NHÂN CA CYSTIC LYMPHANGIOMA CỦA ĐUÔI TUỴ TẠI MEDIC

Xem HUGE CYSTIC LYMPHANGIOMA of PANCREAS tại MEDIC.

Discussion of Pancreatic Lymphangioma

from http://www.tmuh.org.tw
Background

- Neoplasms, hamartomas, or lymphangiectasias ?

- Malformations arising from sequestered lymphatic channels

or

- Acquired lesions due to obstruction caused by fibrosis of lymph channels.

- Developmental anomaly, distension of sequestered lymphatic channels within primitive mesenchyme rather than a true neoplasm.

- Most common sites: head, neck, and axilla.

- Only 5 % at mesentery, omentum, mesocolon, and retroperitoneum.

- Pancreatic lymphangiomas (1%) occur predominantly in women (F/M: 2:1). Average age : 25.6 years.

Classification

- Cystic, capillary, and cavernous.

- Only cystic and cavernous types have been reported in the pancreas

- Considered to be of pancreatic origin :

• in the pancreatic parenchyma,
• adjacent to the pancreas,
• connected to the organ by a pedicle

Clinical Presentations

- Abdominal pain

- Nausea

- Vomiting

- Palpable mass

- Silent, incidental finding.

Morbidity/ Mortality

- No risk of malignant transformation.

- May local invasion.

- Strong tendency for local recurrence unless they are completely excised.

Pathology 

Gross

- Soft, multiloculated cystic masses.

- Content: serous, serosanguinous, or lymphatic fluid.

Histology

- Dilated lymphatic channels, separated by thin septa.

- Cystic spaces lining:  flattened or cuboidal endothelial cells.

- Aggregates of lymphocytes.

- The septa and walls: smooth muscle fascicles and collagenous connective

tissue.

Image -- Sonography character

- Anechoic or hypoechoic

- Fluid-filled

- Multiseptated mass in the pancreatic region.

Image -- CT character

- Well-circumscribed

- Homogeneous cystic masses in or adjacent to the pancreas.

- Septums and thin walls may enhance after IV contrast injection.

Image -- MRI character

- Hypointense on T1-weighted image

- Hyperintense on T2-weighted image.

- Not provide new information.

Diagnosis

- History

- Imaging: sono, CT, MRI

- Fine-needle aspiration cytology.

- Definite diagnosis: pathology report.

Treatment

- No proven medical care for lymphangiomas exists.

- Treatment of choice: complete surgical excision.

Prognosis

- Lymphangiomas are benign hamartomatous malformations instead of true neoplasms.

- Locally invasion may occur.

- The prognosis is excellent.