Umair Chishti, MD1, Sultan Mahmood, MD2, Muhammad Tahir, MD2, Misbah Safdar, MD3 1Bayhealth Hospital, Dover, DE; 2University at Buffalo Gastroenterology, Buffalo, NY; 3Nishtar Medical University, Dover, Punjab, Pakistan
Introduction: Lymphangiomas of the anal canal are extremely rare. They are most commonly found in the head and neck although rarely they can be found in the gastrointestinal tract. (1) Duodenum remains the most common site while the large intestine is the least common site. Lymphangiomas are circumcised lesions containing clear fluid involving mucosa and submucosa. Described herein a case of lymphangioma of the anal canal which is rare and only a few cases have been reported in the literature.
Case Description/Methods: 55 years old male presented for average risk screening colonoscopy. Patient denied any complaints and was found to have 1cm polypoid growth seen on the retroflexion, as seen in the images. Biopsies were taken using cold forceps and the pathology confirmed lymphangioma (see image 1a & 1b). After discussion with the patient, surgical referral was made. Patient underwent surgical excision successfully and did well post-operatively.
Discussion: Lymphangiomas are uncommon and hamartomatous malformations of the lymphatic system. They are commonly found in skin and subcutaneous tissue although can be found in mucous membranes. The gastrointestinal site is a rare site for lymphangiomas however only a handful of cases have been reported in the anal canal. Cases of lymphangiomas in the lower GI tract are rising due to the increased use of diagnostic procedures. Clinical presentation ranges from asymptomatic cases to iron deficiency anemia and rectal bleeding. Endoscopically it appears soft, translucent and lustrous. Case presentation by Mannami et al. described it on narrow-band imaging (NBI) as scattered bullous-like transparent areas on the tumor. (2) While magnifying endoscopy demonstrated elongated, dark brown looping capillary vessel without dilation or caliber change in the superficial layer.(2) Therefore, the endoscopic findings using magnifying endoscopy with narrow-band imaging techniques may be useful in identifying lymphangioma. The treatment used is usually total excision of the tumor, excision can be done endoscopically or surgically. Lymphangioma of the anal canal is a rare entity and should be considered in the differential diagnosis of the polypoid growths of the anal canal. We await new information to come in coming years to understand the clinical presentations and clinical significance of this interesting entity.
1.Schwartz R. A., Fernandez G. Lymphangioma. Medscape November 2017
2. Mannami Tomohiko et al. Lymphangioma of the anal canal ... Endoscopy 2014; 46: E545–E546
Figure: Figure 1
Disclosures: Umair Chishti indicated no relevant financial relationships. Sultan Mahmood indicated no relevant financial relationships. Muhammad Tahir indicated no relevant financial relationships. Misbah Safdar indicated no relevant financial relationships.
Umair Chishti, MD1, Sultan Mahmood, MD2, Muhammad Tahir, MD2, Misbah Safdar, MD3. P1335 - A Rare Case of Anal Canal Lymphangioma, ACG 2021 Annual Scientific Meeting Abstracts. Las Vegas, Nevada: American College of Gastroenterology.