Massive Retroperitoneal Cystic Lymphangioma (18.5 L) Mimicking an Ovarian Tumor in an Adolescent: A Case Report Highlighting the "Crowding Effect" and Diagnostic Pitfalls

Massive Retroperitoneal Cystic Lymphangioma (18.5 L) Mimicking an Ovarian Tumor in an Adolescent: A Case Report Highlighting the "Crowding Effect" and Diagnostic Pitfalls | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Case Report Massive Retroperitoneal Cystic Lymphangioma (18.5 L) Mimicking an Ovarian Tumor in an Adolescent: A Case Report Highlighting the "Crowding Effect" and Diagnostic Pitfalls Lanhua Chen, Huizhong Li, Jue Wang, Yunhai Liao This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-9011649/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 9 You are reading this latest preprint version Abstract Introduction : Retroperitoneal cystic lymphangioma (CL) is a rare benign malformation, predominantly pediatric, and exceptionally uncommon in adolescents. Due to the expansive nature of the retroperitoneal space, these tumors can reach massive dimensions. The resulting "mass effect" frequently mimics gynecological malignancies, creating a significant diagnostic pitfall. Case Presentation : We report a rare case of a 16-year-old female presenting with progressive abdominal distension resembling a full-term pregnancy. Preoperative CT and MRI revealed a giant cystic mass occupying the entire abdominopelvic cavity. Radiologically, the lesion was indistinguishable from a giant ovarian cystadenoma. However, a critical discordance was noted: despite the massive tumor burden, serum tumor markers (CA-125, HE4, AFP) were strictly within normal limits. During surgical exploration, the mass was identified as originating from the retroperitoneum, strictly separating it from the adnexa. Approximately 18,500 mL of fluid was drained. The cyst wall encased the left renal hilum and was densely adherent to the renal artery, leading to an intraoperative vascular injury. A multidisciplinary approach facilitated vascular repair and complete cyst excision while successfully preserving the left kidney. Pathological examination confirmed a cystic lymphangioma. Conclusion : This case highlights the diagnostic challenge of massive abdominal cysts in adolescent females. The discordance between imaging features suggestive of an ovarian origin and negative serum tumor markers should serve as a "red flag," prompting consideration of retroperitoneal etiologies. Furthermore, this report demonstrates that even when the tumor involves complex hilar vasculature, organ-sparing resection is achievable through meticulous surgical technique and multidisciplinary collaboration. Retroperitoneal cystic lymphangioma Diagnostic Error Ovarian Tumor Adolescent Crowding Effect Transvaginal Ultrasound Differential Diagnosis Case report Figures Figure 1 Figure 2 Figure 3 Figure 4 1. Introduction Cystic lymphangioma (CL) is a benign congenital malformation of the lymphatic system, classified as a low-flow vascular malformation according to the latest ISSVA guidelines [ 1 ]. It is predominantly a pediatric pathology, with over 90% of cases identified before two years of age, typically in the head and neck regions [ 2 ]. Retroperitoneal involvement is exceedingly rare, accounting for less than 1% of all abdominal neoplasms [ 3 ]. In the adolescent population, giant retroperitoneal cysts present a formidable diagnostic dilemma [ 4 ]. Due to the distensible nature of the retroperitoneum, these lesions grow insidiously, often remaining asymptomatic until they reach massive proportions [ 5 ]. In female patients, the substantial "mass effect" distorts anatomical landmarks, frequently leading to a radiologic misdiagnosis of ovarian mucinous cystadenoma [ 6 , 7 ]. This report details the management of a 16-year-old female with a massive (18.5 L) retroperitoneal CL involving the renal hilum. It highlights the discordance between imaging and serology as a critical diagnostic clue and emphasizes the surgical strategy required for renal preservation [ 8 ] 2. Case Presentation 2.1 Patient Information and Clinical History A 16-year-old female presented with a three-month history of progressive abdominal distension. The condition, initially asymptomatic, had deteriorated significantly in the month prior to admission, manifesting as anorexia, lumbar soreness, and cachexia. Due to severe intra-abdominal pressure, the patient developed orthopnea and chest tightness, necessitating a semi-recumbent position. There was no history of abdominal pain, fever, or menstrual irregularities. 2.2 Physical Examination On admission, the patient appeared malnourished with gross abdominal distension comparable to a full-term pregnancy. Physical examination revealed a giant, tension-filled mass extending from the xiphoid process to the pelvic brim. A distinct fluid thrill was elicited upon palpation. The abdomen was non-tender, with no signs of peritoneal irritation. 2.3 Diagnostic Investigations Preoperative abdominal ultrasonography revealed a huge cystic mass in the abdominopelvic cavity, with multiple internal septations and sparse blood flow signals in the cystic wall. These findings are suggestive of a benign cystic lesion(Fig. 1 ).Computed Tomography (CT) revealed a massive, low-density cystic lesion (approx. 31 × 24 × 47 cm) with thin septations, causing significant displacement of visceral organs(Fig. 2 A). Subsequent Magnetic Resonance Imaging (MRI) demonstrated a unilocular cystic mass with T2-weighted hyperintensity༈Fig. 2 B༉. Crucially, the lesion appeared anatomically inseparable from the left ovary, leading to a radiologic impression of a giant ovarian cystadenoma. However, serum tumor markers, including CA-125, HE4, and AFP, were strictly within normal limits. 2.4 Therapeutic Intervention Under a provisional diagnosis of an ovarian tumor, the patient underwent diagnostic laparoscopy. To facilitate exposure, slow, controlled drainage of the cyst was performed, yielding 18,500 mL of fluid. Subsequent inspection revealed normal bilateral ovaries and fallopian tubes, excluding a gynecological origin. The procedure was converted to a laparotomy.Intraoperative exploration identified the cyst originating from the retroperitoneum, encasing the left renal hilum. The cyst wall was densely adherent to the renal vasculature. During sharp dissection of the inflammatory adhesions, a branch of the left renal artery was compromised. A multidisciplinary team performed meticulous ligation and repair of the vessel. Complete excision of the cyst wall was achieved without sacrificing the left kidney. Intraoperative frozen sections indicated a benign lesion, and final histopathology, supported by a comprehensive immunohistochemical panel (strongly positive for endothelial and lymphatic markers such as CD31, CD34, and D2-40, while negative for epithelial markers), definitively confirmed a retroperitoneal cystic lymphangioma (Figs. 3 and 4 ). 2.5 Outcomes The patient was transferred to the ICU for monitoring and received blood transfusions to manage intraoperative loss. Recovery was uneventful; the abdominal drain was removed following a decrease in output, and she was discharged with satisfactory renal function. 3. Discussion 3.1 The "Crowding Effect" Trap: Why Cross-Sectional Imaging Failed? In the adolescent population, giant retroperitoneal cysts present a formidable diagnostic dilemma. While Computed Tomography (CT) and Magnetic Resonance Imaging (MRI) are standard for evaluating abdominal masses, this case highlights their limitations when dealing with "occupancy limits"[ 9 ].The sheer volume of the 18.5 L cyst created a massive "mass effect," exerting extreme pressure on the abdominopelvic viscera. This phenomenon, known as the "crowding effect," obliterates the fat planes that typically serve as radiological boundaries between organs. In our patient, the cyst occupied the entire pelvic cavity, making it radiologically indistinguishable from the adnexa. The ovarian vascular pedicle—a key landmark for tracing the origin of pelvic masses—was likely compressed or obscured, leading the radiologist to default to the most common diagnosis in this demographic: a giant ovarian mucinous cystadenoma. This illustrates that relying solely on static anatomical images for giant cystic masses is prone to error, as the "origin" is frequently masked by the "extent" of the lesion[ 10 ]. 3.2 The "Discordance Sign": A Serological Red Flag A retrospective analysis of this case reveals a critical missed clue: the discordance between the massive tumor burden and the negative serum tumor markers. Ovarian mucinous cystadenomas or low-grade malignancies capable of reaching such dimensions typically exhibit elevated levels of CA-125, HE4, or CA-19-9 due to epithelial secretion or peritoneal irritation[ 11 ]. This phenomenon, where a giant pelvic mass exists without a corresponding elevation in tumor markers, has been noted in the literature as an important diagnostic consideration[ 12 ].In sharp contrast, our patient presented with a "silent" serological profile despite an 18.5 L mass.We propose that this "Giant Cyst – Negative Marker" mismatch should serve as a powerful diagnostic "red flag." It strongly argues against an epithelial ovarian neoplasm and should prompt clinicians to broaden the differential diagnosis to include non-gynecological etiologies, such as retroperitoneal cystic lymphangioma, mesenteric cysts, or duplication cysts[ 13 – 14 ]. Recognizing this discordance early is the first step in avoiding a "gynecologic tunnel vision." 3.3 The Role of Ultrasound: From "Screening" to "Problem-Solving" From an ultrasound diagnostics perspective, this case represents a "missed opportunity" for dynamic differentiation. While the initial transabdominal ultrasound correctly identified the cystic nature of the mass, it stopped short of identifying its origin[ 15 – 16 ]. We advocate for a refined diagnostic algorithm: in adolescent females with massive abdominal cysts and negative tumor markers, a targeted "second-look" ultrasound is mandatory[ 17 ]. Specifically, if the abdominal approach is limited by the massive fluid burden, a transvaginal or transrectal ultrasound should be employed. Despite the huge abdominal component, the pelvic floor anatomy often remains accessible. High-resolution transvaginal probes can navigate the pouch of Douglas to search for the "separate ovary sign" (SOS)[ 18 ]. Demonstrating a normal ovary that is structurally distinct and separate from the cystic mass is the most reliable sonographic sign to exclude an ovarian origin[ 19 ]. Had this specific sign been actively sought, the retroperitoneal nature of the mass could have been suspected preoperatively, allowing for better surgical planning regarding the renal hilum involvement and potentially avoiding the intraoperative vascular surprise[ 20 ]. 4. Limitations A key limitation in the preoperative management of this case was the reliance solely on transabdominal ultrasound and cross-sectional imaging without proceeding to a transvaginal or transrectal ultrasound. The lack of a targeted sonographic search for the "separate ovary sign" prevented the clinical team from ruling out an ovarian origin prior to surgery. 5. Conclusion This case underscores the diagnostic vulnerability of relying solely on anatomical cross-sectional imaging (CT/MRI) for giant abdominal masses in adolescents, where the significant "crowding effect" often mimics ovarian malignancy.[ 21 ] We propose a refined diagnostic workflow: the combination of a massive cystic burden with strictly negative serum tumor markers should be recognized as a critical discordant finding[ 22 ]. This clinical phenotype mandates a targeted sonographic search for the "separate ovary sign," utilizing transvaginal or transrectal approaches to overcome the limitations of abdominal scanning[ 23 ]. By integrating these serological and dynamic ultrasound clues, clinicians can effectively distinguish retroperitoneal etiologies from gynecological tumors, ensuring optimal preoperative planning and organ preservation in complex cases. Declarations Ethics approval and consent to participate: Institutional approval was not required for this case report. However, all procedures performed were in accordance with the ethical standards of the institutional and/or national research committee. Consent for publication Written informed consent was obtained from the patient and her legal guardians to publish this case report and the accompanying medical images. Availability of data and materials: The data and materials of this case report are available from the corresponding authors upon reasonable request and after approval from the hospital administration. Competing interests: The authors declare no conflict of interest. Funding: This research was supported by the Natural Science Foundation of Fujian Province (2023J011359). Authors' contributions: Conceptualization, H.L. and L.C.; methodology, L.C.; investigation, J.W.; resources, H.L. and L.C.; data curation, Y.L.; writing—original draft preparation, L.C and Y.L.; writing—review and editing, Y.L.; supervision, H.L.; project administration, H.L.; funding acquisition, H.L. All authors have read and agreed to the published version of the manuscript. Ethics approval and consent to participate: Not applicable. Informed Consent Statement: Written informed consent was obtained from the patient to publish this paper. Acknowledgments: The authors wish to express their sincere gratitude to the medical staff of the Departments of Obstetrics and Gynecology, General Surgery, and Pathology at the 900th Hospital of Joint Logistics Support Force. Their multidisciplinary collaboration and expertise were instrumental in the successful surgical management and definitive diagnosis of this complex case. References Kunimoto K, Yamamoto Y, Jinnin M. ISSVA Classification of Vascular Anomalies and Molecular Biology. Int J Mol Sci. 2022;23(4):2358. 10.3390/ijms23042358 . Published 2022 Feb 21. Orvidas LJ, Kasperbauer JL. Pediatric lymphangiomas of the head and neck. Ann Otol Rhinol Laryngol. 2000;109(4):411–21. 10.1177/000348940010900412 . Su T, Li C, Song B, et al. Case report and literature review: Giant retroperitoneal cystic lymphangioma. Front Surg. 2023;10:1074067. 10.3389/fsurg.2023.1074067 . Published 2023 Jan 17. Morotti A, Busso M, Consiglio Barozzino M, et al. Detection and management of retroperitoneal cystic lesions: A case report and review of the literature. Oncol Lett. 2017;14(2):1602–8. 10.3892/ol.2017.6323 . Kruse E, Gardner A, Vaca E, et al. Six year natural progression of a clinically monitored retroperitoneal schwannoma: A case report. Int J Surg Case Rep. 2025;126:110622. 10.1016/j.ijscr.2024.110622 . Mahfoud H, Flissate F, Tligui S, Benammi S, Etber A, Baidada A. Mesenteric cystic lymphangioma misdiagnosed as ovarian cyst in a 63-year-old female: A case report and review of literature. Int J Surg Case Rep. 2024;120:109846. 10.1016/j.ijscr.2024.109846 . Kumar N, Yadav P, Ansari MS, Lal H. Surgical management of giant retroperitoneal lymphangioma in a child. BMJ Case Rep. 2020;13(2):e234447. 10.1136/bcr-2020-234447 . Published 2020 Feb 13. Asadzadeh Aghdaei H, Rabbani A, Sadeghi A et al. Retroperitoneal lymphangioma as the final diagnosis of a middle-aged woman with abdominal pain: a case report. J Med Case Rep. 2023;17(1):93. Published 2023 Mar 15. 10.1186/s13256-023-03803-6 Raufaste Tistet M, Ernst O, Lanchou M, et al. Imaging features, complications and differential diagnoses of abdominal cystic lymphangiomas. Abdom Radiol (NY). 2020;45(11):3589–607. 10.1007/s00261-020-02525-3 . Ballard DH, Mazaheri P, Oppenheimer DC, et al. Imaging of Abdominal Wall Masses, Masslike Lesions, and Diffuse Processes. Radiographics. 2020;40(3):684–706. 10.1148/rg.2020190170 . Li T, Hou N, Mao L, et al. Tumor Markers in Differential Diagnosis of Benign Ovarian Masses. Int J Womens Health. 2024;16:1517–31. 10.2147/IJWH.S471058 . Published 2024 Sep 16. Aloui H. Rachid Hentati.A giant ovarian mass. Pan Afr Med J. 2024;47:172. 10.11604/pamj.2024.47.172.43287 . Hornick JL, Fletcher CD. Intraabdominal cystic lymphangiomas obscured by marked superimposed reactive changes: clinicopathological analysis of a series. Hum Pathol. 2005;36(4):426–32. 10.1016/j.humpath.2005.02.007 . Albers CE, Ranjit E, Sapra A, Bhandari P, Wasey W. Clinician Beware, Giant Ovarian Cysts are Elusive and Rare. Cureus. 2020;12(1):e6753. 10.7759/cureus.6753 . Published 2020 Jan 23. Barros DMR, Costa ACG, Grilo F, et al. A trainee's guide to T2-Hypointense adnexal lesions. Eur Congress Radiol. 2021. 10.26044/ecr2021/C-12506 . Alibrahim H, Al Ali A, Bohsas H, Ahmed SMA, Ahmed EMS, Swed S. Massive retroperitoneal cyst impersonating ovarian tumor: A case report. Int J Surg Case Rep. 2022;97:107393. 10.1016/j.ijscr.2022.107393 . Amara A, Adem A, Salhi H, et al. Giant serous cystadenoma in an adolescent: A case report. SAGE Open Med Case Rep. 2024;12. 10.1177/2050313X241296296 . Published 2024 Oct 31. :2050313X241296296. Chan TS, Wong T, Pan NY. Primary pelvic retroperitoneal ancient schwannoma-a rare diagnosis of pelvic complex cystic lesion. Hong Kong Med J. 2019;25(2):e1601–3. 10.12809/hkmj187188 . Ribeiro MA Jr, Elias YG, Augusto SS, et al. Laparoscopic resection of primary retroperitoneal schwannoma: A case report. World J Clin Cases. 2020;8(18):4114–21. 10.12998/wjcc.v8.i18.4114 . Faroun A, Gharbia BA, Sarahna A. Coexistence of giant serous cystadenoma and hemorrhagic corpus luteal cyst in a 12-year-old: diagnostic and fertility-sparing surgical approach. BMC Pediatr. 2025;25(1):559. Published 2025 Jul 19. 10.1186/s12887-025-05932-x Kanizsai B, Turi Z, Orley J, Szigetvári I, Doszpod J. Sonographic diagnosis of a retroperitoneal dermoid cyst in a young girl. Ultrasound Obstet Gynecol. 1998;12(5):367–8. 10.1046/j.1469-0705.1998.12050367.x . Agarwal M, Singh S, Sinha S. Comprehensive Evaluation of Ovarian Growths in Young Women. Gynecol Minim Invasive Ther. 2025;14(2):145–51. 10.4103/gmit.GMIT-D-24-00030 . Published 2025 May 22. Kim JS, Woo SK, Suh SJ, Morettin LB. Sonographic diagnosis of paraovarian cysts: value of detecting a separate ipsilateral ovary. AJR Am J Roentgenol. 1995;164(6):1441–4. 10.2214/ajr.164.6.7754888 . Additional Declarations No competing interests reported. Cite Share Download PDF Status: Under Review Version 1 posted Reviews received at journal 22 Apr, 2026 Reviewers agreed at journal 05 Apr, 2026 Reviews received at journal 01 Apr, 2026 Reviewers agreed at journal 25 Mar, 2026 Reviewers invited by journal 25 Mar, 2026 Editor invited by journal 05 Mar, 2026 Editor assigned by journal 03 Mar, 2026 Submission checks completed at journal 03 Mar, 2026 First submitted to journal 02 Mar, 2026 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-9011649","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Case Report","associatedPublications":[],"authors":[{"id":612055402,"identity":"7ea66d90-901f-4081-aae2-68296659cb67","order_by":0,"name":"Lanhua Chen","email":"","orcid":"","institution":"900th Hospital of Joint Logistics Support Force","correspondingAuthor":false,"prefix":"","firstName":"Lanhua","middleName":"","lastName":"Chen","suffix":""},{"id":612055403,"identity":"dd1895d3-77da-4f77-863d-c36d6c89918b","order_by":1,"name":"Huizhong Li","email":"","orcid":"","institution":"900th Hospital of Joint Logistics Support Force","correspondingAuthor":false,"prefix":"","firstName":"Huizhong","middleName":"","lastName":"Li","suffix":""},{"id":612055404,"identity":"7dfcec9d-3a3f-41a9-b32b-517448fcef4e","order_by":2,"name":"Jue Wang","email":"","orcid":"","institution":"The Second Affiliated Hospital of Fujian University","correspondingAuthor":false,"prefix":"","firstName":"Jue","middleName":"","lastName":"Wang","suffix":""},{"id":612055405,"identity":"c7a4ef84-15a7-4b6e-9bc6-7a3d968a0704","order_by":3,"name":"Yunhai Liao","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA1klEQVRIiWNgGAWjYHACxgOMDTY8bOzNBw58+EGkHqCWNDl+nmOJB2f2EK/lsLHkDB/jwxxsRCiXn93AcJh3B3Pihhs8Hw4z8DDI84sdwK+Fcc4BoJYzbIkbbvduOFxgwWA4c3YCfi3MEglALW08iRvunN1weAYPQ4LBbQJa2CBaJIAOy3lwmIeNCC08EC0GQO/nMBCnRULmAMPBuW0JoEA2AAayBGG/AEOM8cHbtv+gqHz84cMPG3l+aQJaGCT4PzDxIHEJKIeqYSQ2mYyCUTAKRsEIBQCxqknyD4M/gQAAAABJRU5ErkJggg==","orcid":"","institution":"The Second Affiliated Hospital of Fujian University","correspondingAuthor":true,"prefix":"","firstName":"Yunhai","middleName":"","lastName":"Liao","suffix":""}],"badges":[],"createdAt":"2026-03-02 15:08:15","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-9011649/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-9011649/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":105575506,"identity":"8ee0bd1a-224e-476f-996c-ae249e5592b8","added_by":"auto","created_at":"2026-03-27 13:39:41","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":237229,"visible":true,"origin":"","legend":"\u003cp\u003ePreoperative Color Doppler Ultrasonography of the Abdominopelvic Mass: The central finding is a vast, predominantly anechoic (black) cystic structure occupying nearly the entire field of view. A thin, smooth internal septation is visible traversing the cyst cavity (white arrow). The Color Doppler imaging demonstrated sparse blood flow signals in the cyst wall (color box).\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-9011649/v1/3eb446df6ebafb477546fe04.png"},{"id":105575488,"identity":"fbbe4f64-cdc7-4bae-8c8a-5f11d3ff4e70","added_by":"auto","created_at":"2026-03-27 13:39:12","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":1762443,"visible":true,"origin":"","legend":"\u003cp\u003eSee image above for figure legend\u0026nbsp;\u003c/p\u003e","description":"","filename":"2.png","url":"https://assets-eu.researchsquare.com/files/rs-9011649/v1/082dbb63ada1f4ed2876fb4f.png"},{"id":105575817,"identity":"64e445a0-ec60-4f9f-9296-3afd758db182","added_by":"auto","created_at":"2026-03-27 13:41:40","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":762783,"visible":true,"origin":"","legend":"\u003cp\u003eIntraoperative photograph of the resected cyst wall after aspiration of 18.5 L of fluid. The specimen shows a thin-walled, translucent cystic structure, consistent with a lymphatic malformation.\u003c/p\u003e","description":"","filename":"3.png","url":"https://assets-eu.researchsquare.com/files/rs-9011649/v1/a04a38f0651bca2196aad314.png"},{"id":105575498,"identity":"951f36a1-58be-4846-af29-d04ac48ae330","added_by":"auto","created_at":"2026-03-27 13:39:29","extension":"png","order_by":4,"title":"Figure 4","display":"","copyAsset":false,"role":"figure","size":2114778,"visible":true,"origin":"","legend":"\u003cp\u003eImmunohistochemistry: CD31 (+++), CR (-), CKpan (-), SOX17 (++, vascular endothelium), ERG (+++), D2-40 (+), S-100 (+, fat and nerve bundles), CD34 (+++), β-catenin (+, cytoplasm, stromal spindle cells), Desmin (+, perivascular smooth muscle), WT-1 (+, stromal cells), Ki-67 (3%, stromal 15-20%), pan-Trk (-), EMA (MUC-1) (-)\u003c/p\u003e","description":"","filename":"4.png","url":"https://assets-eu.researchsquare.com/files/rs-9011649/v1/4c752bf87222211a8a6e8fad.png"},{"id":105903904,"identity":"d2138328-6901-41bf-9e1f-0dde57647b7a","added_by":"auto","created_at":"2026-04-01 09:57:26","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":7319086,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-9011649/v1/16c1ddab-2d81-411f-bbd7-f73ec86e6a34.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Massive Retroperitoneal Cystic Lymphangioma (18.5 L) Mimicking an Ovarian Tumor in an Adolescent: A Case Report Highlighting the \"Crowding Effect\" and Diagnostic Pitfalls","fulltext":[{"header":"1. Introduction","content":"\u003cp\u003eCystic lymphangioma (CL) is a benign congenital malformation of the lymphatic system, classified as a low-flow vascular malformation according to the latest ISSVA guidelines [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. It is predominantly a pediatric pathology, with over 90% of cases identified before two years of age, typically in the head and neck regions [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. Retroperitoneal involvement is exceedingly rare, accounting for less than 1% of all abdominal neoplasms [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. In the adolescent population, giant retroperitoneal cysts present a formidable diagnostic dilemma [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. Due to the distensible nature of the retroperitoneum, these lesions grow insidiously, often remaining asymptomatic until they reach massive proportions [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. In female patients, the substantial \"mass effect\" distorts anatomical landmarks, frequently leading to a radiologic misdiagnosis of ovarian mucinous cystadenoma [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. This report details the management of a 16-year-old female with a massive (18.5 L) retroperitoneal CL involving the renal hilum. It highlights the discordance between imaging and serology as a critical diagnostic clue and emphasizes the surgical strategy required for renal preservation [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]\u003c/p\u003e"},{"header":"2. Case Presentation","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003e2.1 Patient Information and Clinical History\u003c/h2\u003e \u003cp\u003eA 16-year-old female presented with a three-month history of progressive abdominal distension. The condition, initially asymptomatic, had deteriorated significantly in the month prior to admission, manifesting as anorexia, lumbar soreness, and cachexia. Due to severe intra-abdominal pressure, the patient developed orthopnea and chest tightness, necessitating a semi-recumbent position. There was no history of abdominal pain, fever, or menstrual irregularities.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec4\" class=\"Section2\"\u003e \u003ch2\u003e2.2 Physical Examination\u003c/h2\u003e \u003cp\u003eOn admission, the patient appeared malnourished with gross abdominal distension comparable to a full-term pregnancy. Physical examination revealed a giant, tension-filled mass extending from the xiphoid process to the pelvic brim. A distinct fluid thrill was elicited upon palpation. The abdomen was non-tender, with no signs of peritoneal irritation.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec5\" class=\"Section2\"\u003e \u003ch2\u003e2.3 Diagnostic Investigations\u003c/h2\u003e \u003cp\u003ePreoperative abdominal ultrasonography revealed a huge cystic mass in the abdominopelvic cavity, with multiple internal septations and sparse blood flow signals in the cystic wall. These findings are suggestive of a benign cystic lesion(Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).Computed Tomography (CT) revealed a massive, low-density cystic lesion (approx. 31 \u0026times; 24 \u0026times; 47 cm) with thin septations, causing significant displacement of visceral organs(Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003eA). Subsequent Magnetic Resonance Imaging (MRI) demonstrated a unilocular cystic mass with T2-weighted hyperintensity༈Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003eB༉. Crucially, the lesion appeared anatomically inseparable from the left ovary, leading to a radiologic impression of a giant ovarian cystadenoma. However, serum tumor markers, including CA-125, HE4, and AFP, were strictly within normal limits.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec6\" class=\"Section2\"\u003e \u003ch2\u003e2.4 Therapeutic Intervention\u003c/h2\u003e \u003cp\u003eUnder a provisional diagnosis of an ovarian tumor, the patient underwent diagnostic laparoscopy. To facilitate exposure, slow, controlled drainage of the cyst was performed, yielding 18,500 mL of fluid. Subsequent inspection revealed normal bilateral ovaries and fallopian tubes, excluding a gynecological origin. The procedure was converted to a laparotomy.Intraoperative exploration identified the cyst originating from the retroperitoneum, encasing the left renal hilum. The cyst wall was densely adherent to the renal vasculature. During sharp dissection of the inflammatory adhesions, a branch of the left renal artery was compromised. A multidisciplinary team performed meticulous ligation and repair of the vessel. Complete excision of the cyst wall was achieved without sacrificing the left kidney. Intraoperative frozen sections indicated a benign lesion, and final histopathology, supported by a comprehensive immunohistochemical panel (strongly positive for endothelial and lymphatic markers such as CD31, CD34, and D2-40, while negative for epithelial markers), definitively confirmed a retroperitoneal cystic lymphangioma (Figs.\u0026nbsp;\u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e3\u003c/span\u003e and \u003cspan refid=\"Fig4\" class=\"InternalRef\"\u003e4\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec7\" class=\"Section2\"\u003e \u003ch2\u003e2.5 Outcomes\u003c/h2\u003e \u003cp\u003eThe patient was transferred to the ICU for monitoring and received blood transfusions to manage intraoperative loss. Recovery was uneventful; the abdominal drain was removed following a decrease in output, and she was discharged with satisfactory renal function.\u003c/p\u003e \u003c/div\u003e"},{"header":"3. Discussion","content":"\u003cdiv id=\"Sec9\" class=\"Section2\"\u003e \u003ch2\u003e3.1 The \"Crowding Effect\" Trap: Why Cross-Sectional Imaging Failed?\u003c/h2\u003e \u003cp\u003eIn the adolescent population, giant retroperitoneal cysts present a formidable diagnostic dilemma. While Computed Tomography (CT) and Magnetic Resonance Imaging (MRI) are standard for evaluating abdominal masses, this case highlights their limitations when dealing with \"occupancy limits\"[\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e].The sheer volume of the 18.5 L cyst created a massive \"mass effect,\" exerting extreme pressure on the abdominopelvic viscera. This phenomenon, known as the \"crowding effect,\" obliterates the fat planes that typically serve as radiological boundaries between organs.\u003c/p\u003e \u003cp\u003eIn our patient, the cyst occupied the entire pelvic cavity, making it radiologically indistinguishable from the adnexa. The ovarian vascular pedicle\u0026mdash;a key landmark for tracing the origin of pelvic masses\u0026mdash;was likely compressed or obscured, leading the radiologist to default to the most common diagnosis in this demographic: a giant ovarian mucinous cystadenoma. This illustrates that relying solely on static anatomical images for giant cystic masses is prone to error, as the \"origin\" is frequently masked by the \"extent\" of the lesion[\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e].\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec10\" class=\"Section2\"\u003e \u003ch2\u003e3.2 The \"Discordance Sign\": A Serological Red Flag\u003c/h2\u003e \u003cp\u003eA retrospective analysis of this case reveals a critical missed clue: the discordance between the massive tumor burden and the negative serum tumor markers.\u003c/p\u003e \u003cp\u003eOvarian mucinous cystadenomas or low-grade malignancies capable of reaching such dimensions typically exhibit elevated levels of CA-125, HE4, or CA-19-9 due to epithelial secretion or peritoneal irritation[\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. This phenomenon, where a giant pelvic mass exists without a corresponding elevation in tumor markers, has been noted in the literature as an important diagnostic consideration[\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e].In sharp contrast, our patient presented with a \"silent\" serological profile despite an 18.5 L mass.We propose that this \"Giant Cyst \u0026ndash; Negative Marker\" mismatch should serve as a powerful diagnostic \"red flag.\" It strongly argues against an epithelial ovarian neoplasm and should prompt clinicians to broaden the differential diagnosis to include non-gynecological etiologies, such as retroperitoneal cystic lymphangioma, mesenteric cysts, or duplication cysts[\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. Recognizing this discordance early is the first step in avoiding a \"gynecologic tunnel vision.\"\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003e3.3 The Role of Ultrasound: From \"Screening\" to \"Problem-Solving\"\u003c/h2\u003e \u003cp\u003eFrom an ultrasound diagnostics perspective, this case represents a \"missed opportunity\" for dynamic differentiation. While the initial transabdominal ultrasound correctly identified the cystic nature of the mass, it stopped short of identifying its origin[\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eWe advocate for a refined diagnostic algorithm: in adolescent females with massive abdominal cysts and negative tumor markers, a targeted \"second-look\" ultrasound is mandatory[\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]. Specifically, if the abdominal approach is limited by the massive fluid burden, a transvaginal or transrectal ultrasound should be employed.\u003c/p\u003e \u003cp\u003eDespite the huge abdominal component, the pelvic floor anatomy often remains accessible. High-resolution transvaginal probes can navigate the pouch of Douglas to search for the \"separate ovary sign\" (SOS)[\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]. Demonstrating a normal ovary that is structurally distinct and separate from the cystic mass is the most reliable sonographic sign to exclude an ovarian origin[\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]. Had this specific sign been actively sought, the retroperitoneal nature of the mass could have been suspected preoperatively, allowing for better surgical planning regarding the renal hilum involvement and potentially avoiding the intraoperative vascular surprise[\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e].\u003c/p\u003e \u003c/div\u003e"},{"header":"4. Limitations","content":"\u003cp\u003eA key limitation in the preoperative management of this case was the reliance solely on transabdominal ultrasound and cross-sectional imaging without proceeding to a transvaginal or transrectal ultrasound. The lack of a targeted sonographic search for the \"separate ovary sign\" prevented the clinical team from ruling out an ovarian origin prior to surgery.\u003c/p\u003e"},{"header":"5. Conclusion","content":"\u003cp\u003eThis case underscores the diagnostic vulnerability of relying solely on anatomical cross-sectional imaging (CT/MRI) for giant abdominal masses in adolescents, where the significant \"crowding effect\" often mimics ovarian malignancy.[\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e] We propose a refined diagnostic workflow: the combination of a massive cystic burden with strictly negative serum tumor markers should be recognized as a critical discordant finding[\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e]. This clinical phenotype mandates a targeted sonographic search for the \"separate ovary sign,\" utilizing transvaginal or transrectal approaches to overcome the limitations of abdominal scanning[\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e]. By integrating these serological and dynamic ultrasound clues, clinicians can effectively distinguish retroperitoneal etiologies from gynecological tumors, ensuring optimal preoperative planning and organ preservation in complex cases.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate:\u003c/strong\u003eInstitutional approval was not required for this case report. However, all procedures performed were in accordance with the ethical standards of the institutional and/or national research committee.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWritten informed consent was obtained from the patient and her legal guardians to publish this case report and the accompanying medical images.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials:\u0026nbsp;\u003c/strong\u003eThe data and materials of this case report are available from the corresponding authors upon reasonable request and after approval from the hospital administration.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests:\u003c/strong\u003e The authors declare no conflict of interest.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding:\u003c/strong\u003eThis research was supported by the Natural Science Foundation of Fujian Province (2023J011359).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026apos; contributions:\u003c/strong\u003eConceptualization, H.L. and L.C.; methodology, L.C.; investigation, J.W.; resources, H.L. and L.C.; data curation, Y.L.; writing\u0026mdash;original draft preparation, L.C and Y.L.; writing\u0026mdash;review and editing, Y.L.; supervision, H.L.; project administration, H.L.; funding acquisition, H.L. All authors have read and agreed to the published version of the manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate:\u003c/strong\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eInformed Consent Statement:\u003c/strong\u003eWritten informed consent was obtained from the patient to publish this paper.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgments:\u003c/strong\u003eThe authors wish to express their sincere gratitude to the medical staff of the Departments of Obstetrics and Gynecology, General Surgery, and Pathology at the 900th Hospital of Joint Logistics Support Force. Their multidisciplinary collaboration and expertise were instrumental in the successful surgical management and definitive diagnosis of this complex case.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eKunimoto K, Yamamoto Y, Jinnin M. 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Sonographic diagnosis of paraovarian cysts: value of detecting a separate ipsilateral ovary. AJR Am J Roentgenol. 1995;164(6):1441\u0026ndash;4. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.2214/ajr.164.6.7754888\u003c/span\u003e\u003cspan address=\"10.2214/ajr.164.6.7754888\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-womens-health","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bmwh","sideBox":"Learn more about [BMC Women's Health](http://bmcwomenshealth.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bmwh/default.aspx","title":"BMC Women's Health","twitterHandle":"","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Retroperitoneal cystic lymphangioma, Diagnostic Error, Ovarian Tumor, Adolescent, Crowding Effect, Transvaginal Ultrasound, Differential Diagnosis, Case report","lastPublishedDoi":"10.21203/rs.3.rs-9011649/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-9011649/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e \u003cb\u003eIntroduction\u003c/b\u003e: Retroperitoneal cystic lymphangioma (CL) is a rare benign malformation, predominantly pediatric, and exceptionally uncommon in adolescents. Due to the expansive nature of the retroperitoneal space, these tumors can reach massive dimensions. The resulting \"mass effect\" frequently mimics gynecological malignancies, creating a significant diagnostic pitfall.\u003c/p\u003e \u003cp\u003e \u003cb\u003eCase Presentation\u003c/b\u003e: We report a rare case of a 16-year-old female presenting with progressive abdominal distension resembling a full-term pregnancy. Preoperative CT and MRI revealed a giant cystic mass occupying the entire abdominopelvic cavity. Radiologically, the lesion was indistinguishable from a giant ovarian cystadenoma. However, a critical discordance was noted: despite the massive tumor burden, serum tumor markers (CA-125, HE4, AFP) were strictly within normal limits. During surgical exploration, the mass was identified as originating from the retroperitoneum, strictly separating it from the adnexa. Approximately 18,500 mL of fluid was drained. The cyst wall encased the left renal hilum and was densely adherent to the renal artery, leading to an intraoperative vascular injury. A multidisciplinary approach facilitated vascular repair and complete cyst excision while successfully preserving the left kidney. Pathological examination confirmed a cystic lymphangioma.\u003c/p\u003e \u003cp\u003e \u003cb\u003eConclusion\u003c/b\u003e: This case highlights the diagnostic challenge of massive abdominal cysts in adolescent females. The discordance between imaging features suggestive of an ovarian origin and negative serum tumor markers should serve as a \"red flag,\" prompting consideration of retroperitoneal etiologies. Furthermore, this report demonstrates that even when the tumor involves complex hilar vasculature, organ-sparing resection is achievable through meticulous surgical technique and multidisciplinary collaboration.\u003c/p\u003e","manuscriptTitle":"Massive Retroperitoneal Cystic Lymphangioma (18.5 L) Mimicking an Ovarian Tumor in an Adolescent: A Case Report Highlighting the \"Crowding Effect\" and Diagnostic Pitfalls","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-03-27 13:25:19","doi":"10.21203/rs.3.rs-9011649/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"editorInvitedReview","content":"","date":"2026-04-22T06:12:00+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"136155908742860681705155105228632515946","date":"2026-04-05T21:43:53+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-04-01T17:15:33+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"109379267166951666802560529388521153413","date":"2026-03-25T13:30:51+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2026-03-25T13:03:36+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2026-03-05T06:33:15+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2026-03-03T07:09:57+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2026-03-03T07:09:12+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Women's Health","date":"2026-03-02T14:52:00+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-womens-health","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bmwh","sideBox":"Learn more about [BMC Women's Health](http://bmcwomenshealth.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bmwh/default.aspx","title":"BMC Women's Health","twitterHandle":"","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"260f0cfe-7915-4ccf-9577-9b63e1504b0a","owner":[],"postedDate":"March 27th, 2026","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2026-03-27T13:25:19+00:00","versionOfRecord":[],"versionCreatedAt":"2026-03-27 13:25:19","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-9011649","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-9011649","identity":"rs-9011649","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}