Peritoneal and retroperitoneal lymphangioma

Case contributed by Dr Jan Frank Gerstenmaier

Presentation

This patient had a follow up CT abdomen 4 months after partial left nephrectomy for RCC.

Patient Data

Age: 50 years
Gender: Male

Renal CT (preoperative)

CT

Left upper pole renal tumor. Infiltrate in the retroperitoneum extending into the mesentery

Follow up CT 4 months after left partial nephrectomy.

CT

Evidence of left partial nephrectomy involving the upper pole. No new solid renal mass lesion evident. Numerous simple cysts are noted in both kidneys. No hydronephrosis. The ureters and urinary bladder are normal.

Moderately extensive mesenteric infiltrative increased density is again noted, similar in extent to the August scan. No associated mesenteric lymphadenopathy. In the absence of further history, this is suspicious for mesenteric lymphoma.

The remaining solid organs of the abdomen and pelvis are normal. No free fluid. Bowel is unremarkable within the confines of CT. Minor band atelectasis in the left lung base. No skeletal metastasis.

F-18 FDG PET/CT

Nuclear medicine

No evidence of disease recurrence. No metabolic activity in the retroperitoneal infiltrate.

MRI ABDOMEN

MRI

Reference is made to the CT. Extending between the levels of segments D3 of the duodenum, and the L5 level, located within the posterior abdomen, adjacent to duodenum and extending into the mesentery, there is a 9 cm x 9 cm x 4.5 cm defined somewhat lobulated predominantly T2 hyperintense structure with possible faint diffuse mild enhancement on the latest of the dynamic phases obtained approximately 6 min after contrast injection. Review of non-contrast CT does not show any calcifications. Bilateral renal cysts and left-sided upper pole renal scarring. Spleen, adrenal glands, pancreas and normal in appearance. Limited imaging of liver within normal limits. No free fluid and no lymphadenopathy are identified.

Conclusion: Combined retroperitoneal and mesenteric lymphatic malformation; likely lymphangioma. Stable over many months, and no features to suggest malignancy.     

Case Discussion

The MR findings are typical however on CT the appearances are less well clear cut.

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