Incidental paracaval retroduodenal hemangiolymphangioma in an adult patient. Report of a case removed laparoscopically

INTRODUCTION: Retroperitoneal hemangiolymphangioma is a benign tumor, only occasionally reported in adult patients. Surgical removal of the tumor is the best treatment option. The laparoscopic surgical approach, however, have never been reported. The authors report a case of retroperitoneal hemangiolymphangioma removed by laparoscopic surgery and discuss the role of laparoscopic surgery in the treatment of this tumors. CASE REPORT: A 45-year-old man was referred to the surgical unit for a paracaval retroperitoneal mass, detected occasionally by an ultrasound examination. An abdominal computed tomography scan confirmed a primitive retroperitoneal solid enhancing mass, 3 cm in diameter. Surgical removal of the mass was planned by the laparoscopic approach. With the patient in semilateral position, 3 trocars were inserted in the right subcostal region. With an intraoperative ultrasound, the mass was located close to the left side of the inferior vena cava. Then it was dissected and completely removed by the laparoscopic approach, without any damage to the surrounding structures. Operative time was 45 minutes and length of hospital stay was 2 days. No complications were observed either intraoperatively or postoperatively. No recurrence has been observed in an 8-month follow-up. Pathology revealed hemangiolymphangioma. DISCUSSION: Laparoscopic surgical removal of retroperitoneal hemangiolymphangioma seems to be a safe approach. Besides the well-acknowledged advantages of laparoscopy, the mini-invasive approach allows a better exposure of the operative field. Intraoperative ultrasound and experienced surgical team are, however, recommended.