PMC9630908_01
(A) Colonoscopy indicated numerous cysts in the ascending colon, transverse colon, and descending colon. (B) The patient treated with sirolimus within 3 months, and colonoscopy indicated that the number and size of cysts decreased.
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Colonoscopy indicated numerous variable-sized hyaline cysts, involving the ascending colon, transverse colon, and descending colon ( Figure 1A ), while no biopsy was carried out. Colonoscopy indicated decreased number and size of cysts compared with the condition observed 6 months before ( Figure 1B ).
(A-C) Abdominal ultrasound observed multiple hypoechoic nodules in the spleen and the lower poles of the left kidney, and enlarged lymph nodes in the retroperitoneum. (D) Abdominal CT scan observed multiple diffuse low-density shadowing zones in the mesenteric area, which presented a doughnut shape. (E-H) Low-density shadowing zones can be observed in the left kidney, spleen, ilium, and the fifth lumbar vertebra in abdominal CT scan images.
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Enlarged lymph nodes (1.9 * 1.1 cm2) were found in the retroperitoneum ( Figures 2A-C ). The boundaries were blurred ( Figure 2D ). Low-density shadowing zones were observed in the left kidney, spleen, ilium, and fifth lumbar vertebra on CT scan images ( Figures 2E-H ).
(A, B) Exploratory laparoscopy showed numerous hyalines, smooth-walled, variable-sized cystic microstructures in the root of the mesentery.
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Figure 3A ). Further exploratory laparoscopy showed numerous hyalines, smooth-walled, variable-sized cystic microstructures in the root of the mesentery, involving total mesenteric excision ( Figure 3B ).
(A, B) Histological examination showed the positive D2-40 immunohistochemistry and confirmed mesenteric lymphangiomatosis. (C, D) Lymph vessels were identified imunohistochemically as D2-40-positive.
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Histopathology revealed diffuse or multi-centric proliferation of thin-walled, dilated lymphatic vessels ( Figure 4A ). D2-40 (a monoclonal antibody), a highly sensitive and specific marker of lymphatic endothelium in the normal tissue and a subset of vascular lesions, confirmed mesenteric lymphangiomatosis by immunoreaction ( Figure 4B ). D2-40-positive lymphatic vessels were shown in mesentery ( Figures 4C, D ).