Laparoscopic Excision of a Giant Cystic Adrenal Lymphangioma

Bachar Raad, MD, FACS, Turki Al Nuzha, MD, Ayman Arbaeen, Mohamad Elmy, MRCS, Fakhry Ebouda. Royal Commission Medical Center

Cystic adrenal lymphangiomas are very rare benign lymphatic neoplasms. They are believed to arise from vascular malformation of the lymphatics. They are usually large, well-circumscribed, mul¬tiloculated cystic spaces lined by endothelium containing a connective tissue component that are discovered incidentally most of the time during clinical and diagnostic work up for unrelated reason. Its incidence in autopsy series varies between 0,064 and 0,18%.

We report a case of a 52-year old lady who was evaluated for lower abdominal pain, during her radiological workup the CT showed a large 13x11x12 cm left adrenal cystic neoplasm, which was excised laparoscopically. Postoperative pathological findings were consistent with lymphangioma.

Cystic lymphangiomas may mimic other adrenal neoplasms and must be kept in mind in the clinical and radiologic differential diagnosis of cystic adrenal lesions.

We present this case for the rarity of this condition and the small number of cases managed by laparoscopy as literature review showed.

Introduction:

Adrenal lymphangiomas, also known as cystic adrenal lymphangiomas are very rare and most often found incidentally during abdominal imaging studies or abdominal surgery or autopsy, Its incidence in autopsy series varies between 0,064 and 0,18%(1,2) They are best described as developmental abnormalities of the lymphatics, and they thought to be benign malformations of lymphatic vessels(3,4). They mostly (95%) occur in the neck and axillary regions, rarely in the chest and abdominal cavity.

They are extremely rare located in the adrenal gland, less than 1% of abdominal lymphangiomas originate from the adrenal gland(3).

Imaging is helpful in diagnosing such condition but surgery is the most effective way for treatment and establishing a definite diagnosis(2,4).