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Cystic Lymphangioma: Are Triglycerides Always Measurable?
Silke François1, Manuella Martin2, Olivier Costa2
1Universitair Ziekenhuis Brussel (UZ Brussel), Vrije Universiteit Brussel (VUB), Department of Gastro-Enterology, Laarbeeklaan 101, 1090 Brussels, Belgium.
Case Reports in Gastrointestinal Medicine
|April 25, 2018
Summary
Chylous fluid in pancreatic cysts, often indicating cystic lymphangiomas, may show absent triglyceride levels due to sample dilution or lipase activity. This highlights potential diagnostic challenges in endoscopic ultrasound-guided fine needle aspiration.
Area of Science:
- Gastroenterology
- Endocrinology
- Surgical Pathology
Background:
- Cystic lymphangiomas of the pancreas are rare benign neoplasms.
- Endoscopic ultrasound- (EUS-) guided fine needle aspiration (FNA) is a key diagnostic tool.
- Chylous fluid with high triglycerides is considered pathognomonic for cystic lymphangiomas.
Observation:
- A case report details a pancreatic cyst puncture yielding milky fluid, characteristic of chylous effusion.
- However, laboratory analysis revealed undetectable triglyceride concentrations.
- This presented a diagnostic discrepancy despite the fluid's appearance.
Findings:
- Two potential explanations for absent triglyceride levels were identified.
- 1. Grossly lipemic samples may yield false-negative results due to slow color development and insufficient dilution.
- 2. Elevated lipase levels can hydrolyze triglycerides into glycerol and fatty acids, rendering them undetectable.
Implications:
- The findings suggest that triglyceride levels alone may not be definitive in diagnosing pancreatic cystic lymphangiomas.
- Clinicians should consider sample handling and potential enzymatic activity when interpreting EUS-FNA fluid analysis.
- Further investigation into diagnostic markers for pancreatic cystic lymphangiomas is warranted.
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