Retroperitoneal Cystic Lymphangioma Diagnosed by Endoscopic Ultrasound-Guided Fine Needle Aspiration
A 66-year-old female presented to her primary care physician for evaluation of 3 months of abdominal pain. Her pain was associated with heartburn, bloating, and indigestion and had been unresponsive to acid suppressing therapy. She denied any nausea or vomiting but did note occasional diarrhea. Further evaluation was performed with an abdominal ultrasound which revealed a 5 cm hypoechoic mass in the region of the tail of the pancreas. She underwent a magnetic resonance imaging (MRI) which confirmed the mass and noted it to be cystic in nature with multiple thin septations (). The patient was referred to gastroenterology and underwent EUS with FNA of the cystic lesion. EUS identified a 4.7×3.3 cm cystic lesion with internal septations adjacent to the tail of the pancreas, but not within the pancreas itself (). White colored fluid was aspirated using a 19 gauge Cook Echotip FNA needle and initial fluid analysis was notable for lymphocytes. A fluid triglyceride level was noted to be elevated at 8,243 mg/dL. The patient was referred to surgery and underwent laparoscopic removal of the cystic lesion. Post resection, surgical pathology specimens were consistent with a cystic lymphangioma (, ). At her 1 month postoperative visit, the patient noted significant improvement in her abdominal pain.