Cystic mass of the right iliac fossa: don't forget about lym
Lymphatic malformation or cystic lymphangioma is a benign tumor of the lymphatic vessels. It is more commonly reported among children and has polymorphic clinical presentations. The diagnosis is based on imaging but requires histological confirmation. The treatment of choice is surgical excision for the abdominal and symptomatic localization.

A 30-year-old female with no pathological history was consulted for acute pain in the right iliac fossa without fever or transit disorders. Physical examination has revealed a slight tenderness in the right iliac fossa without palpable mass. The clinical presentation suggested the diagnosis of acute appendicitis. The biological screening was normal. Abdominal ultrasound has shown a normal appendix (2 mm in mural thickness and 5 mm in maximal diameter) without infiltration of surrounding fat neither abdominal abscess. It also has objectified a multiloculated cyst in the right iliac fossa which measures 150 × 53 mm containing a few thin septa without vascularisation in Doppler. For better characterization of the cystic mass, an abdominal CT scan with intravenous (i.v.) contrast was performed and documented a low-density, non-enhancing cystic mass with fluid density (4 HU), without the visible wall, located at the ascending colon and measuring 15 cm. There were no signs of hemorrhage, rupture, or volvulus.

A laparoscopy was performed, and the exploration found a cystic mass that measured 15 cm in diameter. Complete resection was done with right hemicolectomy and the cystic mass was sent for a histological exam. On gross, the specimen consisted of a well-demarcated mass, measuring 150 × 50 mm. At sectioning, it was grey-white multicystic appearing with serous type fluid. The histological analysis has revealed multiple cavities lined by endothelial bland cells and fibrous stroma. Thus, the diagnosis of lymphatic malformation (LM) was retained.