Soft tissue tumors
Cystic / cavernous lymphangioma (cystic hygroma)

Reviewer: Vijay Shankar, M.D. (see Authors page)

Revised: 1 February 2016, last major update November 2012

Copyright: (c) 2003-2016,, Inc.

PubMed Search: Cystic / cavernous lymphangioma cystic hygroma
Definition / General
  • Large, irregular vascular spaces (similar to cavernous hemangioma, may resemble cysts) lined by flattened, bland epithelial cells
  • Cystic and cavernous lymphangiomas are usually considered the same entity (eMedicine)
Clinical Features
  • In children, usually in neck or axilla; may extend into mediastinum
  • Large mediastinal lesions may compress lungs, heart and nerves, but most lesions are asymptomatic and found on Xray
  • Rarely occur in lymph nodes (Am J Surg Pathol 1992;16:335)
Case Reports
  • Complete surgical excision is recommended to prevent recurrence
  • May cause fetal death due to hydrops
  • Intra-uterine sclerosing agents may reduce respiratory and feeding problems associated with fetal neck tumors (Fetal Diagn Ther 2009;26:102)
  • Rarely may spontaneously regress
Clinical Images

Images hosted on other servers:

Omentum: 30 cm tumor in 4 year old girl

Scrotal tumor with hemorrhage in 3 year old boy

Abdominal cyst: 25 cm

Broad ligament: 19 kg tumor in 70 year old woman

Mesentery: 1 year old boy

Mesenteric tumors

Thigh tumor

Mesenteric tumor: 12 year old girl

Gross Description
  • May be massive
  • Gray-white, edematous appearing
  • Variable sized cystic cavities with serous type fluid and smooth inner lining
Micro Description
  • Large, irregular vascular spaces lined by flattened, bland epithelial cells with fibroblastic or collagenous stroma
  • Stroma may contain lymphocytes
  • Abdominal tumors may have marked inflammatory changes that obscure their lymphatic origin (Hum Pathol 2005;36:426)
  • Rarely has papillary endothelial proliferation (Arch Pathol Lab Med 1979;103:306)
  • No specialized epithelium, no cholesterol granulomas
  • Not encapsulated, so removal can be difficult
Micro Images

Images hosted on PathOut server - Case of the Week #377:

Images hosted on other servers:



Abdominal mass

Mesenteric tumor

Adrenal gland: H&E and CD31

Broad ligament: H&E and D2-40

Breast tumor

Factor VIII

AFIP Third Series:

Orbital tumor has large dilated lymphatics, some with blood

Numerous lymphatics, some with blood; lymphocytes between lymphatics


Neck tumor
Molecular / Cytogenetics Description