|
Year : 2010 | Volume
: 3
| Issue : 3 | Page : 139-144 |
|
Cystic hygroma: An overview |
|
Bilal Mirza, Lubna Ijaz, Muhammad Saleem, Muhammad Sharif, Afzal Sheikh
Department of Pediatric Surgery, The Children's Hospital and The Institute of Child Health, Lahore, Pakistan
Click here for correspondence address and email
Date of Web Publication | 1-Jan-2011 |
|
|
 |
|
Abstract | | |
Cystic hygromas are the cystic variety of lymphangioma, common locations being cervico-facial regions and axilla. Respiratory distress, recurrent infections or cosmetic reasons are the main indications of the treatment. The ideal treatment is complete surgical excision; however, there is a gradual conversion towards sclerosant therapy. This article reviews the current literature and discusses the various problems encountered during the management of these lesions. Keywords: Cystic hygroma, surgical excision, bleomycin, complications
How to cite this article: Mirza B, Ijaz L, Saleem M, Sharif M, Sheikh A. Cystic hygroma: An overview. J Cutan Aesthet Surg 2010;3:139-44 |
Introduction | |  |
Hygroma in Greek means water-containing tumour. They are congenital malformations of lymphatic system. Cystic hygroma occurs more frequently as compared to other types of lymphangioma, and may compose of single or multiple macrocystic lesions having scarce communication with normal lymphatic channels. [1]
Lymphangiomas are usually classified as capillary, cavernous or cystic lymphangiomas. They may also be classified more conveniently, on the basis of size of the cysts contained, as microcystic, macrocystic and mixed lymphangiomas. Microcystic lymphangioma consists of cysts measuring less than 2 cm in size, whereas the size of cysts in case of macrocystic lymphangioma is more than 2 cm. The mixed lymphangioma is characterized by cysts of variable sizes, i.e. some cysts are more than 2 cm in size and others are less than 2 cm. [2],[3]
Embryology
In the eighth week of gestation, six lymphatic sacs can be identified in the developing embryo. These lymphatic sacs are two jugular sacs, two iliac, one at the base of root of mesentery and one dorsal to the abdominal aorta (cysterna chyli). Jugular lymphatic sacs develop in the region of neck, whereas iliac sacs develop in the lumbar region. Later on, a network of lymphatics develops that communicate with lymphatics of various regions. During the ninth week of gestation, these sacs are invaded by connective tissue to form lymph nodes. [2]
There are a number of proposed mechanisms to explain the pathophysiology of cystic hygroma. Embryologically, these lesions are believed to originate from sequestration of lymphatic tissue from lymphatic sacs, during the development of lymphatico-venous sacs. These sequestered tissues fail to communicate with remainder of the lymphatic or venous system. Later on, dilatation of the sequestered lymphatic tissues ensues, resulting in the cystic morphology of these lesions. [2]
Location of cystic hygromas
Cystic hygromas can manifest anywhere in the body. The common locations are cervico-facial regions (especially posterior cervical triangle), axilla, mediastinum, groin and below tongue. Occasionally, these malformations occur in liver, spleen, kidney and intestine. Omental cyst in omentum and mesenteric cyst in the mesentery of intestine represents parallel lesions at these locations. [4],[5],[6]
We have observed other rare sites of its occurrence especially at limbs, chest wall, cheek, lumbar region, supra-sternal area and over the shoulder or deltoid [Figure 1] and [Figure 2]. Though, usually isolated and single at these unusual occasions, cystic hygroma at multiple sites in the body have been observed.
Diagnosis of cystic hygromas
In about 80% of instances, the location of cystic hygromas is cervico-facial region. Therefore, cystic hygroma should always be considered first in the preliminary differential diagnosis of cystic lesions with onset at birth, in the above-mentioned location. More than 60% of cystic hygromas have onset at birth and up to 90% become overt before the age of two years. [1],[2],[4],[5],[6]
The nascent appearance of cystic hygroma in adults has scarcely been reported in the literature. Some case reports depicted post-traumatic appearance (acquired cystic hygroma) of cystic hygroma in previously normal adults. These might represent the dormant variety of cystic hygromas that can appear at any age and trauma might be a coincidental event in those cases. [7],[8],[9]
The usual presentation of cystic hygroma apparent at birth is a painless mass with worries and queries of the parents about the lesion. The other modes of presentations are related to the complications or effects of cystic hygroma, such as respiratory distress, feeding difficulty, fever, sudden increase in the size and infection in the lesion. [1],[2],[3]
On clinical examinations, these lesions appear soft, compressible, non-tender, transluminant and without any bruit [Figure 3] and [Figure 4]. Ultrasound of the lesion usually features multicystic lesion with internal septations and no blood flow is detected on color doppler ultrasonographs. Other modalities like CT scan and MRI can be employed to delineate the lesion, in a better way. A CT scan demonstrates multicystic, homogeneous, non-invasive density with low attenuation [Figure 5]. These modalities are usually helpful in ascertaining the extent of the lesion and their association with nerves and vessels and are particularly useful, when surgical management of the lesion is contemplated. [1],[10],[11],[12] These cysts may produce milky, serous, sero sanguinous or straw-coloured fluid, when aspirated with a wide-bore needle. [5] | Figure 4 :Transillumination is positive in the lumbar region cystic hygroma
Click here to view |
The prenatal diagnosis of cystic hygroma using ultrasound is well documented in the literature. This malformation is commonly localized in the nuchal region. An additional 20% are found in the axilla, while the remaining 5% are found in the mediastinum, retroperitoneum, abdominal viscera, groin, bones and scrotum. The characteristic sonographic appearance on antenatal ultrasonography is multiseptate, thin-walled cystic mass; occasionally the cystic mass may have a more complex echo texture with cystic and solid components. The foetus with cystic hygroma can be associated with other anomalies in about 62% of cases. The associated anomalies are Turner's syndrome, Down's syndrome, Trisomy 18, Trisomy 13, Noonan syndrome, etc. [13],[14],[15],[16]
Sometimes biopsy correlation is needed for the precise diagnosis of the lesion occurring at unusual sites such as laryngeal, intra-oral and orbital lymphangiomas. [17],[18]
Complications of cystic hygroma
Cystic hygromas are benign lesions; however, complications may arise. These lesions can get infected any time. The usual source of infection is seedling of microorganisms from a secondary focus of infection (respiratory tract infections), though they may get infected primarily also. During the course of infection, the cystic hygroma increases in size and becomes warm, red and tender. The patient may become febrile. The infection may involve entire cystic hygroma or a few of its cysts [Figure 6]. During active infection, it may not remain transluminant. Sometimes cystic hygroma turns into an abscess, which needs to be drained for amelioration of the symptoms. The treatment is conservative with antibiotics, antipyretics and analgesics. [1],[2],[3],[4],[5],[19] It is our observation that in some instances, post-infection size of the cystic hygroma reduces remarkably. | Figure 6 :Cystic hygroma of neck and oral cavity. The lower portion of cystic hygroma was infected
Click here to view |
The other most frequently reported and observed complication is spontaneous bleeding in the cyst. In this case, the cysts get tense and hard. On aspiration, they yield haemorrhagic fluid. Spontaneous haemorrhage in the scrotal lymphangioma may have to be dealt surgically to avoid testicular ischemia [Figure 7]. [20] Kaur et al. reported spontaneous rupture, on the fourth day after birth, of a giant cystic hygroma of neck, necessitating urgent surgical intervention. [4]
The other complications include respiratory difficulties and dysphagia, especially in cystic hygroma of neck and oral cavity. Sometimes, the cystic hygroma of neck and oral cavity occurs concurrently in the same patient; thus, creating a difficult situation for the management of respiratory distress and dysphagia. Lymph discharging sinus, resulting from infection or trauma is another rare complication. [1],[2],[3],[4]
Management of cystic hygroma
The most preferred modality of treating cystic hygroma remains complete surgical excision; however, many recent case reports and case series have increasingly documented remarkable results for management of such lesions with sclerosant agents. [1],[2],[3],[4],[18],[19],[20],[21],[22] The other treatment modalities that have been employed with variable results include simple drainage, aspirations, radiation, laser excision, radio-frequency ablation and cauterization. [17],[18],[22]
Cystic hygromas are benign lesions and can remain asymptomatic in a patient for long duration. The indications of treatment are recurrent bouts of infection in the lesion, respiratory distress, dysphagia, haemorrhage inside cystic hygroma, sudden increase in the size of lesion, lymph discharging sinus and disfigurement. The respiratory distress can be of severe nature necessitating a tracheostomy due to complete or significant laryngeal or tracheal compressions by external and sometimes laryngeal lymphangiomas. [18],[19],[20],[21],[22],[2]3,[24],[25],[26] In our observation, a few patients showed partial self-regression of the lesion; however, complete spontaneous resolution has not been observed by us.
Surgical excision of the complex cystic hygromas, involving deep and vital structures, is not an easy task. Extreme care has to be followed to avoid per-operative complications. The possible complications during surgery are damage to facial nerve, facial artery, carotid vessels, internal jugular vessels, thoracic duct and pleura, and incomplete excision in case of infiltration to the surrounding structures. The post-operative complications observed after surgical excision of cystic hygroma are wound infection, haemorrhage, hypertrophied scar and lymphatic discharge from the wound. In about 20 % of cases, there is recurrence even after apparent complete excision of the lesion. [1],[18],[19],[20],[21],[22],[23],[24],[25],[26] Despite these possible complications, surgical excision of the cystic hygroma is still a preferred option in cases of life threatening lymphangiomas and wherein there is spontaneous bleeding. Intra-thoracic and intra-abdominal lesions are also preferably managed with surgical approach. [23]
Aspiration of the cystic hygroma can be performed as a temporary measure to reduce the size of the cystic hygroma, and thereby, reducing its pressure effects on the respiratory and feeding passages. A tracheostomy and feeding gastrostomy can be performed if the patient is not fit for any type of intervention, and especially in those with severe respiratory and feeding difficulties. [8],[18]
As mentioned earlier, the other successful and popular treatment option for the management of cystic hygroma is sclerotherapy. Previously, sclerotherapy was carried out with sclerosant agents, such as boiling water, quinine, sodium morrhuate, urethane, iodine tenture, doxycycline and nitromin. However, sclerotherapy with the above-mentioned agents has been associated with low success rates and frequent complications. [16],[20],[21],[22],[23],[24]
Sclerotherapy with intra-lesional bleomycin, as a primary treatment modality, for cystic hygroma, has been tried. Various case reports and original studies have documented good response to the therapy. [20],[21],[22],[23] The other agent used as sclerosant is OK432, has more satisfactory results and less complications as compared to bleomycin. [20],[21],[22],[23],[24]
Bleomycin is a chemotherapeutic agent used in chemotherapy for a number of malignancies. Yura et al. used intra-lesional bleomycin as sclerosant agent for the first time. [21] It is a DNA synthesis inhibitor and its exact mechanism of action in cystic hygroma is not known; however, it is believed that it may produce a non-specific inflammatory process that results in the fibrosis of the cysts. In about 60% of patients treated with intra-lesional bleomycin, there was complete resolution of the lesion; and in about 30% patients, it caused remarkable reduction in size. [20],[21],[22],[23],[24] The same is true in our experience.
Bleomycin can be prepared as aqueous solution or as fat emulsion. Bleomycin is usually given according to the weight of the patient. The recommended dosage is 0.3 mg/kg to 3 mg/kg per session. However, many authors prefer giving bleomycin according to the size of the lesion and not the weight of the patient. Higher dosage is usually associated with complications. [20],[21],[22],[23],[24] In our experience, 0.5 mg/kg is a safer dose and can give excellent results. The recommended therapy schedule is fortnightly sessions with intra-lesional bleomycin, and 3-6 sessions have to be given for ultimate results. Some authors suggested weekly sessions for sclerotherapy with bleomycin. [20],[21],[22],[23],[24] However, we prefer a minimum interval of three weeks between sessions.
The reported complications of sclerotherapy with bleomycin are discolouration of the injection site, sudden increase in the size of cystic hygroma, fever, vomiting, cellulitis, interstitial pneumonia and pulmonary fibrosis. Pulmonary fibrosis is associated with high dosage of bleomycin. The safe upper limit for dosage of bleomycin in a single session is 30 mg/m 2 . In published case series, where small doses of bleomycin were used, there was no pulmonary fibrosis in any of their patients. [20],[21],[22],[23],[24] In some patients, we have observed an increase in the size of cystic hygroma after few hours of sclerotherapy with bleomycin [Figure 8]. Sometimes the cysts of the lesion reduced in size, but turned very tense and hard. Another cosmetic complication is the persistent firm hard residual lesion after disappearance of all the palpable cysts [Figure 9]. | Figure 8 :Increase in the size of cystic hygroma after 2 weeks of intra-lesional bleomycin as sclerosant in a patient shown in Figure 2
Click here to view |
 | Figure 9 :Cystic hygroma resolved completely but a thickened area can be observed
Click here to view |
In difficult patients, where cystic hygroma is compressing upon the respiratory passages and located very deep, we have used combined approach. The part of cystic hygroma, which can be excised without any damage to vital structures, is removed surgically and the remaining cysts were injected with injection bleomycin under vision. This has given excellent results with respect to recurrence.
OK-432 is another agent which has been tried, with good results with respect to the lesion resolution and complications [25] . It acts by causing migration of acute inflammatory cells into the cysts, which release cytokines, resulting in the damage of the endothelium of the cysts and an increase in its permeability and apoptosis. All these factors contribute to the reduction of size of the lesion. [25]
Katsuno et al[26] described successful surgical excision of the cystic hygroma after filling each cyst with hydrocolloid dental impression material. In their technique, they simultaneously aspirated the cyst fluid and injected the hydrocolloid dental impression material under direct vision after exposing the cysts surgically. This resulted in perfect delineation of each cyst all around and its complete excision became very easy. The prerequisite for the procedure is that the lesion should not involve major nerves and vessels. [26]
The other techniques recently introduced in the management of lymphangiomas are radio-frequency ablation and laser excision of the lymphangiomas. Laser has been increasingly used especially for laryngeal lymphangiomas. It causes point destruction of the lesion, thus avoiding damage to the adjacent vital structures. [8],[27]
Conclusion | |  |
Cystic hygroma is a manageable lesion in paediatric population. Suitable treatment should be opted based upon case to case variation. Optimum treatment can be given by surgery alone, sclerotherapy alone or combined use of both. Recently invented treatment modalities such as laser and radiofrequency can also be used in selected patients.
Acknowledgements | |  |
We are thankful to Miss Attiya Bano for her help in retrieval of many articles from paid sites.
References | |  |
1. | Manikoth P, Mangalore GP, Megha V. Axillary cystic hygroma. J Postgrad Med 2004;50:215-6.  [PUBMED] |
2. | Fonkalsrud EW. Lymphatic disorders. In: Grosfeld JL O'Neill JA Jr, Coran AG, Fonkalsrud EW, Caldamone AA. editors. Pediatric surgery. 6 th ed. Chicago: Mosby Elsevier; 2006. p. 2137-45.  |
3. | Sanlialp I, Karnak I, Tanyel FC, Senocak ME, Buyukpamukcu N. Sclerotherapy for lymphangioma in children. Int J Pediatr Otorhynolaryngol 2003;67:795-800.  |
4. | Kaur N, Gupta A, Amratash, Singh N. Giant cystic hygroma of the neck with spontaneous rupture. J Indian Assoc Pediatr Surg 2007;12:154-5.  |
5. | Kocher HM, Vijaykumar T, Koti RS, Bapat RD. Lymphangioma of the chest wall. J Postgrad Med 1995;41:89-90.  [PUBMED] |
6. | Dhrif AS, El Euch D, Daghfous M, Cherif F, Mokni M, Dhahri AB. Macrocystic lymphatic lymphangioma (cystic lymphangioma) of upper extremity: A case report. Arch Pediatr 2008;15:1416-9.  [PUBMED] [FULLTEXT] |
7. | Antoniades K, Kiziridou A, Psimopoulou M. Traumatic cervical cystic hygroma. Int J Oral Maxillofac Surg 2000;29:47-8.  [PUBMED] |
8. | Selz PA, Arjmand EM. Laryngeal lymphangioma: a case report of an uncommon entity. Otolaryngol Head Neck Surg 1998;118:382-4.  [PUBMED] |
9. | Carpenter CT, Pitcher JD Jr, Davis BJ, Gomez R, Schofield TD, Youngberg RA. Cystic hygroma of arm: A case report and review of literature. Skeletal Radiol 1996;25:201-4.  [PUBMED] |
10. | Oak SN, Redkar RG, Kapur VK. Posterior midline cervical fetal cystic hygroma. J Postgrad Med 1992;38:93-6.  [PUBMED] |
11. | Mansingani S, Desai N, Pancholi A, Prajapati A, Vohra PA, Raniga S. A case of axillary cystic hygroma. Indian J Radiol Imag 2005;15:517-9.  |
12. | Arora A, Narula MK, Sonkar P, Chadha R. Cystic hygroma of chest wall. Indian J Radiol Imag 2003;13:120-1.  |
13. | Descamps P, Jourdian O, Paillet C, Toutain A, Guichet A, Pourcelot D. Etiology, prognosis and management of nuchal cystic hygroma: 25 new cases and literature review. Europ J Obstet Gyenecol Reprod Biolog 1997;71:3-10.  |
14. | Gustavii B, Ecivall H. First trimester diagnosis of cystic nuchal hygroma. Acta Obstet Gynecol Scand 1984;63:377-80.  |
15. | Zanotti SD, LaRusso S, Coulson C. Prenatal sonographic diagnosis of axillary cystic lymphangiomas. J Clin Ultrasound 2001;29:112-5.  [PUBMED] |
16. | Ibrahim AH, Kandeel A, Bazeed MF. Successful non surgical management of a huge life threatening cervicomediastinal cystic hygroma case report and review of the literature. J Pediatr Surg Specialt 2009;3:48-50.  |
17. | Sheila S, Nazarian-Mobin, Simms K, Urata MM, Tarczy-Hornoch K, Jeffrey A. Misleading presentation of an orbital lymphangioma. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2010;109:82-5.  |
18. | Sobol SE, Manoukian JJ. Acute airway obstruction from a laryngeal lymphangioma in a child. Int J Pediatr Otorhynolaryngol 2001;58:255-7.  |
19. | Ameh EA, Nmadu PT. Cervical cystic hygroma: Pre, intra and postoperative morbidity and mortality in Zaria, Nigeria. Pediatr Surg Int 2001;17:342-3.  [PUBMED] [FULLTEXT] |
20. | Mahajan JK, Bharathi V, Chowdhary SK, Samujh R, Menon P, Rao KL. Bleomycin as intralesional sclerosant for cystic hygromas. J Indian Assoc Pediatr Surg 2004;9:3-7.  |
21. | Yura J, Hashimoto T, Tsuruga N. Bleomycin treatment for cystic hygroma in children. Arch Jpn Chir 1977;46:607-14.  |
22. | Okada A, Kubota A, Fukuzawa M, Imura K, Kamata S. Injection of bleomycin as a primary therapy of cystic lymphangioma. J Pediatr Surg 1992;27:440-3.  [PUBMED] [FULLTEXT] |
23. | Orford J, Barker A, Thonell S, King P, Murphy J. Bleomycin therapy for cystic hygroma. J Pediatr Surg 1995;30:1282-7.  [PUBMED] [FULLTEXT] |
24. | Zhong PQ, Xhi FX, Li R, Xue JL, Shu GY. Long-term results of intratumorous bleomucin-A5 injection for head and neck lymphangioma. Oral Surg Oral Med Oral Pathol Oral Radiol Endodnone 1998;86:139-44.  |
25. | Ogita S, Tsuto T, Nakamura K, Deguchi E, Tokiwa K, Iwai N. OK-432 therapy for lymphangioma in children: Why and how does it work? J Pediatr Surg 1996;31:477-80.  [PUBMED] [FULLTEXT] |
26. | Katsuno S, Ezawa S, Minemura T. Excision of cervical cystic lymphangioma using injection of hydrocolloid dental impression material, a technical case report. Int J Oral Maxillofac Surg 1999;28:295-6.  [PUBMED] |
27. | Bozkaya S, Ugar D, Karaka I, Ceylan A, Uslu S, Baris E, et al. The treatment of lymphangioma in the buccal mucosa by radiofrequency ablation: a case report. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2006;102:28-31.  |

Correspondence Address: Bilal Mirza Department of Pediatric Surgery, The Children's Hospital and The Institute of Child Health, Lahore Pakistan
 Source of Support: None, Conflict of Interest: None  | Check |
DOI: 10.4103/0974-2077.74488

[Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5], [Figure 6], [Figure 7], [Figure 8], [Figure 9] |
|
This article has been cited by | 1 |
A neonatal large neck lymphatic malformation successfully treated with Eppikajyutsuto |
|
| Shunsuke Watanabe, Yusuke Funato, Masafumi Miyata, Tatsuya Suzuki | | Journal of Pediatric Surgery Case Reports. 2022; : 102174 | | [Pubmed] | [DOI] | | 2 |
Management of Macrocystic Lymphatic Malformation in the Cervicofacial Region |
|
| Tao Han, Haini Chen, Jie Cui, Weimin Shen | | Annals of Plastic Surgery. 2022; 88(6): e9 | | [Pubmed] | [DOI] | | 3 |
Intralesional doxycycline and bleomycin hydrochloride in the treatment of cystic hygroma |
|
| Ashfaque Nabi, K. M. N. Ferdous, Naila Atik Khan, Nazmul Hasan, M. Kabirul Islam | | Annals of Pediatric Surgery. 2022; 18(1) | | [Pubmed] | [DOI] | | 4 |
Using deep-learning in fetal ultrasound analysis for diagnosis of cystic hygroma in the first trimester |
|
| Mark C. Walker, Inbal Willner, Olivier X. Miguel, Malia S. Q. Murphy, Darine El-Chaâr, Felipe Moretti, Alysha L. J. Dingwall Harvey, Ruth Rennicks White, Katherine A. Muldoon, André M. Carrington, Steven Hawken, Richard I. Aviv, Ruxandra Stoean | | PLOS ONE. 2022; 17(6): e0269323 | | [Pubmed] | [DOI] | | 5 |
Pediatric breast lymphatic malformation with recurrent presentation in an adolescent female |
|
| Rachel Kaye, Rebecca Leddy | | BJR|case reports. 2021; : 20210077 | | [Pubmed] | [DOI] | | 6 |
Incidental solitary cystic mediastinal lymphangioma with mass effect complications |
|
| Sofian Youssef, Sana Iftikhar, Mohammed Haris, Sathya Sundararajan, Qamar Abid | | British Journal of Hospital Medicine. 2021; 82(9): 1 | | [Pubmed] | [DOI] | | 7 |
Cervical lymphatic malformations amenable to transhairline robotic surgical excision in children |
|
| Han-Jie Lin, Frank Cheau-Feng Lin, Tsung-Lin Yang, Chun-Hsiang Chang, Chia-Hui Kao, Stella Chin-Shaw Tsai | | Medicine. 2021; 100(37): e27200 | | [Pubmed] | [DOI] | | 8 |
Cystic Hygroma with Multiple Benign Bone Lymphangiomas in an Adult Patient: A Rare Entity in the Differential Diagnosis of Multiple Osseous Lesions in Oncology Practice |
|
| Ferit Aslan, Inanç Güvenç, Aydin Aslan, Elif Günaydin | | Current Medical Imaging Formerly Current Medical Imaging Reviews. 2021; 17(3): 439 | | [Pubmed] | [DOI] | | 9 |
Phenotypic and Genomic Analysis of Cystic Hygroma in Pigs |
|
| Anna Letko, Alexandria Marie Schauer, Martijn F. L. Derks, Llorenç Grau-Roma, Cord Drögemüller, Alexander Grahofer | | Genes. 2021; 12(2): 207 | | [Pubmed] | [DOI] | | 10 |
Cystic Hygroma in a Dental Hygienist Reporting With Carpal Tunnel Syndrome: A Case Report |
|
| Jennifer D. Illes, John A. Taylor | | Journal of Chiropractic Medicine. 2021; 20(1): 30 | | [Pubmed] | [DOI] | | 11 |
Education of pediatric surgery residents over time: Examining 15?years of case logs |
|
| Claire B. Cummins, Kanika A. Bowen-Jallow, Sifrance Tran, Ravi S. Radhakrishnan | | Journal of Pediatric Surgery. 2021; 56(1): 85 | | [Pubmed] | [DOI] | | 12 |
Lymphatic and Mixed Malformations |
|
| Brynn A. Hathaway, Stephanie Radu, Johanna Wilson, Allison C. Nauta | | Lymphatic Research and Biology. 2021; 19(1): 41 | | [Pubmed] | [DOI] | | 13 |
Massive cystic hygroma of the neck with respiratory distress in newborn |
|
| Martono Tri Utomo, Aminuddin Harahap, Risa Etika | | Journal of Pediatric Surgery Case Reports. 2021; 71: 101945 | | [Pubmed] | [DOI] | | 14 |
Giant cervical cystic hygroma treated with EXIT procedure and bleomycin sclerotherapy |
|
| Elaf MohammedHameed Aljifri, Rawan Fahad Bazuhayr, Ruqiah Abdulwahab Alqurashi, Ahdab Hashim Alharbi, Osama A. Bawazir, Alya Alkaff, Hadeel H. Alwadie | | Journal of Pediatric Surgery Case Reports. 2021; 73: 101994 | | [Pubmed] | [DOI] | | 15 |
Monitoring of hemodynamic changes during huge cystic lymphangioma resection in a 91-day-old infant |
|
| Sung Wan Kim, Kyung Hyun Lee, Deuk Won Eom, Tae Hyung Kim, Sang Yoong Park | | Clinical Case Reports. 2021; 9(11) | | [Pubmed] | [DOI] | | 16 |
Fetal head and neck tumors |
|
| Tamara Feygin, Larissa T. Bilaniuk | | Pediatric Radiology. 2020; 50(13): 1999 | | [Pubmed] | [DOI] | | 17 |
Role of Bleomycin Sclerotherapy as a Non-surgical Method for the Treatment of Cystic Hygroma of Head and Neck Region-an Institutional Study |
|
| Anoop M, Rajeev Kumar Nishad, Shobhit Gupta, Yogendra Yadav | | Indian Journal of Otolaryngology and Head & Neck Surgery. 2020; | | [Pubmed] | [DOI] | | 18 |
Adult axillary lymphangioma removal using indocyanine green fluorescence imaging system: A case report |
|
| Osamu Kubota, Takashi Uchiyama, Koichi Nakamura, Yoshiro Hayashi, Yoshinori Onuki, Satoshi Baba | | International Journal of Surgery Case Reports. 2020; 72: 255 | | [Pubmed] | [DOI] | | 19 |
Rare cystic lymphangioma in the chest wall of an adult patient: A case report and comprehensive review of the literature |
|
| Shuai Song, Dong Chang, Hao Li, Bowen Li, Kaikai Xu, Chunquan Liu, Yong Cui | | Thoracic Cancer. 2020; 11(11): 3388 | | [Pubmed] | [DOI] | | 20 |
Doxycycline Sclerotherapy of a Cervical Cystic Hygroma: A Caribbean Institution Experience |
|
| Nicholas Figaro, Robbie Rampersad, Solaiman Juman | | Case Reports in Otolaryngology. 2020; 2020: 1 | | [Pubmed] | [DOI] | | 21 |
Surgical excision: an effective initial therapeutic option in the management of giant macrocystic lymphatic malformations in children |
|
| Moaied A. Hassan, Hasan K. Gatea, Thura K. Ja’afar | | Annals of Pediatric Surgery. 2020; 16(1) | | [Pubmed] | [DOI] | | 22 |
Giant lymphangioma breast – A rare occurrence: Case report and current review |
|
| GulshanKumar Garg, Sunder Goyal, ShamLal Singla | | Clinical Cancer Investigation Journal. 2020; 9(5): 205 | | [Pubmed] | [DOI] | | 23 |
The curious case of fibrofatty conversion of cystic hygroma treated with bleomycin sclerotherapy |
|
| Anjuna Reghunath, RohiniG Ghasi, Suchana Kushvaha | | Journal of Cutaneous and Aesthetic Surgery. 2020; 13(3): 229 | | [Pubmed] | [DOI] | | 24 |
Management of macrocystic lymphatic malformation at uncommon site with aqueous bleomycin sclerotherapy |
|
| Ankur Bhatnagar, VijaiDatta Upadhyaya, Rajnikant Yadav, Basant Kumar | | National Journal of Maxillofacial Surgery. 2020; 11(2): 193 | | [Pubmed] | [DOI] | | 25 |
New Treatment Option for Capillary Lymphangioma: Bleomycin-Based Electrochemotherapy of an Infant |
|
| Szandra Dalmády, Zsanett Csoma, Zsuzsanna Besenyi, Krisztina Bottyán, Judit Oláh, Lajos Kemény, Erika Kis | | Pediatrics. 2020; 146(6) | | [Pubmed] | [DOI] | | 26 |
Cystic Hygroma Occurring on the Left Side of Neck of an Adult : A Case Report and Literature Review |
|
| Keun-Hwan Kim, Jin-Wook Kim, So-Young Choi | | The Korean Journal of Oral and Maxillofacial Pathology. 2020; 44(3): 93 | | [Pubmed] | [DOI] | | 27 |
CERVICAL LYMPHANGIOMA IN ADULT- A CASE REPORT |
|
| Pradeep Balineni, Samuel Dev Merlin, Sandeep Pathivada, Prasanna Manickam, Shruthi Kamal | | Journal of Evolution of Medical and Dental Sciences. 2019; 8(12): 951 | | [Pubmed] | [DOI] | | 28 |
CERVICAL LYMPHANGIOMA IN ADULTS- A RARE ENTITY IN ADULT NECK SWELLINGS |
|
| Rajesh Daniel, Abhinav Bharadwaj Rajkumar, Prakash Sadasivam, Maramreddy Lokesh Reddy, Parivallal Damodaran | | Journal of Evolution of Medical and Dental Sciences. 2018; 7(27): 3144 | | [Pubmed] | [DOI] | | 29 |
Low-Flow Vascular Malformation Pitfalls: From Clinical Examination to Practical Imaging Evaluation—Part 1, Lymphatic Malformation Mimickers |
|
| Candace L. White, Brandon Olivieri, Ricardo Restrepo, Brett McKeon, S. Pinar Karakas, Edward Y. Lee | | American Journal of Roentgenology. 2016; 206(5): 940 | | [Pubmed] | [DOI] | | 30 |
Cases of Atypical Lymphangiomas in Children |
|
| Prashant K. Minocha,Lakhan Roop,Rambachan Persad | | Case Reports in Pediatrics. 2014; 2014: 1 | | [Pubmed] | [DOI] | | 31 |
A 13-Year-Old Girl with Recurrent Localized Bruising and Hemorrhagic Skin Papules |
|
| Katherine M. Mercy,Sarah L. Chamlin | | Pediatric Annals. 2013; 42(1): 5 | | [Pubmed] | [DOI] | | 32 |
Management of cystic lymphangioma |
|
| Hussam Hassan,Kamal AbdElelah Aly | | Annals of Pediatric Surgery. 2012; 8(4): 123 | | [Pubmed] | [DOI] | | 33 |
Cystic Hygroma |
|
| S. Barry,J. Allotey,A. M. Brundler,M. S. Duggal | | European Archives of Paediatric Dentistry. 2012; 13(6): 323 | | [Pubmed] | [DOI] | | 34 |
Maximizing time-resolved MRA for differentiation of hemangiomas, vascular malformations and vascularized tumors |
|
| Jane S. Kim,Alexander Chandler,Ross Borzykowski,Beverly Thornhill,Benjamin H. Taragin | | Pediatric Radiology. 2012; 42(7): 775 | | [Pubmed] | [DOI] | | 35 |
Literature Watch |
|
| Francine Blei | | Lymphatic Research and Biology. 2011; 9(3): 169 | | [Pubmed] | [DOI] | |
|
|
 |
 |
|
|
|
|
|
|
Article Access Statistics | | Viewed | 21644 | | Printed | 443 | | Emailed | 5 | | PDF Downloaded | 934 | | Comments | [Add] | | Cited by others | 35 | |
|

|