Three cases of intestinal lymphangiectasia diagnosed based on characteristic endoscopic and pathological findings

Abstract

Intestinal lymphangiectasia is a disease in which protein-rich lymphatic fluid leaks from dilated lymphatic vessels into the intestinal tract, resulting in Protein-losing gastroenteropathy (PLG), which can be difficult to diagnose. We encountered three cases in which PLG was suspected based on endoscopic findings and confirmed diagnoses of intestinal lymphangiectasia by biopsy. Because protein leakage from the gastrointestinal tract had been observed by protein leakage scintillation assay, upper gastrointestinal endoscopy was performed, revealing scattered white spots or white villi in the duodenum or upper jejunum. Histopathological findings from biopsy samples from the affected site showed lymphatic vessel dilation in the lamina propria and submucosa, confirming our diagnosis of intestinal lymphangiectasia. To differentiate the primary disease of PLG, it is important to recognize that scattered white spots and white villi in the duodenum and small intestine are endoscopic findings characteristic of enterolymphangiectasia, and thus biopsy these tissues.