University of Missouri Columbia, MO, United States
Olalekan H. Akanbi, MD, MPH1, Harleen K. Chela, MBBS, MD1, Muhammad Mubarak, MD2, Mary Mikhael, MD1, Fnu Samiullah, MD1 1University of Missouri, Columbia, MO; 2University of Missouri - Columbia, Columbia, MO
Introduction: Lymphangiomas are benign tumors of lymphatic origin usually occurring in the head and neck region. Pancreatic involvement manifesting as cystic lesions is extremely rare representing approximately 1% of all lymphangiomas and 0.2% of pancreatic cystic lesions. Typically asymptomatic, diagnosis is suggested by endoscopic ultrasound evaluation, analysis of pancreatic cyst fluid and histopathology of surgically resected lesions.
Case Description/Methods: We present a case of a 38-year-old male with no significant past medical history who was referred to GI clinic from urgent care due to complaints of right upper quadrant pain which started 2 weeks prior to presentation following consumption of a large hamburger meal. He reported no other associated symptoms. Abdominal ultrasound obtained at urgent care reported possible pancreatic mass. Follow-up computed tomography (CT) scan abdomen and pelvis showed a 4.6 x 4.7 x 6.7 cm pancreatic cystic mass concerning for mucinous cystadenoma or cystadenocarcinoma, intraductal papillary mucinous neoplasm or pancreatic pseudocyst. CBC, CMP, carbohydrate antigen (CA) 19-9 and carcinoembryonic antigen (CEA) were unremarkable. Endoscopic ultrasound (EUS) revealed a large cyst with internal septation from which a fine needle aspiration sample fluid was obtained, normal common bile and pancreatic ducts no definite signs of chronic pancreatitis except mild lobularity of the pancreatic tail. Fluid appeared white with analysis revealing significantly high triglyceride level ( >4425mg/dl), normal amylase (228) and CEA level (3.42). Cytology was negative for malignancy. Based on these findings, an assessment of pancreatic lymphangioma was made. He was seen the surgical oncology clinic where a recommendation of surveillance imaging with magnetic resonance imaging (MRI) in 3 months was made to assess stability.
Discussion: Lymphangiomas of the pancreas are an extremely rare entity and may be asymptomatic presenting as a diagnostic dilemma. They may present incidentally as an intra-abdominal mass or can mimic a pseudocyst and other pancreatic lesions or cause symptoms due to increasing size. Diagnosis can be established with the use of endoscopic ultrasound and fine needle aspiration. Recognition of this unique lesion is important as is differentiation from malignant lesions of the pancreas.
Figure: FNA sample of pancreatic cyst
Olalekan Akanbi indicated no relevant financial relationships.
Harleen Chela indicated no relevant financial relationships.
Muhammad Mubarak indicated no relevant financial relationships.
Mary Mikhael indicated no relevant financial relationships.
Fnu Samiullah indicated no relevant financial relationships.
Olalekan H. Akanbi, MD, MPH1, Harleen K. Chela, MBBS, MD1, Muhammad Mubarak, MD2, Mary Mikhael, MD1, Fnu Samiullah, MD1. P1149 - Lymphangioma: A Peculiar Pancreatic Pathology, ACG 2021 Annual Scientific Meeting Abstracts. Las Vegas, Nevada: American College of Gastroenterology.