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).