Retropancreatic cystic lymphangioma - considerations upon a case

Cystic lymphangiomas are benign tumors developing as an anomaly of the lymphatic channels. Most of them are discovered in children and are located mostly in the head and neck with no differences between sexes. Retroperitoneal locations are rare, clinical symptoms not specific and are discovered incidentally. We report the case of a 32-year-old female sex patient with a cystic tumor situated in the retroperitoneum, behind the pancreas, discovered by abdominal ultrasound during a diagnostic work-out for urinary infection and hypertension. Anamnesis, physical examination and CT-scan could not indicate the nature of the cyst. The cystic tumor had a shape of a butterfly, crossing the midline in front of the aorta and vena cava. A laparotomy was indicated and established the diagnosis of a cystic lymphagioma based on its macroscopic appearance. The tumor was approached from its right side by a generous Kocher maneuver and then from the left by disinsertion of the Treitz ligament and elevating the pancreatic body and splenic vessels. It was completely removed. Postoperative course was uneventful. Histopathologic examination confirmed the diagnosis of benign cystic lymphangioma. At 2 years of follow-up the patient was free of recidive.

Retropancreatic cystic lymphangioma are rarely seen in adults. Precise diagnosis is made at laparotomy, imagistic test give details about walls, content, relationship with the surrounding structures and major blood vessels. Complete surgical resection represents the treatment of choice avoiding recurrence.