Cases and Techniques Library (CTL)

Lymphangioma as a rare cause of acute recurrent pancreatitis

Fig. 1 Lymphangioma causing acute recurrent pancreatitis. Computed tomography shows a cystic mass behind the pancreatic head with thin calcifications and lipid-like tissue.

Fig. 2 Magnetic resonance imaging shows a cystic mass behind the pancreatic head with thin septa inside.

Fig. 3 Endoscopic ultrasound shows a well-delineated cystic lesion with hyperechoic septa and homogeneous, more solid parts.

A 26-year-old woman presented with sharp pain in the upper abdomen. Elevated amylase and lipase levels suggested pancreatitis. Emergency computed tomography (CT) of the abdomen showed a cystic lesion with calcifications and lipidlike tissue located between the aorta and vena cava and compressing the pancreatic " Fig. 1). Teratoma head and duodenum (● was suspected. The patient had experienced acute idiopathic pancreatitis 4 years earlier, at which time CT had shown a pancreatic head pseudocyst, so it seemed that the appearance of the lesion had changed. The patient was referred for magnetic resonance imaging, which showed a cystic lesion with a thin capsule, septa, calcifications, and a solid part clearly not originat" Fig. 2). ing from the pancreatic head (● The patient then underwent endoscopic ultrasound (EUS) because of the suspicion of teratoma. EUS showed a well-delineated cystic lesion with hyperechoic septa and homogeneous, more solid parts. Calcifications were not seen on EUS " Fig. 3). EUS-guided fine-needle aspira(● tion was performed with a 22-gauge needle (Expect; Boston Scientific, Natick, Massachusetts, USA). Chylous, milky white fluid was aspirated from the cyst. Biochemistry of the fluid showed a high level of triglycerides and low levels of carcinoembryonic antigen (CEA) and amylases, which definitely excluded pseudocyst from the differential diagnosis. Sediments of the fluid contained lymphocytes that were CD3+ on immunocytochemistry. The cytologic diagnosis was consistent with cystic lymphangioma. The patient refused surgical treatment. On follow-up, she was symptoms free and had serum values of amylase, lipase, cancer antigen (CA) 19-9, and CEA within normal range. This case is interesting because it shows lymphangioma as a rare cause of recurrent acute pancreatitis. Lymphangioma is a malformation of lymphatic vessels and should not be misinterpreted as a cystic or solid–cystic pancreatic tumor [1, 2]. Although it is benign, a compression effect on other organs can cause symptoms [3]. The patient had no other probable cause of acute pancreatitis, and we therefore concluded that in this case lymphangioma was the cause of pancreatitis. Endoscopy_UCTN_Code_CCL_1AF_2AF_3AC

Competing interests: None

Tadic Mario et al. Lymphangioma causing acute recurrent pancreatitis … Endoscopy 2014; 46: E598–E599

This document was downloaded for personal use only. Unauthorized distribution is strictly prohibited.

E598

Cases and Techniques Library (CTL)

1

Department of Gastroenterology, Dubrava University Hospital, Zagreb, Croatia 2 Department of Pathology and Cytology, Dubrava University Hospital, Zagreb, Croatia 3 Department of Radiology, Dubrava University Hospital, Zagreb, Croatia

References 1 Sriram PV, Weise C, Seitz U et al. Lymphangioma of the major duodenal papilla presenting as acute pancreatitis: treatment by endoscopic snare papillectomy. Gastrointest Endosc 2000; 51: 733 – 736 2 Coe AW, Evans J, Conway J. Pancreas cystic lymphangioma diagnosed with EUS-FNA. JOP 2012; 13: 282 – 284 3 Black T, Guy CD, Burbridge RA. Retroperitoneal cystic lymphangioma diagnosed by endoscopic ultrasound-guided fine needle aspiration. Clin Endosc 2013; 46: 595 – 597

Bibliography DOI http://dx.doi.org/ 10.1055/s-0034-1390720 Endoscopy 2014; 46: E598–E599 © Georg Thieme Verlag KG Stuttgart · New York ISSN 0013-726X

Corresponding author Mario Tadic, MD, PhD Department of Gastroenterology Dubrava University Hospital Av. Gojka Suska 6 10040 Zagreb Croatia Fax: +38512902550 [email protected]

Tadic Mario et al. Lymphangioma causing acute recurrent pancreatitis … Endoscopy 2014; 46: E598–E599

This document was downloaded for personal use only. Unauthorized distribution is strictly prohibited.

Mario Tadic1, Zeljko Cabrijan1, Tajana Stoos-Veic2, Mirjana Vukelic-Markovic3

E599

Lymphangioma as a rare cause of acute recurrent pancreatitis.

Lymphangioma as a rare cause of acute recurrent pancreatitis. - PDF Download Free
153KB Sizes 0 Downloads 7 Views

Recommend Documents


Eosinophilic Pancreatitis: A Rare Cause of Recurrent Acute Pancreatitis.
Eosinophilic pancreatitis is a rare form of recurrent acute pancreatitis that demonstrates distinct histologic features, including diffuse, periductal, acinar, and septal inflammatory infiltrates comprised of a pure or predominant population of eosin

Hepatic hydatid cyst: a rare cause of recurrent pancreatitis.
A case of pancreatitis secondary to a hepatic hydatid cyst is illustrated together with its preoperative imaging and intraoperative appearance. Cystobiliary communication is a common complication of large hydatid cysts, and episodes of recurrent panc

A Rare Cause of Recurrent Acute Pancreatitis in a Child: Isovaleric Acidemia with Novel Mutation.
Recurrent acute pancreatic attacks is a rare clinical condition (2-5% of all acute pancreatis) in children and is mainly idiopathic in most cases. Sometimes it may be associated with congenital anomalies, metabolic diseases or hereditary conditions.

Medication as a Cause of Acute Pancreatitis.
BACKGROUND Acute pancreatitis is an inflammatory condition of the pancreas characterized clinically by epigastric abdominal pain and elevated levels of pancreatic enzymes in the blood. Drug-induced pancreatitis has recently gained more attention and

Pancreatic herniation: a rare cause of acute pancreatitis?
Acute pancreatitis is a common and potentially fatal condition, with several well-known causes including gallstones, excessive alcohol consumption and specific medications. We report a case of an 89-year-old man presenting with acute pancreatitis, wh

Hiatus Hernia: A Rare Cause of Acute Pancreatitis.
Hiatal hernia (HH) is the herniation of elements of the abdominal cavity through the esophageal hiatus of the diaphragm. A giant HH with pancreatic prolapse is very rare and its causing pancreatitis is an even more extraordinary condition. We describ

A Rare Surprising Cause of Acute Severe Pancreatitis.
A 39-year-old woman is admitted with clinical, biochemical and imaging features suggestive of acute pancreatitis. Conservative and guideline based management failed to improve her condition. Repeate the imaging utilizing contrast revealed the progres

Pancreatic metastasis from a solitary fibrous tumor of the kidney: a rare cause of acute recurrent pancreatitis.
Solitary fibrous tumors are unusual spindle cell neoplasms that uncommonly originate from the kidney. We report a case of a 43-year old male who presented with acute recurrent pancreatitis secondary to a mass in the head of the pancreas. Endoscopic u