Imaging features, complications and differential diagnoses of abdominal cystic lymphangiomas

Our plain-English summary of Imaging features, complications and differential diagnoses of abdominal cystic lymphangiomas, by M. Raufaste Tistet, O. Ernst, M. Lanchou, et al (Abdominal Radiology, 2020).

The study

• Authors: M. Raufaste Tistet, O. Ernst, M. Lanchou, M. Vermersch, P. Lebert
• Journal: Abdominal Radiology
• Published: 2020;45(11):3589-3607
• Type of article: Review
• Cited by: 22 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

Purpose: The aim of the study is to describe the imaging features, complications and differential diagnoses of abdominal cystic lymphangiomas (ACLs).

Results: ACLs are benign lymphatic malformations that mainly arise in the subperitoneal space and the retroperitoneum. The typical presentation of an ACL is a multilocular lesion with homogenous serous content, presenting a thin wall and septa, usually free from adjacent organ compression. Atypical findings, including fat or hemorrhagic content, septal calcifications and unilocular presentation, are not uncommon. Rarely, ACLs can be revealed by acute complications, such as infection, hemorrhage, intussusception, complications with a twisting mechanism (including torsion around its own pedicle) or spontaneous rupture, which can be diagnosed by imaging. Ultrasonography and CT are the most useful modalities in emergency situations. MRI performs best in the noninvasive characterization of cystic lesions. ACLs should be differentiated from normal anatomic structures (e.g., cisterna chyli) or pitfalls (e.g., ascites, extrapancreatic necrosis, lymphocele) that can simulate ACLs. Among other primary peritoneal cystic lesions, benign cystic mesothelioma can be difficult to differentiate from ACL. Some neoplastic peritoneal lesions may have cystic components or content that looks like fluid on imaging (such as mucinous or myxoid content) and be misdiagnosed as ACL. Nodular or thick enhancement of the wall or septa should then be considered worrisome features and should not suggest ACL. ACLs mostly require a simple follow-up. If treatment is necessary, percutaneous sclerotherapy is a safe and effective alternative to surgery.

Conclusion: Imaging, especially MRI, allows the noninvasive diagnosis of ACL and helps to exclude potential malignant differential diagnoses.

In plain English

This article is a pictorial essay, published as a review, from a radiology department at a university hospital in Lille, France. It described how abdominal cystic lymphangiomas look on ultrasound, CT and MRI. The authors call these benign lymphatic malformations. The article also covered the complications they can cause and the conditions that can be mistaken for them. The authors said it summarized their experience with 78 pathologically confirmed cases diagnosed from January 2011 to December 2017. Beyond that total, it gives no breakdown or statistics for those cases. Instead it illustrates individual patients and draws heavily on earlier published studies. The authors described infection as the most common complication. Among look-alike conditions, they said benign cystic mesothelioma may be difficult to tell apart from a lymphangioma. They also said that a cystic malignant mesothelioma showing nodular wall enhancement should not be diagnosed as a lymphangioma. Figures such as recurrence rates after surgery came from other studies. The article does not discuss asbestos. The authors concluded that imaging, especially MRI, allows noninvasive diagnosis and helps exclude possible malignant diagnoses.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: Pictorial essay (published under the heading 'Review') describing imaging features, illustrated with cases from the authors' center and drawing largely on published literature
• Who was studied: 78 pathologically confirmed abdominal cystic lymphangiomas diagnosed from January 2011 to December 2017 at a tertiary medical center (University Hospital, Lille, France). Beyond the total, the article gives no breakdown of these cases. Individual patients are shown in figures.
• Exposure: No exposure was studied. The article concerns the imaging appearance of a benign lymphatic malformation, and it does not mention asbestos. Mesothelioma (benign cystic mesothelioma and malignant mesothelioma of the peritoneum) appears only as a condition to distinguish from lymphangioma on imaging.
• Main results:
  • The authors described the typical lymphangioma as a multilocular lesion with homogeneous serous content and a thin wall and septa, usually not compressing nearby organs. This description cites earlier published studies.
  • The authors described infection as the most common complication of abdominal cystic lymphangiomas.
  • The authors described twisting of a lymphangioma around its own pedicle as a possible but exceedingly rare complication. One patient with this complication is shown in a figure.
  • The authors stated that benign cystic mesothelioma (peritoneal inclusion cyst) may be difficult to differentiate from a lymphangioma, because it also has a mildly complex cystic appearance.
  • The authors stated that malignant mesothelioma can look cystic, but that nodular enhancement in the wall is a worrisome feature that rules against a lymphangioma diagnosis.
  • Citing earlier studies, the authors stated that no malignant transformation of abdominal cystic lymphangioma had been formally diagnosed to date.
  • Earlier studies cited by the authors reported recurrence rates of 10 to 27% after complete surgical resection. These are not results from this article's cases.
  • Earlier studies cited by the authors reported complete resolution in 63 to 90% of macrocystic lesions treated with percutaneous sclerotherapy. These are not results from this article's cases.
• The authors' conclusion: The authors concluded that imaging, especially MRI, allows the noninvasive diagnosis of abdominal cystic lymphangioma and helps to exclude potential malignant differential diagnoses.

Topics

Medical terms in this study, explained in our Lexicon: Retroperitoneum, Ascites, Necrosis, Mesothelioma.

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• Primary malignant tumors of peritoneal and retroperitoneal origin: clinical and imaging features — M.G. Lubner, J.L. Hinshaw, et al. (2014)
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• Multidetector CT Findings and Differential Diagnoses of Malignant Pleural Mesothelioma and Metastatic Pleural Diseases in Korea — Y.K. Kim, J.S. Kim, et al. (2016)

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