CASE 135: HUGE CYSTIC LYMPHANGIOMA of PANCREAS, Dr PHAN THANH HẢI, MEDIC MEDICAL CENTER, HCMC, VIETNAM.

MALE 26YO  PAIN AT RIGHT LUMBAR AREA  AND POLYURIA.
XRAY KUB FILM SHOWED A RIGHT URETERAL STONE AND ONE MASS ON THE LEFT  SITE OF HIS ABDOMEN.

ULTRASOUND  DISCLOSED RIGHT HYDRONEPHROSIS AND A BIG CYSTIC TUMOR AT THE LEFT RETROPERITONEAL AREA EXTENDING  FROM THE LEFT KIDNEY TO THE PELVIS.

AT FIRST, ONE SONOLOGIST'S SUGGESTION WAS PSEUDOCYST OF PANCREAS.
MDCT abdomen with CE showed this tumor being in retroperitoneum without contrast enhancement, and right hydronephrosis due to ureteral stone.

Blood test Amylasemia of 70.3 (normal= 35-115UI/mL).
Percutanous puncture withdrawed 3 liters of brown clear fluid. Analysis no abnormal cell, no inflamation cell, with biochemistry results.

Ultrasound guided puncture images and then 3 liters of fluid removed...

DISCUSSION: IT WAS A BIG CYST OF RETROPERITONEUM. BASED ON THE WALL, NO SEPTATION, AND ANALYSIS OF THE FLUID, WE CAN RULE OUT URINOMA, OR PSEUDOCYST OF PANCREAS. IT IS LYMPHANGIOMA OF THE TAIL OF PANCREAS.

(REF. Abdominal Lymphangiomas: Imaging Findings with Pathologic Correlation.)