Symptomatic diffuse cystic lymphangioma of the spleen in an adult: A case report

Introduction: Cystic lymphangioma of the spleen is a rare, benign tumor originating from lymphatic malformations, typically discovered incidentally during imaging. Its etiology is believed to stem from congenital lymphatic anomalies. Although often asymptomatic, larger splenic lymphangiomas can cause abdominal pain and complications.

Case presentation: We present the case of a 54-year-old woman with a history of hypertension who experienced chronic left upper quadrant pain for five months. Physical examination was unremarkable, with no detectable abdominal masses. An initial abdominal ultrasound revealed a 3.9 cm non-vascular mass in the spleen. Subsequent contrast-enhanced CT and MRI identified multiple cystic lesions consistent with cystic lymphangioma. Due to the patient's persistent symptoms and diffuse splenic involvement, a laparoscopic total splenectomy was performed. Histopathological analysis confirmed the diagnosis, showing cysts lined by CD31-positive endothelial cells. The patient had an uneventful postoperative recovery.

Discussion: Splenic cystic lymphangiomas are exceptionally rare, particularly in adults. While benign, these lesions can lead to significant complications, necessitating surgical intervention in symptomatic cases. Imaging techniques such as ultrasound, CT, and MRI play a crucial role in diagnosis and differentiation from other splenic pathologies. Laparoscopic splenectomy is the treatment of choice for symptomatic or large cystic lymphangiomas due to its minimal invasiveness and low recurrence rates.

Conclusion: This case highlights the importance of considering cystic lymphangioma in the differential diagnosis of splenic cystic lesions. It also emphasizes the effectiveness and safety of laparoscopic splenectomy as a definitive treatment option for symptomatic cases.