Author(s)

V. Poncelet

Patient

female, 43 year(s)

was referred with complaints of constipation and intermittent pain at the right upper flank. Clinical examination was normal. The patient’s history revealed surgery for appendicitis in 1972 and cuneiforme resection of a right ovarian cyst after pelvic hemorrhage in 1991. A CT scan showed a cystic mass in the right upper abdomen. A CT guided percutaneous aspiration was performed with complete emptying of the cyst. Bacteriological, cytological and electrophoretic analyses are performed. Two weeks later the mass recurred.

A 43-year-old woman was referred with complaints of constipation and intermittent pain at the right upper flank. Clinical examination was normal. The patient’s history revealed surgery for appendicitis in 1972 and cuneiforme resection of a right ovarian cyst after pelvic hemorrhage in 1991. A CT scan showed a cystic mass in the right upper abdomen. A CT guided percutaneous aspiration was performed with complete emptying of the cyst. Bacteriological, cytological and electrophoretic analyses are performed. Two weeks later the mass recurred. Because of recurrence of the lesion, surgery was performed and a large cyst with variable wall thickness located in Morison's pouch and extending into the retropancreatic space was found. Histologic diagnosis after resection was unilocular cystic lymphangioma.

Lymphangiomas are benign malformations of lymphatic vessels most frequently discovered in childhood. They are most commonly located in the neck, axillary region and mediastinum (95%). The remaining 5% are found in the abdominal cavity (mesentery, omentum, retroperitoneum, spleen, liver, pancreas). Three histologic types are described: capillary, cavernous and cystic lymphangiomas. Cystic lymphangiomas are usually multilocular, although they may be unilocular. They contain serous or chylous fluid. Differences in cyst content depend on degree of stenosis of the chyle ducts and intrication with the lymphatic system. Clinical symptomatology is linked to the size of the lesion. Differential diagnosis includes mesenteric cyst, duplication cyst and lymphocoele.