25 Pancreatic Lymphangioma

Clinical Presentation

A 38-year-old woman presents with abdominal pain and epigastric tenderness.

Fig. 25.1 (A–D) Images from a contrast-enhanced abdominal CT scan show a large, lobulated, well-defined, hypodense, finely septated mass associated with the pancreatic head and body.

Abdominal contrast-enhanced computed tomography (CT) scans (Fig. 25.1) show a large, lobulated, hypodense lesion with multiple thin septations, centered in the upper abdomen, intimately associated with the pancreas. The superior mesenteric artery and vein and the portal vein are patent.

Diagnosis

Pancreatic lymphangioma

Differential Diagnosis

Pseudocyst
Pancreatic cystic neoplasms: mucinous cystic neoplasms, intraductal papillary mucinous neoplasia (IPMN)
Rare pancreatic cystic neoplasms: solid pseudopapillary tumor, acinar cell cystoadenocarcinoma, hemangioma, paraganglioma
Solid pancreatic lesion with cystic degeneration: pancreatic adenocarcinoma, cystic islet cell tumor
Metastasis
Cystic teratoma
True epithelial cyst (associated with von Hippel-Lindau disease, autosomal dominant polycystic kidney disease, cystic fibrosis)
Lymphocele (if patients have recently undergone surgery)