case_images: PMC10927243_01
case_images: A - A plain abdominal radiograph revealing ground glass appearance with multiple air fluid levels in the abdomen; B - Gross specimen of small intestine with large cystic mesenteric mass encroaching the serosal surface of ileum and comprising of cysts containing milky fluid. (scale bar=10 cm); C and D - Photomicrographs of the surgical specimen; C - Variable sized dilated lymphatic channels lined by flattened endothelium within the mesenteric mass; and D - in the serosa (H&E, 400x).
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case_images: The initial abdominal radiograph showed a ground glass appearance with multiple air-fluid levels (Figure 1A). On gross examination, the surgical specimen consisted of a 30 cm segment of the small intestine, along with a large, lobulated, soft to cystic mesenteric mass measuring 30x17x8 cm, encroaching the serosal surface of the ileum (Figure 1B). On microscopic examination, the mesenteric mass showed variable-sized dilated lymphatic channels (Figure 1CD).
case_images: A and B - Photomicrographs of the surgical specimen showing mature adipose tissue interspersed with variable-sized, dilated lymphatic channels within the mucosa, submucosa, and muscularis propria (H&E, 400x); C - CD31 positive lymphatic channels in the mesenteric mass (CD31, 400x).
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case_images: Sections from the intestine revealed similar dilated lymphatics within the serosa, muscularis propria, submucosa, and mucosa (Figures 2AB). These lymphatic channels demonstrated positivity with D2-40 and CD 31 (Figure 2C) by immunohistochemistry (IHC).
case_images: PMC10927243_02
case_images: A - Gross specimen of large mesenteric mass with multiple tiny cysts and areas of vascular congestion. (scale bar= 4 cm); B - Variable-sized, thin-walled, dilated lymphatic channels lined by flattened endothelium (H&E, 400x); C - Dilated lymphatic channels with focal surrounding lymphoid aggregates (H&E, 400x).
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case_images: The patient underwent surgery, and a 25 cm segment of the small intestine was resected, along with a large, circumscribed, soft to cystic mesenteric mass measuring 19x14x13 cm (Figure 3A). Microscopically, multiple sections demonstrated mature adipose tissue interspersed with numerous thin-walled muscular, dilated lymphatic channels lined by flattened endothelium (Figure 3B). Focal surrounding lymphoid aggregates were noted (Figure 3C).
case_images: Photomicrographs of surgical sections stained with immunohistochemistry. A - D2-40 positive endothelial cells lining the lymphatic channels (200x); B - CD31 positive endothelial cells lining the lymphatic channels (200x).
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case_images: On IHC, D2-40 (podoplanin) and CD 31 were positive in these channels, confirming the lymphatic origin of the lesion (Figure 4AB).