Giant cystic lymphangioma in the pancreatic tail-splenic hilum region managed by en bloc resection: A case report.
Yuting Wang, Bin Xiong, Junwei Niu et al.
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Case in brief
A 43-year-old woman presented with two days of persistent dull left upper abdominal pain and nonspecific inflammatory and mild hepatobiliary laboratory abnormalities. Imaging showed an approximately 160 × 110 mm multiloculated cystic lesion closely related to the pancreatic tail and splenic hilum. Histology demonstrated dilated endothelial-lined lymphatic spaces, with D2-40 positivity supporting lymphangioma. Dense adherence without a safe dissection plane led to en bloc resection with distal pancreatectomy, splenectomy, and cholecystectomy. A postoperative biochemical leak required no additional intervention; she was discharged on postoperative day 11.
What made this case unusual
The giant lymphangioma occupied the pancreatic tail–splenic hilum region, where it could mimic pancreatic or peripancreatic cystic disease; dense adherence also precluded safe separation from adjacent organs.
Diagnostic / clinical pearl
Include lymphangioma in the differential for a giant multiloculated cystic lesion near the pancreatic tail and splenic hilum; histology with endothelial-lined lymphatic spaces and D2-40 positivity supported the diagnosis in this case.
Why it matters
When a symptomatic lesion cannot be safely separated from adjacent organs, en bloc resection can provide definitive diagnosis and treatment, as in this case.