Digestive and Liver Disease 47 (2015) 815
Contents lists available at ScienceDirect
Digestive and Liver Disease journal homepage: www.elsevier.com/locate/dld
Image of the Month
Small bowel lymphangioma: A rare case of intestinal bleeding Francesca Bucciero, Maria Marsico, Andrea Galli, Mirko Tarocchi ∗ Gastroenterology Unit, Department of Experimental and Clinical Biomedical Sciences “Mario Serio”, University of Florence, Florence, Italy
Fig. 2.
Fig. 1.
A 28-year-old male with history of melena and anaemia went to Emergency Unit for weakness: laboratory tests revealed severe anaemia with haemoglobin of 4 g/dL. Thereafter endoscopic investigation revealed a bleeding circumferential ulcerated lesion of the third duodenal segment (Fig. 1A). An abdominal computerized tomography scan showed an inhomogeneous mass involving a tract of jejunum with intestinal lumen stenosis (Fig. 1B). Histopathological examination demonstrated numerous dilated lymphatic vessels in the mucous corium with histiocytes compatible with lymphangiectasia (Fig. 2A(H&E staining) and B(D2-40 staining) – 10× magnification). Considering the radiological findings and the multiple gastrointestinal bleeding episodes, the patient underwent surgicalry resection of third and fourth duodenal segments and a small tract of jejunum. Histological examination confirmed an intestinal lymphangioma.
Lymphangiomas are rare lymphatic system tumours and represent 6% of small bowel tumours found in children and 1.4–2.4% in adults [1]. Lesions affecting the jejunum or ileum are extremely rare and account for less than 1% of all lymphangiomas. Small-bowel lymphangiomas are commonly asymptomatic, but sometimes present with gastrointestinal bleeding, abdominal pain, intussusception, and protein-losing gastroenteropathy. Due to its rarity the diagnosis of an endoluminal localization is difficult and may require multiple radiological investigations, capsule endoscopy and/or enteroscopy. Optimal treatment is radical surgical excision to avoid recurrence. Reference [1] Suthiwartnarueput W, Kiatipunsodsai S, Kwankua A, et al. Lymphangioma of the small bowel mesentery: a case report and review of the literature. World Journal of Gastroenterology 2012;18:6328–32.
∗ Corresponding author at: Department of Experimental and Clinical Biomedical Sciences, University of Florence, Viale Pieraccini 6, 50139 Florence, Italy. Tel.: +39 0554271299; fax: +39 0554271297. E-mail address: mirko.tarocchi@unifi.it (M. Tarocchi). http://dx.doi.org/10.1016/j.dld.2015.03.025 1590-8658/© 2015 Editrice Gastroenterologica Italiana S.r.l. Published by Elsevier Ltd. All rights reserved.
Contents lists available at ScienceDirect
Digestive and Liver Disease journal homepage: www.elsevier.com/locate/dld
Image of the Month
Small bowel lymphangioma: A rare case of intestinal bleeding Francesca Bucciero, Maria Marsico, Andrea Galli, Mirko Tarocchi ∗ Gastroenterology Unit, Department of Experimental and Clinical Biomedical Sciences “Mario Serio”, University of Florence, Florence, Italy
Fig. 2.
Fig. 1.
A 28-year-old male with history of melena and anaemia went to Emergency Unit for weakness: laboratory tests revealed severe anaemia with haemoglobin of 4 g/dL. Thereafter endoscopic investigation revealed a bleeding circumferential ulcerated lesion of the third duodenal segment (Fig. 1A). An abdominal computerized tomography scan showed an inhomogeneous mass involving a tract of jejunum with intestinal lumen stenosis (Fig. 1B). Histopathological examination demonstrated numerous dilated lymphatic vessels in the mucous corium with histiocytes compatible with lymphangiectasia (Fig. 2A(H&E staining) and B(D2-40 staining) – 10× magnification). Considering the radiological findings and the multiple gastrointestinal bleeding episodes, the patient underwent surgicalry resection of third and fourth duodenal segments and a small tract of jejunum. Histological examination confirmed an intestinal lymphangioma.
Lymphangiomas are rare lymphatic system tumours and represent 6% of small bowel tumours found in children and 1.4–2.4% in adults [1]. Lesions affecting the jejunum or ileum are extremely rare and account for less than 1% of all lymphangiomas. Small-bowel lymphangiomas are commonly asymptomatic, but sometimes present with gastrointestinal bleeding, abdominal pain, intussusception, and protein-losing gastroenteropathy. Due to its rarity the diagnosis of an endoluminal localization is difficult and may require multiple radiological investigations, capsule endoscopy and/or enteroscopy. Optimal treatment is radical surgical excision to avoid recurrence. Reference [1] Suthiwartnarueput W, Kiatipunsodsai S, Kwankua A, et al. Lymphangioma of the small bowel mesentery: a case report and review of the literature. World Journal of Gastroenterology 2012;18:6328–32.
∗ Corresponding author at: Department of Experimental and Clinical Biomedical Sciences, University of Florence, Viale Pieraccini 6, 50139 Florence, Italy. Tel.: +39 0554271299; fax: +39 0554271297. E-mail address: mirko.tarocchi@unifi.it (M. Tarocchi). http://dx.doi.org/10.1016/j.dld.2015.03.025 1590-8658/© 2015 Editrice Gastroenterologica Italiana S.r.l. Published by Elsevier Ltd. All rights reserved.
