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Published on: September 24, 2020
A case of invasive hemolymphangioma of the pancreas
Yoshikazu Toyoki1, Kenichi Hakamada, Shunji Narumi
1Department of Gastroenterological Surgery, Hirosaki University School of Medicine, 5 Zaifu-cho, Hirosaki, Aomori 0368652, Japan. ytoyoki@cc.hirosaki-u.ac.jp
Abstract:
Hemolymphangioma of the pancreas is a very rare benign tumor. There were only five reports of this disease until March 2008. Herein, we report a case of hemolymphangioma of the pancreas with gastrointestinal bleeding due to duodenal invasion. A 53-year-old man had been admitted a referral hospital because of severe anemia due to gastrointestinal bleeding in December 2005. He was then transferred to our institute with a diagnosis of a tumor of the head of the pancreas with duodenal invasion in January 2006. No abnormalities were revealed except for anemia in laboratory data including CEA and CA19-9. Gastrointestinal endoscopy revealed bleeding at the duodenum. Computed tomography also demonstrated a heterogenous mass at the pancreatic head and suspected invasion to the duodenal wall. Ultrasonography showed a huge mass at the pancreatic head with a mixture of high and low echoic areas. Pylorous-preserving pancreatoduodenectomy was performed. The pancreatic tumor was soft and had invaded to the duodenum. The pathological diagnosis was a hemolymphangioma of the pancreas invaded to the duodenum. His postoperative course was uneventful and he was discharged on the 26th d after surgery. Hemolymphangioma of the pancreas is a very rare benign tumor. In a literature review until March 2008, we found five case reports. Major symptoms are abdominal pain and distension due to the enlarged tumor. However, we experienced a case of hemolymphangioma of the pancreas with gastrointestinal bleeding due to invasion to the duodenum. This disease is a very rare entity, but should be considered when patients have gastrointestinal bleeding.
Insights
Pancreatic hemolymphangioma, a rare benign tumor, can cause gastrointestinal bleeding due to duodenal invasion. This case highlights the need to consider this rare entity in patients presenting with bleeding.
Area of Science:
- Gastroenterology
- Surgical Oncology
- Pathology
Background:
- Hemolymphangioma of the pancreas is an exceptionally rare benign tumor, with limited documented cases prior to March 2008.
- Typical presentations involve abdominal pain and distension due to tumor mass effect.
Observation:
- A 53-year-old male presented with severe anemia secondary to gastrointestinal bleeding.
- Diagnostic imaging revealed a heterogeneous pancreatic head mass with suspected duodenal invasion.
- Endoscopy confirmed duodenal bleeding, leading to a diagnosis of pancreatic hemolymphangioma with duodenal invasion.
Findings:
- The pancreatic hemolymphangioma was confirmed pathologically after a pylorus-preserving pancreatoduodenectomy.
- The tumor demonstrated invasion into the duodenal wall, a less common presentation.
- Postoperative recovery was uneventful.
Implications:
- This case underscores that pancreatic hemolymphangioma, despite its rarity, can manifest with significant gastrointestinal bleeding.
- Clinicians should consider hemolymphangioma in the differential diagnosis for patients with unexplained gastrointestinal bleeding, particularly when pancreatic lesions are identified.
- Further research into the clinical behavior and management of pancreatic hemolymphangioma is warranted.