Cystic lymphangiomas of the neck and mediastinum: are there acquired forms?

Background: In 9 our of 10 cases, lymphangiomas nr-e observed during the fi rst rears of life, generally located in the neck. Rai-e lymphangiomas have been reported in adults, usually in an intrathoracic localization, raising the hypothesis of an acquired origin. Patients and methods: A retrospective analysis of patients undergoing surge ry for lymphanioma of the neck or mediastinum was conducted. Pathology repo rts, clinical data and medical imaging (CT) were reviewed and operative and post-operative findings were analyzed in order to deter-mine whether rile cases could be divided into congenital and non-congenital forms. Results: Data were obtained on 37 patients (23 men and 14 women, mean age 4 5 years, range 8 - 77). Four lesions (11%) were located in the neck: 3 in c hildren and one in an elder-ly subject (77 yrs). Thirty-three tumors (89%) were located in the mediastinum. In 5 cases, rite tumor. was located in the phrenic nodes of the anterior mediastinum. These lymphangiamas occurred in young adults, had a CT density less than liquid with enhancement after con trast injection, and had a malformative vascular component pi-oven anatomic ally and histologically (hemolymphangioma). These elements favor-ed a conge nital origin. In 28 cases (76.6%) the tumor involved nodes in the posterior or middle mediastinum. They occurred in older adults and were purely liqui d I with no vascular component. These lymphangiomas were undoubtedly acquir ed. Conclusion: In children, adolescents and young adults, lymphangiomas are fo und in the neck or anterior: mediastinum and have a tissular component. The se tumors should be considered as congenital lymphangiomas. in older adults , lymphangiomas are found in the posterior or middle mediastinum and are pu rely liquid cysts suggesting an acquired origin.