Misdiagnosis of Scrotal and Retroperitoneal Lymphangioma in Children

Abstract

Abstract Objective:Scrotal and retroperitoneal lymphangioma (SRL) in children is relatively rare, the clinical symptoms of which are usually difficult to distinguish from hydrocele, incarcerated inguinal oblique hernia, etc. The study aimed to explore the clinical diagnosis and treatment of abdominal scrotal lymphangioma in children, and thus to expand the understanding of this disease in clinical practice. Method:Nine male children, aged from 1 to 10 years, that were admitted to Shanghai Children’s Hospital from January 2019 to December 2020 and finally confirmed as lymphangioma in the inguinal area, were recruited for the study. The clinical manifestations, diagnosis and treatment of these children were retrospectively analyzed. The time periods from onset to final diagnosis are in the ranged of 3 weeks to 20 months. We also reviewed the SRL cases which were misdiagnosed at first in published English literature from 2000 to 2022. Results:The 9 cases were misdiagnosed as hydrocele, hematoma and inguinal hernia. 3 cases underwent intracystic injection of bleomycin, 3 had laparoscopic mass resection, and 3 received resection of inguinal lymphangioma under direct vision. Postoperative pathological analysis of the surgical specimen confirmed the diagnosis of benign cystic lesions and lymphangioma. We found a total of 14 SRL cases in published English literature, of which 8 were misdiagnosed .To be specific，6 cases were diagnosed as hydrocele ，1 as inguinal oblique hernia, and 1 as testicular tumor, all of which underwent ultrasonography scans. All cases were confirmed to be lymphangioma depend on the pathological examination. Conclusion:The high similarity of clinical manifestations may contribute to the misdiagnosis of children with scrotal mass. The detailed and accurate medical history, careful physical examination, imaging are significant in the differential diagnosis of scrotal lump in children before surgery, and the final diagnosis is based on pathological examination.