Lymphatic cysts of the colon

Abstract

SUMMARY A patient with a lymphatic cyst of the descending colon is reported. He underwent segmental resection of the colon. The clinical features, pathology, radiology, and treatment of these lesions are reviewed. It is emphasized that these cysts are very rare and cannot be diagnosed radiologically, but must be included in the differential diagnosis of polypoid lesions of the colon.Lymphatic cysts (cystic lymphangiomata, lymphangiomatous, lymphangiectatic, or chylous cysts) of the abdomen are rare and can occurinthemesentery, omentum, retroperitoneum, and very occasionally in the wall of the stomach, duodenum, and the small or large intestine.The extreme rarity of the lesion and the interesting radiological appearances and differential diagnosis warrant the report of a case and a brief review of the literature. Case ReportA 65-year-old man reported a three-month history of left-sided abdominal colic and melaena. He had a normal bowel habit and there was no vomiting.On examination there was guarding and tenderness in the central abdomen and left hypochondrium. No mass could be palpated.Rectal and sigmoidoscopic examinations were negative. Double-contrast barium enema study demonstrated a large, smoothly outlined and well circumscribed polypoidal lesion with a broad base on the medial wall of the descending colon ( Figs. 1 and 2). There was diverticular disease of the sigmoid colon.At laparotomy the polypoidal mass was palpated in the upper third of the descending colon, but suddenly disappeared. (Subsequently, this was found to be due to rupture and emptying of the cyst during palpation.) A segmental resection was undertaken. The resected colon was opened and a large redundant fold of mucosa was found which was clearly all that remained of a ruptured cyst. The lesion was inflated with water and a photograph taken (Fig. 3).Received for publication 26 June 1971. PathologyThe inflated specimen was thin walled and measured 2.5 cm in diameter.Histology revealed a large unilocular submucosal cyst lined with flattened endothelium and the appearances were in keeping with those of a lymphatic cyst. There was no evidence of malignant change. DiscussionLymphatic cysts of the gut are extremely rare entities. A review of these cysts at the Mayo Clinic over a 36-year period revealed nine cases; six of these were found in the mesentery, two in the retroperitoneum, and one was of undetermined origin. No mural cysts of the alimentary tract were reported (Beahrs, Judd, and Dockerty, 1950).

Lymphangioma of the Duodenum: (Diagnosis by Endoscopic Resection)

“…Submucosal lymphatic cysts or lymphangiomas are very rare tumors of the duodenum (4,6,7,8). Roentgenographically, they are described as sharply marginated filling defects and may be overlooked easily.…”