Retroperitoneal Cystic Lymphangioma: A Rare Presentation

Background: Lymphangiomas are benign congenital malformations of lymphatic vessels that are usually detected by the second year of life. They commonly affect the neck (75%) and axilla (20%) whereas fewer than 5% are reported to be intra-abdominal. Around 70% of intra-abdominal lymphangiomas are intraperitoneal in the small bowel mesentery but presented here is a case of a retroperitoneal mesenteric cystic lymphangioma. Case Information: A 55-year-old female with a surgical history of hysterectomy, bilateral oophorectomy, and laparoscopic adjustable gastric band was referred to surgery with a three-to-four-month history of bloating, early satiety, and lower abdominal discomfort. She denied changes in weight, appetite, or bowel movements. On previous abdominal CT, the lap-band appeared unremarkable, but there was an incidental discovery of a mass near the cecum and ascending colon. After a negative colonoscopy, she underwent repeat CT with contrast, which showed interval growth of the mass from 1.2x4.3 cm to 1.5x5.1 cm. Due to uncertainty of its nature and inaccessibility via percutaneous biopsy, a laparoscopic right hemicolectomy was recommended in addition to removal of the lap band, the latter of which was felt to be causing her symptoms. During surgery, the mass was identified in the right mesocolon and found to be cystic and multilobulated, and it was resected. Histopathology showed a CD34 positive cystic lesion filled with lymphoid nodules, confirming the diagnosis of cystic lymphangioma. Conclusion: This case illustrates a unique presentation of a condition rarely encountered in adulthood.