Test Paper 1
Teck Yew Chin, Susan Cheng Shelmerdine, Akash Ganguly, Chinedum Anosike in Get Through, 2017
A cystic hygroma is the most common form of lymphangioma and constitutes about 5% of all benign tumours of infancy and childhood. On US scans, most cystic hygromas manifest as a multilocular predominantly cystic mass with septa of variable thickness. The echogenic portions of the lesion correlate with clusters of small, abnormal lymphatic channels. Fluid–fluid levels can be observed with a characteristic echogenic, haemorrhagic component layering in the dependent portion of the lesion. Prenatal US may demonstrate a cystic hygroma in the posterior neck soft tissues. On CT images, cystic hygromas tend to appear as poorly circumscribed, multiloculated, hypoattenuated masses. They typically have characteristic homogeneous fluid attenuation. Usually, the mass is centred in the posterior triangle or in the submandibular space.
Malformations of the Lymphatic System
Waldemar L. Olszewski in Lymph Stasis: Pathophysiology, Diagnosis and Treatment, 2019
Lymphangioma cavernosum, with its larger cavities, has a location deeper in the skin and subcutaneous tissue (see Figure 2). The skin-colored to reddish-bluish vascular tumors have a preferred location on the genitals and lower extremities, where they may become the starting point for elephantiasis. The less frequent localization on the lip and tongue (as also for L. circumscriptum) may lead to macrochilia and macroglossia and even to tracheal stenosis.3 The tongue is affected either on one side or in its anterior third. The cavernous lymphangioma may affect large areas of body and create a picture of elephantiasis.4 In the case of hematolymphangioma, this involves cavities connected with blood vessels, in addition to cystic dilatations of the lymph vessels. Congenital lymphangioma cysticum is usually a generalized malformation which starts from the submaxillary region, preferentially involving the throat, neck, and axilla, and may advance into one half of the face. A localization on the trunk or legs is less frequent. Cystic lymphangioma may protrude to the muscles.6 In addition to a dominant tumor, many smaller lymph ectasias, down to the “lymph-vessel varices”, are found.
Mediastinal tumours
Anju Sahdev, Sarah J. Vinnicombe in Husband & Reznek's Imaging in Oncology, 2020
The presence of any soft tissue strands should suggest the possibility of liposarcoma (130). Liposarcomas are not homogeneously fatty like lipomas, but contain islands of soft tissue (134). Poorly differentiated liposarcomas may not demonstrate any visible fatty component on imaging studies (134). The prognosis of these tumours depends on the grade and extent of local invasion. The most common CT finding of lymphangioma includes a smoothly-marginated cystic mass with homogeneous water density (135,136). Multiple locations may be seen within the mass in approximately one-third of patients. Haemorrhage into a lesion may lead to an increase in size and attenuation values on CT. The findings on MRI are variable and non-specific. Haemangiomas on CT are often heterogeneous in attenuation on unenhanced images, and fat may occasionally be seen within them. Heterogeneous enhancement is typical after contrast-medium administration, but is not always present (137). Enhancement may be dense, multifocal, or diffuse, and central or peripheral. Hemangiopericytomas are inhomogeneous in appearance with central areas of low attenuation and peripheral rim enhancement after intravenous administration of contrast material (138). On MRI, they are heterogeneous in signal intensity in T1-weighted (T1W) and T2-weighted (T2W) spin-echo images (138). Although some hemangiopericytomas are truly benign, many invade locally at the time of diagnosis and may recur after surgical excision (139).
Isolated cranio-orbitofacial neurofibroma mimicking vascular malformation
Published in Orbit, 2018
Harinder S. Chahal, Brandon Kuiper, Puneet S. Braich, A. Tyrone Glover
We were led to a presumptive diagnosis of lymphangioma because of the cystic-lobulated appearance of the tumor, along with bony remodeling and extension into various anatomic compartments, combined with the initial presentation in early childhood. Despite the presence of pain, the absence systemic signs of neurofibromatosis made the diagnosis of a neurofibroma less likely. The presumptive diagnosis of lymphangioma, along with the patient’s initial reluctance, led us to postpone surgery. The final diagnosis of isolated neurofibroma, therefore, may have had significant diagnostic, prognostic, and treatment implications if discovered earlier in the management of this unusual case.
Thoracic benign cystic mesothelioma
Published in Acta Chirurgica Belgica, 2023
M. Furkan Sahin, Alkin Yazicioglu, Neslihan Inci Zengin, Erdal Yekeler
Lymphangioma and malignant cystic mesothelioma are important in differential diagnosis. Lymphangioma can be distinguished by the observation of lymphoid aggregates with smooth muscle cells on its wall and by observing cytokeratin and calretinin as negative immunohistochemically. In macroscopic and microscopic evaluation, widespread mesothelial proliferation with cellular atypia is often sufficient for the diagnosis of mesothelioma [7].
Enterogenous cyst of the small bowel mesentery: a case report and review of the literature
Published in Acta Chirurgica Belgica, 2019
Donatas Danys, Raminta Martinaitytė, Jolanta Zacharic, Eligijus Poskus, Edvardas Zurauskas, Tomas Poskus, Kęstutis Strupas
Ultrasound showed a thin-walled cyst with clear filling in right inguinal region. Based on radiological findings, retroperitoneal cystic lymphangioma was diagnosed and the patient underwent surgery. During laparotomy, 30 cm from duodenojejunal fold, 7 × 7 × 5 cm cystic mass was identified on mesentery and excised. It occurred to be 170 g cystic mass filled with white lymph (Figures (2–4)).
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