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We report the case of a 17-year-old male who presented with intractable nausea and vomiting. Cross-sectional imaging revealed a large retrogastric abdominal mass. Fine needle aspiration done via endoscopic ultrasound (EUS) was nondiagnostic. Exploratory laparotomy revealed a large inflammatory mass densely adherent to the stomach and retroperitoneum. Incisional biopsy frozen section revealed spindle cells, and subsequent resection of the mass with en-bloc subtotal gastrectomy with Roux-en-y gastrojejunostomy reconstruction was performed. Final pathology demonstrated a lymphatic malformation with reactive myofibroblastic proliferation. Inflammatory abdominal lymphatic malformations are especially rare and not well described in the literature. These masses may present diagnostic challenges until the specimen is sent for pathologic analysis.

Lymphatic malformations (LM) or lymphangiomas are congenital errors in vascular embryogenesis. Percutaneous sclerosis is considered the best treatment for LM with external localization and yields excellent results. Surgical resection for deep LM is currently the mainstay of therapy, but high recurrence and morbidity rates are reported. Uniform therapeutic protocols are still unavailable. We describe two cases of abdominal LM treated by video-assisted sclerosis with OK432. The first case was a 5-month-old girl with pre-natal diagnosis of a left retroperitoneal LM with vascular encasement. A laparoscopic approach was used to expose the mass and a video-assisted injection of OK-432 in major cysts was performed. A remarkable reduction of the lesion size was observed after 18 months. The second case was a 15-year-old boy who presented at the ER acute abdominal pain. A mesenteric LM was diagnosed and a video-assisted sclerosis of the lesion with OK432 was performed. The LM completely disappeared. Follow-up was of 12 months. In our experience, video-assisted sclerosis of abdominal LM with OK-432 is a valid alternative to surgical resection. The procedure is feasible, safe, effective and minimally invasive; complete resolution may be observed in some cases. Long-term follow-up is required to rule out recurrences.

Lymphangioma is a type of developmental abnormality of the lymphoid system that occurs at the site of lymphatic-venous connections. In most cases, lymphangiomas are located in the posterior neck and head as cystic hygroma colli, which are frequently associated with chromosomal abnormalities and various malformation syndromes. Lymphangiomas at locations other than the posterior neck and head are rarely seen. We report the prenatal diagnosis of two cases of intrauterine axillary lymphangiomas and one case of an intraabdominal lymphangioma. The sonographic appearance of these lymphangiomas was a thin-walled, multilocular cyst located in the axillary area or the pelvis. The karyotypes of these babies were normal. One of the babies did well after surgery; one had neurologic sequelae, and one later developed a lymphangioma in the skull. The prognoses of these babies seemed to be better than those with cervical lymphangiomas. However, we are unable to draw any definite conclusions because of the limited number of cases. More investigations should be conducted in the future.