ascaris-induced pancreatitis
- tropical pancreatitis
- autoimmune pancreatitis
- emphysematous pancreatitis
- hereditary pancreatitis
- pancreatitis associated with cystic fibrosis
- segmental pancreatitis
- acute pancreatitis
- pancreatic atrophy
- pancreatic lipomatosis
- pancreatic trauma
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