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Lymphangiomas of the liver and spleen: rare case presentation
(2020)
Nikolovska Trpchevska, Emilija
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Objectives: Lymphatic malformations are benign lesions of vascular origin that show lymphatic differentiation. It is considered the lymphatic equivalent of a hemangiomas of blood vessels. A hepatic lymphangioma is a rare benign neoplasm and is usually associated with lymphangiomas of other viscera. It can occur at any age and most lesions are found inciden- tally. Splenic lymphangiomas are relatively rare benign tumors that correspond to abnormal dilatation of lymphatic chan- nels that can be either congenital or acquired. On imaging, they usually present as lobulated and multiloculated cystic le- sions without solid component or significant enhancement. Here we report a rare case of a hepatic cystic lymphangioma in a 73-year-old man and multiple lymphangiomas (cyst) in spleen. Material and methods: It was discovered on a routine ultrasound examination and the patient had no obvious symptoms. A surgical resection of adenocarcinoma of prostate was performed one year ago. There is no need of hemotherapy after sur- gical treatment. Abdominal ultrasonography and computed tomography (CT) showed “hepatic neoplasm” and multiple cys- tic focal lesions in the spleen. Bone biopsy excluded hematological abnormalities. Laboratory examination with tumor markers and X-chest ray were normal. Screening gastroscopy and colonoscopy was performed, and the patient had reflux esophagitis and pendular polyp in sigmoid colon. After polypectomy of sigmoid polyp, histopathology findings show tubu- lous polyp. After all examinations, spleen biopsy was performed. Results: Histological examination of spleen revealed multiple cystic structures lined with epithelial cells on the inner walls, accompanied by interstitial swelling and necrosis, marked as lymphangiomas. Conclusion: A hepatic lymphangioma can be solitary, cystic or associated with multiple liver lesions and is characterized by cystic dilatation of lymphatic vessels in the hepatic parenchyma. A solitary lymphangioma is unusual. Presentation ranges from asymptomatic incidental finding to a large multicentric, symptomatic mass require surgical intervention. They may occur alone on the spleen or as a part of systemic lymphangiomatosis. In our case patient has been followed up for nearly two years with no worsen and enlarged lesions.
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SPLENIC ABSCESS IN PATIENT WITH CHRONIC PANCREATITIS: A CASE REPORT
(2019-06-05)
Bozhinovska Beaka, Gordana
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Noveska-Petrovska, Biljana
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Bozinovska, Nadica
<jats:p>The abscess of the spleen is a rare condition with diverse аetiologies and highly polymorphic clinical expression. It is more common in male than female patient, with a wide age range. Regarding varied and often unspecific symptomatology it poses a great problem for diagnostic and overall treatment with a very high mortality rate in untreated patients. Recent diagnosis and treatment are based on modern imaging techniques that enable precise and rapid diagnostics. The following is a presentation of a case that refers to a young male patient with splenic abscess. CASE REPORT. A 37-year-old patient with a history of hypertensive crisis and multiple previous admittances to the emergency room regarding acute attacks of pancreatitis and persistent reduction in body weight was admitted to the emergency room with nonspecific symptoms of abdominal pain, more prominent in the upper left quadrant. Laboratory findings revealed leukocytosis and elevated levels of CRP. Infective panel for hepatitis and HIV was negative. Additional ultrasound investigations were made which revealed hypoechogenic lesion in the spleen, clearly demarcated from the neighboring parenchyma and partially encapsulated, with near proximity to the tail of the pancreas. Hospitalization with additional MRI and surgical treatment was advised, but the patient refused and contrary to the advice of the doctor decided to leave the hospital. After 10 days he was again admitted to the emergency room with persistent leukocytosis and elevated CRP. Because of the worsening condition, he accepted the previously proposed treatment and was hospitalized. The conducted MRI investigation revealed three cystic lesions with dense content in the spleen, measuring from 5x3sm to 2sm in diameter with propagation towards the tail of the pancreas. Surgical splenectomy with partial pancreatectomy was performed, and the surgical specimen was forwarded for histopathological examination. The microscopic examination on the selected specimens revealed severe stasis in the splenic parenchyma with subcapsular abscess formation, and also confirmed the chronic pancreatitis condition. The postoperative course went well without any complications, as well as on the following regular checkups. DISCUSSION. Splenic abscess is very uncommon entity associated with versatile etiologies which covers primary immunocompromised patients, trauma or patients with infective endocarditis. As a potentially life-threatening condition it is essential to emphasize the need for fast detection and splenectomy as a choice of treatment. But also it is very important as a potential aetiology to have in mind other chronic conditions like pancreatitis, especially in young male patients, given that management of the underlying disease is of great importance.</jats:p>

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