ANZ J. Surg. 2005; 75: 365–368 CORRESPONDENCE Dear Editor, Retroperitoneal cystic lymphangioma Lymphangioma is a rare benign tumour of the lymphatic system that usually presents in infancy. About 90% of cystic lymphangi- oma cases are diagnosed by the end of the second year of life. 1 The condition results from a developmental failure of the lym- phatic system. 2 About 95% of cases develop in the cervical and axillary region. The remaining 5% appear in other parts of the body. Less than 1% are found in the retroperitoneal region. 3 We report the case of a 47-year-old man who presented with a retro- peritoneal cystic lymphangioma that was successfully excised. The patient had suffered from on-and-off epigastric pain, decreased appetite and weight loss for 1 year. He had no history of acute or chronic pancreatitis. No abdominal mass was palp- able. Oesophagogastroduodenoscopy (OGD) showed antral gas- tritis only. Ultrasonography (USG) and computed tomography (CT) of the abdomen showed a 5-cm cystic lesion anterior to the splenic vein at the body and tail region of pancreas (Fig. 1). Endoscopic ultrasonography (EUS) also showed a 5-cm cystic mass with focal nodular thickening over the cystic wall at the body and tail of the pancreas. A cystic neoplasm of pancreas was suspected initially. At exploratory laparotomy, a 5-cm retroperi- toneal cystic mass located posterior to the pancreatic body and tail (Fig. 2) was discovered. The tumour was excised completely. Pathology was consistent with a retroperitoneal cystic lymph- angioma. The postoperative course was uneventful. During the follow up, all the symptoms subsided. Retroperitoneal cystic lymphangiomas are very rare. They usually grow slowly. Malignant degeneration is rare also. Most patients are asymptomatic and the mass is found incidentally during investigations for unrelated clinical problems. Like most retroperitoneal masses, they become clinically significant when they grow to a size that can cause pressure or have an obstructive effect on adjacent organs, such as intestinal obstruction and obstructive uropathy. Preoperative diagnosis is always difficult. Most of them are diagnosed during laparotomy as in our case. USG and CT scan are the choices of investigation. The character- istic feature of the condition is a large tumour containing fluid with or without septa. 4 Because of the advancements made by EUS in the preoperative assessment of upper gastrointestinal tumours and pancreatic tumours, it was used for investigation in our patient. Although, in this case, it failed to diagnose the lym- phangioma before the operation, it may still have an important role in the future, when more studies have been performed. For the management of lymphangioma, most authors advo- cate complete surgical excision, as in our case. 3 The prognosis is excellent. Other treatment modalities such as marsupializa- tion and injection of sclerosing agents have been reported in the literature. However, poor long-term results have rendered mar- supialization obsolete. 3 Injection of a sclerosing agent could induce fibrosis around the cyst which may complicate surgical excision later and introduce infection. Laparoscopic excision of retroperitoneal lymphangioma is performed in some centres. 5 However, its use is limited by the lack of long-term results. In conclusion, complete surgical excision is still the recommended treatment. REFERENCES 1. Rekhi BM, Esselstyn CB, Levy I, Mercer RD. Retroperitoneal cystic lymphangioma. Report of two cases and review of the literature. Cleve Clin. Q. 1972; 39: 125–8. 2. Godart S. Embryological significance of lymphangioma. Arch. Dis. Child. 1966; 41 : 204–6. 3. Roisman I, Manny J, Fields S, Shiloni E. Intra-abdominal lymphangioma. Br. J. Surg. 1989; 76 : 485–9. 4. Davidson AJ, Hartman DS. Lymphangioma of the retroperi- toneum CT and sonographic characteristic. Radiology 1990; 175 : 507–10. Fig. 1. Computed tomography scan showing the retroperitoneal cystic lymphangioma in the pancreatic body and tail region. Fig. 2. The retroperitoneal cystic lymphangioma located behind the pancreas.