Rare Case of Cystic Lymphangioma Transforming Into Lymphangiosarcoma: A Case Report

Figures

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  Figure 1. (A) T2-weighted imaging in the coronal section (2008) revealing a polycystic lesion in the right inguinal region with smooth border and low-signal intensity septum. (B) Contrast-enhanced computed tomography scan in the transverse section of the lesion with no significant enhancement. (C) Microscopically, there are several unequal thin-walled cavities, the inner wall is lined with monolayer flat epithelial cells, the cavity is full of protein fluid, the endothelial cells are loose, the nucleus is small, and no atypia is found (hematoxylin and eosin stain, ×100).

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  Figure 2. (A) Coronal T2-weighted imaging (2013) revealing that the lesion is still confined to the right inguinal area with uniform signal intensity and smooth cyst wall. (B) Microscopically, a number of dilated lymphatic vessels of different sizes are observed, the endothelial cells are slightly dense, the size of the nucleus is slightly different, and atypical cells are observed (hematoxylin and eosin stain, ×100).

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  Figure 3. (A) Coronal T2-weighted imaging lipid pressure sequence (2015) revealing multiple cystic lesions of varying sizes in the right inguinal region, infiltrating and growing along the tissue space behind the peritoneum and the space between the anterior femoris muscle group, with uneven signal intensity, scattered spots and slightly low signal intensity, and less uniform thickness of the septum. (B) Microscopically, multiple cystic dilated lymphatic vessels of different sizes, partial hyperplasia, endothelial cell proliferation and accumulation, atypical nucleus, thick nuclear membrane, and polar disappearance of nucleus and nucleolus are observed in some cells (hematoxylin and eosin stain, ×200).

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  Figure 4. (A) Coronal computed tomography reconstruction (2018) showing a multilocular cystic solid heterogeneous mass in the retroperitoneum with poorly delineated boundaries (arrowhead). Right psoas major muscle showing compressed atrophy and decrease in volume (arrow). (B) Coronal T2-weighted imaging revealing that the lesion invaded the retroperitoneum, inguinal region, and upper right thigh with uneven signal intensity. There are many divergent spots of slightly lower signal intensity (arrowhead) in the lesion, with uneven thickness of the septum. The bladder is compressed and moved to the left (arrow). (C) Axial view showing the right abdominal cyst with lymphedema (arrow).