Lymphangiomas of the liver and spleen: rare case presentation

Abstract

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.