Pancreatic Lymphangioma: A Diagnostic and Treatment Dilemma

Cytologic examination is limited due to scant cellularity and is not specific. Because of the lack of epithelial lining, a definitive diagnosis cannot be made based on cytologic criteria only, although the lesion can be suggested from correlation with radiologic studies. Differential diagnosis includes and is not restricted to benign cystic mesothelioma, pancreatic pseudocyst, mucinous cystic lesions of the pancreas, or cystic degeneration of a malignant neoplasm, therefore definitive characterization often requires surgical resection. Endoscopic ultrasound fine needle aspiration with drainage may bring temporary symptomatic relief, but lymphangioma recurrence after drainage has been documented.4 With accurate diagnosis, observation is a possibility in asymptomatic patients, but complete surgical resection is considered the treatment of choice. Because of the possible complications, it should be limited to symptomatic cases or cases with high risk stigmata.