Lymphangioma of the heart: a rare tumor
Although cardiac lymphangioma is of benign nature, it should be considered in the differential diagnosis of vascularized soft tissue masses together with other more aggressive pathologies, such as angiosarcoma, lymphoma and metastatic disease. The following case has been reported in the International Journal of Surgery Case Reports.

A 67-year-old male patient with no significant medical history presented for a mediastinal enlargement incidentally found on routine chest X-ray. Echocardiographic examination revealed a solid mass surrounding the right cardiac chambers, and computed tomography of the chest confirmed the presence of a right lateralized 12 x 4 cm soft tissue mass beginning in the antero-superior pericardium recess down to the right atrium and right ventricle.

The mass did not contain calcification and it appeared adjacent with the right atrium. There was no pericardial effusion. The subsequent techniques included a completely unremarkable coronariography with no signs of any neovascularization to the mass.

The magnetic resonance imaging (MRI) confirmed the presence of an intrapericardial mass, with hypersignal in T2, localized in the anterior and superior pericardial recess, with inferior extension along the interatrial groove, and free wall of the right atrium and ventricle, surrounding the right coronary artery, but with apparent cleavage plane.

Median sternotomy approach was used to access the mass. The mass was completely adherent to the right atrium, right ventricle, and right coronary artery. Due to this adherence, and the lack of a pathologic diagnosis, we ruled it unsafe to attempt a total resection of the mass, and instead performed a partial resection. The macroscopic examination of the cut surface revealed a large cystic space, with smaller spaces dispersed in a fibrotic wall.

The patient had a normal post operative recovery and was discharged four days after the surgery. The patient was clinically well after one month.

The pathology specimen demonstrated a mass containing lymphoid tissue, and the immunohistochemistry stains were consistent with a cardic lymphangioma.

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