Discussion
Cystic lymphangiomas are an uncommon benign maldevelopment of lymphatic vessels that mostly arise in the head and neck as well as axillary reigon of neonates and adults (2). Omental lymphangioma is a rare lymphatic malformation characterized by the presence of dilated lymphatic vessels within the omentum, the fold of peritoneum extending from the stomach and covering the intestines. These malformations typically arise from developmental anomalies in the lymphatic system and are most commonly diagnosed in children, although they can occur at any age (3). Most intra-abdominal lymphangiomas are asymptomatic and are often found incidentally on imaging (4). The clinical presentation of the few symptomatic intra-abdominal cystic lymphangiomas is usually nonspecific, often mimicking other abdominal conditions. Patients may exhibit symptoms such as abdominal pain, distension, or signs of intestinal obstruction. Due to its rarity, omental lymphangioma may be overlooked in the differential diagnosis of abdominal masses, which can lead to delays in diagnosis and management (3).
Imaging studies are crucial for the evaluation of omental lymphangiomas. Ultrasound often shows well-defined cystic structures, while CT and MRI can reveal the extent of the lesion and its relationship with surrounding structures (3, 5). The use of contrast-enhanced imaging techniques has improved diagnostic accuracy, allowing for better differentiation from other abdominal masses, such as cysts or tumors (7, 8).
Fine-needle aspiration cytology (FNAC) of an omental lymphangioma usually shows moderate cellularity with a proteinaceous background and the absence of malignant cells. Definitive diagnosis is established through surgical excision and histopathological examination, which reveals dilated lymphatic vessels lined by endothelial cells (6).
Histopathologically, omental lymphangiomas are characterized by dilated lymphatic vessels lined by endothelial cells, sometimes associated with a chronic inflammatory component (9, 10). These features are essential for distinguishing lymphangiomas from other similar-appearing lesions, such as lymphadenopathy or cystic tumors (11, 12). The management of omental lymphangiomas typically involves surgical intervention, especially in symptomatic cases. Complete excision is considered the gold standard treatment and is associated with a favorable prognosis (13, 14). However, the potential for local recurrence, though rare, underscores the need for long-term follow-up (15, 16). A review of the literature reveals that the recurrence rate for lymphangiomas can be as low as 5% when complete excision is achieved (17, 18).
Management of omental lymphangioma generally involves surgical excision, particularly in symptomatic cases. Laparoscopic techniques are increasingly preferred due to their minimally invasive nature, resulting in quicker recovery times and reduced postoperative complications. Laparotomy is another surgical approach. The prognosis following complete surgical resection is generally favorable, with low recurrence rates (7).
Comparing our case with those documented in existing literature, it is evident that variations in clinical presentation and management strategies exist, emphasizing the necessity for individualized treatment plans (19, 20). Future research should focus on establishing standardized guidelines for the diagnosis and treatment of omental lymphangiomas, particularly given their rarity (21, 22). Recent studies have also begun exploring the genetic and molecular basis of lymphangiomas, which could lead to novel therapeutic approaches (23, 24). The integration of multidisciplinary care, including surgical, radiological, and pathological expertise, is vital in managing these complex cases (25, 26).