Cystic lymphangioma of the pancreas along with the mass itself with the aim of treatment being creas should be taken into consideration as a differential a benign excised surface on microscopic examination diagnosis of pancreatic cystic or retroperitoneal lesions, [6-8]. Our case, included the full excision of the mass, the especially in women. gioma is pathologically possible. On visual inspection, the No potential conflict of interest relevant to this article mass would have clearly defined gray-reddish boundaries was reported. pancreas (the origin of the mass), and the spleen connected to the mass. No complications, such as lymphatic liquid leakage, were seen after the procedure. Diagnostic confirmation of pancreatic cystic lymphan- and a smooth outer membrane. Inside the mass, serous eo- sinophilic exudates would be observed. Microscopic ex- amination would reveal flat endothelial cells bordering pancreatic tissues or ducts in the cystic membrane and di- versified lymph cells in the cystic membrane or lymphatic ducts. Also, the pancreas is likely shrinked due to the pres- sure [4]. Immunohistochemistry can be used to increase the ac- curacy of diagnosis. Since the endothelial cells of the outer membrane of pancreatic cystic lymphangiomas do not normally undergo epithelial differentiation, staining ma- terials, such as (periodic acid-Schiff) PAS stain, Mucicar- mine, Alcian blue, and anti-cytokeratin are unsuitable. However, staining via immunochemical materials like Factor VIII-R Ag, CD31, CD34, and D2-40 is known to pro- duce a response. Diagnosis of the disease, therefore, in- volves the use of such immunochemical materials [3,9]. In our case, pathological testing revealed a close proximity between the pancreas and multiseptated cystic masses of varying sizes that were comprised of lymphatic endothe- lial cells. The cells responded to staining using im- munochemical substances like D2-40, CD31, and CD34, which allowed the diagnosis of pancreatic cystic lym- phangioma (Fig. 6). We therefore report this rare case in the hope that al- though extremely rare, cystic lymphangioma of the pan- CONFLICTS OF INTEREST REFERENCES 1. Losanoff JE, Richman BW, El-Sherif A, Rider KD, Jones JW. Mesenteric cystic lymphangioma. J Am Coll Surg 2003; 196:598-603. 2. Leung TK, Lee CM, Shen LK, Chen YY. Differential diag- nosis of cystic lymphangioma of the pancreas based on imaging features. J Formos Med Assoc 2006;105:512-7. 3. Colovic RB, Grubor NM, Micev MT, Atkinson HD, Rankovic VI, Jagodic MM. Cystic lymphangioma of the pancreas. World J Gastroenterol 2008;14:6873-5. 4. Paal E, Thompson LD, Heffess CS. A clinicopathologic and immunohistochemical study of ten pancreatic lymphangio- mas and a review of the literature. Cancer 1998;82:2150-8. 5. Schneider G, Seidel R, Altmeyer K, Remberger K, Pistorius G, Kramann B, et al. Lymphangioma of the pancreas and the duodenal wall: MR imaging findings. Eur Radiol 2001;11: 2232-5. 6. Bonhomme A, Broeders A, Oyen RH, Stas M, De Wever I, Baert AL. Cystic lymphangioma of the retroperitoneum. Clin Radiol 2001;56:156-8. 7. Iwabuchi A, Otaka M, Okuyama A, Jin M, Otani S, Itoh S, et al. Disseminated intra-abdominal cystic lymphangioma- tosis with severe intestinal bleeding: a case report. J Clin Gastroenterol 1997;25:383-6. 8. Steyaert H, Guitard J, Moscovici J, Juricic M, Vaysse P, Juskiewenski S. Abdominal cystic lymphangioma in chil- dren: benign lesions that can have a proliferative course. J Pediatr Surg 1996;31:677-80. 9. Kalof AN, Cooper K. D2-40 immunohistochemistry: so far! Adv Anat Pathol 2009;16:62-4. thesurgery.or.kr 145