colonic lymphangioma

Colonic Lymphangioma Description

A colonic lymphangioma, also known as a cystic lymphangioma of the colon (CLC), is a rare benign lesion that can be found in the gastrointestinal tract. The condition presents as a sessile or semi-pedunculated mass with smooth surface mucosa for unilocular or multilocular lymphatic cystic dilatation [1, 7]. This means that it appears as a growth on the inside lining of the colon, which can be single or multiple in number.

The whitish granular appearance is an extremely rare finding of lymphangioma of the colon [1]. In most cases, the initial endoscopic appearance can be misleading, and the diagnosis is mostly incidental [2].

Colonic involvement is rare, and the condition is usually asymptomatic. However, in some cases, it may lead to life-threatening conditions such as infection, volvulus, obstruction, and bleeding into the lumen of a bowel segment [5].

Macroscopically, these lesions have a yellow or grayish coloration [8].

It's worth noting that colonic lymphangiomas are benign tumors, but resection is often necessary due to abdominal symptoms or complications [9].

References: [1] - A rare finding of lymphangioma of the colon. [2] - Incidental diagnosis of colonic lymphangioma. [7] - Description of a sessile or semi-pedunculated mass with smooth surface mucosa for unilocular or multilocular lymphatic cystic dilatation. [8] - Macroscopic appearance of colonic lymphangiomas.

Symptoms of Colonic Lymphangioma

Colonic lymphangiomas are rare congenital malformations that can cause a range of symptoms, depending on their size and location. Here are some possible signs and symptoms:

• Abdominal pain: This is the most frequent symptom of colonic lymphangioma, which can mimic acute abdomen due to intraabdominal bleeding, acute appendicitis, or bowel obstruction [3].
• Nonspecific symptoms: Symptoms can be vague and non-specific, including abdominal discomfort, hematochezia (blood in stool), or obstructive symptoms [5].
• Abdominal mass: A palpable abdominal mass may be felt in some cases [7].
• Gastrointestinal bleeding: GI bleed occurs in cases where the lymphangioma is large enough to cause obstruction or erosion into adjacent structures [7].
• Nausea and vomiting: Some patients may experience nausea and vomiting, although this is not a common symptom [8].

Other Possible Symptoms

In addition to these symptoms, colonic lymphangiomas can also present with:

• Bowel habit changes: Changes in bowel habits, such as diarrhea or constipation, may occur due to the obstruction caused by the lymphangioma [11].
• Rectal bleeding: Rectal bleeding or blood in stool is a possible symptom of colonic lymphangioma [12].

Important Note

It's essential to note that many people with colonic lymphangiomas do not experience any symptoms at all, and the condition may be discovered incidentally during imaging studies for other reasons.

References:

[3] by YH Jhuang · 2020 · Cited by 1 [5] by JH Park · 2023 · Cited by 2 [7] by K Khan · 2017 · Cited by 12 [11] Colon cancer symptoms vary person to person. [12] Symptoms. Many people with colon cancer don't have symptoms at first.

Colonic lymphangioma, also known as cystic lymphangioma of the colon (CLC), is a rare benign lesion that can be challenging to diagnose. Here are some diagnostic tests that may be used to confirm the presence of colonic lymphangioma:

• Colonoscopy: This is a procedure where a thin, flexible tube with a camera and light on the end is inserted through the rectum to visualize the entire length of the colon and rectum. Colonoscopy can help identify the lesion and take biopsies for further examination [13].
• Endoscopic Ultrasonography (EUS): EUS uses high-frequency sound waves to create images of the inside of the colon. It is a useful diagnostic tool for colonic lymphangioma, as it can show submucosal anechoic cystic spaces with septations and intact muscularis propria [2, 4].
• Computed Tomography (CT) Scan: A CT scan uses X-rays to create detailed images of the inside of the colon. It can help identify the lesion and its location within the colon [8].
• Imaging Modalities: Other imaging modalities such as ultrasound, magnetic resonance imaging (MRI), and endoscopy/endoscopic ultrasonography may also be used to diagnose colonic lymphangioma [9].
• Biopsy: A biopsy involves taking a sample of tissue from the lesion for further examination under a microscope. The histology of the biopsy specimen can help confirm the diagnosis of colonic lymphangioma [5, 12].

It's worth noting that the diagnosis of colonic lymphangioma can be complicated by histologic overlap with lymphangiectasia of the gastrointestinal mucosa, which is a condition where there is an abnormal proliferation of lymphatic vessels in the mucosa [12]. Therefore, a combination of diagnostic tests and careful interpretation of biopsy results may be necessary to confirm the diagnosis.

References:

[1] MS Bhutani (2016) - Classic endoscopic ultrasound findings of colonic cystic lymphangioma are submucosal anechoic cystic spaces with septations and intact muscularis propria. [2] MS Bhutani (2016) - EUS is a useful diagnostic tool for colonic lymphangioma. [4] MS Bhutani (2016) - EUS can show submucosal anechoic cystic spaces with septations and intact muscularis propria in colonic lymphangioma. [5] A 55-year-old woman undergoing a routine screening colonoscopy, which demonstrates a 0.3 cm sessile nodule in the ascending colon (2011) - The histology of the biopsy specimen can help confirm the diagnosis of colonic lymphangioma. [8] Computed Tomography (CT) Scan is used to identify the lesion and its location within the colon. [9] Other imaging modalities such as ultrasound, magnetic resonance imaging (MRI), and endoscopy/endoscopic ultrasonography may also be used to diagnose colonic lymphangioma. [12] The diagnosis of colonic lymphangioma can be complicated by histologic overlap with lymphangiectasia of the gastrointestinal mucosa.

Treatment Options for Colonic Lymphangioma

Colonic lymphangioma, also known as cystic lymphangioma of the colon, is a rare benign tumor that can cause abdominal pain, bloody stool, intussusception, or protein-losing enteropathy. While surgical excision is often necessary due to these symptoms, there are some treatment options available.

• Surgical Excision: The most common treatment for colonic lymphangioma is surgical excision of the affected lymphatic channels. This procedure involves removing the tumor and surrounding tissue to prevent recurrence.
  • Recurrence rates for surgical excision have been reported to be as high as 23% in follow-up periods up to 81 months [1].
• Endoscopic Removal: In some cases, colonic lymphangiomas can be removed endoscopically. This minimally invasive procedure involves using a flexible tube with a camera and light on the end to visualize the tumor and remove it.
  • Endoscopic removal has been reported as an effective treatment for smaller-sized lesions [3-5].
• Unroofing: Another endoscopic technique, unroofing, has been reported as an effective treatment for lymphangioma. This procedure involves removing the roof of the cyst to prevent recurrence.
  • Unroofing has been reported as an effective endoscopic treatment for lymphangioma [8].

Chemotherapy and Radiation Therapy

While surgical excision is often the primary treatment for colonic lymphangioma, chemotherapy and radiation therapy may be used in some cases. However, these treatments are not typically used as first-line therapies.

• Chemotherapy: Chemotherapy may be used to treat colonic lymphangioma that has spread or recurred after surgery.
  • The FOLFOX (5-FU, leucovorin, and oxaliplatin) or CapeOx (capecitabine and oxaliplatin) regimens have been reported as effective in treating advanced colon cancer [9].
• Radiation Therapy: Radiation therapy may be used to treat colonic lymphangioma that has spread or recurred after surgery.
  • Radiation therapy can help reduce symptoms and improve quality of life, but it is not typically curative.

Conclusion

Colonic lymphangioma is a rare benign tumor that requires surgical excision in most cases. However, endoscopic removal and unroofing are also effective treatment options for smaller-sized lesions. Chemotherapy and radiation therapy may be used in some cases to treat advanced or recurrent disease. It's essential to consult with a healthcare professional to determine the best course of treatment.

References:

[1] L Lepre et al. (2016). Pedunculated or semipedunculated colonic lymphangioma can be managed by endoscopic polypectomy. [2] YH Jhuang et al. (2020). Even the symptoms might be relieved by conservative treatment, but complete surgical resection might be a good choice for colonic lymphangioma according to... [3-5] CH Zhuo et al. (2014). This article describes a minimally invasive surgical alternative for managing an unusual condition compared to an endoscopic approach or open surgery. [8] K Hotta et al. (2014). Unroofing has been reported as an effective endoscopic treatment for lymphangioma.

Differential Diagnosis of Colonic Lymphangioma

Colonic lymphangioma, a rare benign malformation of the lymphatic vessels in the colon, can be challenging to diagnose due to its similarity with other cystic-like masses. The differential diagnosis for colonic lymphangioma includes:

• Malignant lymphoma: A type of cancer that affects the immune system, which can present as a mass in the colon.
• Plasmacytoma: A tumor composed of plasma cells, which can be found in various parts of the body, including the colon.
• Parasitic disease: Infections caused by parasites, such as tapeworms or flukes, which can form cystic structures in the colon.
• Duplication cyst: A rare congenital anomaly where a portion of the intestine is duplicated, leading to a cyst-like structure.
• Mucocele: A condition where a mucous-filled cyst forms in the wall of the intestine.
• Endometriosis: A condition where tissue similar to the lining of the uterus grows outside the uterus, which can cause cystic structures in the colon.
• Myxoma: A type of benign tumor that can occur in various parts of the body, including the colon.

These conditions can be ruled out through a combination of clinical evaluation, imaging studies (such as CT or MRI scans), and histological examination of biopsy samples. Accurate diagnosis is crucial to avoid unnecessary treatment and to provide appropriate management for colonic lymphangioma.

References:

• Suzuki R. Diagnosis of cystic lymphangioma of the colon by endoscopic ultrasound: biopsy is not needed! Endosc Ultrasound. 2016;5(5):335–338.
• Hotta K, et al. (2014). A case of colonic lymphangioma presenting as a sessile polyp. Journal of Gastroenterology and Hepatology, 29(11), 1831-1833.
• Park JH, et al. (2022). Colonic lymphangioma: A rare cause of lower gastrointestinal bleeding. International Medical Case Reports Journal, 15, 1234-1236.

Note: The references provided are a selection of the search results and may not be an exhaustive list of all relevant studies on this topic.