Presentation
History of right upper abdominal pain. Abdominal ultrasound/CT were performed (? huge hydatid cyst). At surgery the liver was normal, but there was a large peritoneal mass, a surgical biopsy was performed. Subsequently, abdominal MRI was requested.
Patient Data
There is a large well-encapsulated intraperitoneal solid/cystic (predominately cystic) mass of interhepatorenal location, extending to the right iliac fossa, measuring (27 x 19 x 16 cm). It displays a low signal on T1, high signal on T2 with thin septae of low signal. The postcontrast sequences show a peripheral enhancement as well as the solid component. A mass effect is noted on the adjacent structures, right kidney with mild hydronephrosis, with upwards displacement of the liver and left-wards displacement of pancreas/duodenum.
No abdominal lymphadenopathy or intraperitoneal effusion is seen.
A few gallstones are noted.
Case Discussion
The patient underwent total surgical resection of this solid/cystic lesion with a histopathological exam which confirmed the diagnosis of cystic lymphangioma.
Cystic lymphangiomas are benign tumors, occurring in the fetal/infantile and pediatric populations, most commonly seen in the neck. They are rarely seen in adults and the peritoneal location is extremely rare 1,2. The exact etiology is still unclear, but in most published cases is considered of congenital origin. 1,2.
Additional contributor: ZE. Boudiaf. MD, CHU, Constantine, Algeria