Yonsei Medical Journal Vol. 46, No. 5, pp. 715 - 718, 2005 Recurrent Retroperitoneal Cystic Lymphangioma Huseyin Ozdemir,1 Ercan Kocakoc,1 Zulkif Bozgeyik,1 and Bengu Cobanoglu2 Departments of 1Radiology and 2Pathology, Firat University School of Medicine, Elazig, Turkey. Retroperitoneal cystic lymphangioma is a rare congenital malformation. The majority of lymphangiomas are present at birth and nearly all present before the age of two years. We report a case of giant cystic retroperitoneal lymphangioma in a patient who first presented with symptoms at the age of 7, underwent surgery, and who then suffered a recurrent mass 11 years later. Key Words: Lymphangioma, retroperitoneal, ultrasonography, computed tomography, magnetic resonance imaging INTRODUCTION Abdominal cystic lymphangiomas are rare benign tumors of the lymphatic vessels.1 They are characterized by the appearance of uni- or multi- septate cystic masses.2 The incidence of cystic lymphangioma is approximately 1/6000 live born and localization of the retroperitoneum is less than 5%.3 More than half (50-65%) of neck and axillar lymphangiomas are present at birth and 90% present symptoms before the age of two years.4 Cystic lymphangiomas of the retroperi- toneum are frequently found in older children or adults.5 Although the lesion is benign in nature, it causes pressure on vital organs by mass effect and can therefore cause symptoms. Here, we pres- ent a case of a giant retroperitoneal cystic lym- phangioma which first presented with symptoms in a 7-year-old who underwent surgery and who returned with a recurrent mass 11 years later. Received March 12, 2003 Accepted October 4, 2003 Reprint address: requests to Dr. Huseyin Ozdemir, Department of Radiology, Firat University, Faculty of Medicine, 23119, Elazig, Turkey. Tel: 90 424 23335, Fax: 90 424 2376773, E-mail: ozdemir@ firat.edu.tr CASE REPORT An 18-year-old male was admitted with epi- gastric and left upper quadrant pain. Distention due to an abdominal mass was detected on physical examination. The patient had also suf- fered from abdominal distension, abdominal pain, nausea and vomiting 11 years previously and sonographic findings revealed a hypoechoic mass with smooth margins which lay between the liver hilus and splenic hilus. Laparotomic measurement of the mass, which contained multiple cysts, was 30×20 cm. It was localized between the stomach and transverse colon and filled the bursa omentalis. During laparotomy, the cysts and bursa omentalis were drained, the vessels and capsule of cysts were excised and capitonnage were per- formed. The cysts contained 2.5 liters of yellow, transudative fluid. Microscopically, the tumor consisted of dilate, large, lymphatic channels of different sizes growing in loose connective tissue. These channels were lined by flattened endothe- lium. A few bundles of smooth muscle were pres- ent in the walls (pathologic number: B-1895/92). In the current hospitalization, ultrasound ex- amination (US) showed an anechoic multicystic mass of 14×15×20 cm with thick septations. There were echogenic areas within the lesion consistent with calcifications (Fig. 1). On CT following the administration of contrast material, there was a non-enhancing mass lesion having low attenuation values (+ 12 HU) while including hyperdense calcific foci. The mass surrounded the body and tail of the pancreas and extended to the right side of the midline. It also had extensions into left renal spaces on its pos- terior aspect, and thereby created a mass effect. The internal septations that were observed on US Yonsei Med J Vol. 46, No. 5, 2005