Mesenteric cyst: abdominal lymphangioma

INTRODUCTION

Mesenteric cyst is defined as a cystic lesion located between the leaflets of the mesentery from the duodenum to the rectum , being most commonly found in ileum level. Since its first description in 1507 by Benevienae until 1993 there are only about 820 cases reported in the literature^4 - 6.

Lymphangiomas are benign tumors, probably congenital, are more common in the cervical and axillary regions. They are unusual in abdominal and pancreas location. Its incidence is estimated at around 1:100,000 and 1:20,000 admissions in adults and in children. The first excision was performed by Tillaux (quoted Chung) only in 1802⁵. Despite the long recognition of this disease, its origin classification and pathology remain controversial. The highest incidence is between the third and fourth decades of life, with 75% of those diagnosed after ten years with a slight female predominance. The term lymphangioma is appropriately used when there is hemodynamic isolation, or the injury is not related to the blood system^10 - 13. Lymphangiomas are a major group of so-called vascular hamartomas, which result from a failure in the evolutionary development of the vascular system, including lymphatic and/or arteries and veins³.

These lymphatic tumors are divided in: 1) simple, with capillary lymphatic channels; 2 ) cavernous, with dilated lymphatics and the presence of capsule; and 3) macrocystic malformations, clinically termed "cystic hygroma"⁶. This is the most common type, and the most affected sites are head and neck. The main differential diagnosis is hemangioma, branchial cysts, lipomas and rabdmiossarcoma. Diagnosis is made by biopsy of suspicious nodules, and the main treatment is surgical excision.

CASE REPORT

Fifty-eight years man came to San Francisco Hospital in Taquaral of Goiás, Brazil, after previous medical care without diagnosis or treatment. He had a history of a large mass over a year of slow evolutionary character. He denied pain, headache, fever, diarrhea and other symptoms. Physical examination revealed good general condition, acyanotic, afebrile, hydrated, normotensive, rhythmic, symmetrical heart sounds without murmur. His abdomen had a moving mass of 10 cm in diameter, painless to superficial and deep palpation. Ultrasonography showed an intraperitoneal cyst apparently mesenteric (Figure 1).