P2297 - Pancreatic Lymphangioma: Case Report

Ghaith Almhanni, MD¹, Usman Afzal, MD², Walid Chalhoub, MD¹
1MedStar Georgetown University Hospital, Washington, DC; 2MedStar Health, Washington, D.C., DC

Introduction: Lymphangiomas are rare, benign malformations of the lymphatic system. It is most likely asymptomatic and found incidentally on imaging. Pancreatic lymphangiomas accounts for >1% of abdominal lymphangiomas and >0.5% of all cystic pancreatic lesions. It has a female predominance (ratio 2:1). We are presenting a case of incidentally found pancreatic cystic lymphangioma.

Case Description/

Methods: 60-year-old Caucasian male with past medical history of hypertension, hyperlipidemia, right bundle branch block, and bladder diverticulum presented to the urology clinic for unrelated hematuria found to have cystic lesion on computed tomography (CT) urogram (Figure 1). He is asymptomatic and denies a history of malignancies. Magnetic Resonance Imaging Magnetic Resonance Cholangiopancreatography (MRI MRCP) with/without contrast showed 5.2 cm simple appearing cystic structure within the left upper quadrant. It was finally diagnosed with endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) showing a cyst on pancreatic tail. No cyst lining cells, extracellular mucin, dysplasia or malignancy were identified (Figure 2). DNA and molecular testing showed low carcinoembryonic antigen (CEA) levels < 0.2 ng/mL, low amylase levels 169 U/L and did not detect oncology mutations. The decision was made to continue with conservative management as the patient is asymptomatic.

Discussion: Pancreatic lymphangiomas are rare malformation and most likely asymptomatic. Symptoms are dependent on the tumor size which usually ranges from 3 to 20 cm, and it includes abdominal pain, palpable mass, nausea, vomiting, acute abdomen, cyst rupture, volvulus, and intracystic hemorrhage.

Pancreatic lymphangiomas are mostly benign and do not require surgical intervention unless of a complication or compressing to adjacent organs. To the best of our knowledge there is no reported malignant transformation and most of the asymptomatic cases were decided to be followed up with no surgical intervention.


Figure: CT incidental finding of cystic pancreatic lymphangioma


Figure: A: ThinPrep Papanicolaou-stained. B: Cell block Hematoxylin and Eosin-stained

Disclosures:
Ghaith Almhanni indicated no relevant financial relationships.
Usman Afzal indicated no relevant financial relationships.
Walid Chalhoub indicated no relevant financial relationships.

Ghaith Almhanni, MD¹, Usman Afzal, MD², Walid Chalhoub, MD¹. P2297 - Pancreatic Lymphangioma: Case Report, ACG 2025 Annual Scientific Meeting Abstracts. Phoenix, AZ: American College of Gastroenterology.