LYMPHANGIOMA OF NECK

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LYMPHANGIOMA OF NECK

• Dr. C. Anjaneyulu Senior Consultant Dept. of
  OtorhinolaryngologyGlobal HospitalHyderabad

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Introduction

• Benign congenital proliferation of lymphatic
  tissue.
• 3 groups - 1. Lymphangioma simplex
• 2. Cavernous lymphangioma
• 3. Cystic hygroma
• Reported incidence - 4 in 100,000 live births.
• 90 are detected by the end of second yr.
• Rare in adults.

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Etiology

• Congenital - Blockage or arrest of the
  primordial lymph channels
• Acquired Trauma
• Infection
• Tumor

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• Common site - Cervical region
• Lymphatic system is more complex and extensive in
  the cervical region.

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• 20 year old female
• Complaint - swelling in right side of neck from 3
  years.gradually increasing
• Past history - Initially patient received ATT for
  9 months because physician diagnosed it as TB
  lymphadenitis
• Examination - Diffuse, soft,lobulated, irregular,
  nontender and nonpulsatile swelling extending
  from mastoid tip and lower border of mandible to
  the clavicle

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Investigations

• MRI - Well defined encapsulated, obulated cystic
  lesion in the anterolateral and posterolateral
  compartment of neck in subcuticular plane. It is
  extended into retro pharyngeal space in
  prevertebral plane.

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• FNAC - Lymphangioma
• Routine investigations - Normal

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Surgery - Transcervical excision under general
anaesthesia

• Tumor was found in subcuticular plane.

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• Multilobulated cystic swelling in carotid
  triangle and posterior triangle.

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• Tumor removed from retropharyngeal space and
  between great vessels.
• Another separate cystic mass removed from
  supraclavicular fossa.

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• POSTOPERATIVE COURSE -
• Uneventful

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FOLLOW UP

• At 6 months
• Asymptomatic
• Clinically no
• recurrence of
• disease

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FOLLOW UP

• CECT Scan
• No residual or
• recurrent disease

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• 26 year old female
• Complaint - Swelling in right side of neck from 6
  yr. gradually increasing
• Examination - 10 cm and 6 cm diffuse swelling
  extending from mastoid tip and lower border of
  mandible to junction of upper two third and lower
  one third of sternocleidomastoid muscle.
• Irregular, lobulated, non tender, non pulsatile
  with ill defined margins.

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Investigations

• Ultrasound - large inhomogenous mass in right
  upper neck and encircling the internal jugular
  vein.
• FNAC - Lymphangioma

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• CECT Scan - Large well defined low density soft
  tissue mass deep to the sternocleidomastoid
  muscle on right side, starting just below the
  right parotid gland and extending up to the root
  of the neck by the side of right lobe of thyroid
  gland. Mass separating the IJV from carotid
  vessels and partly wrapped the IJV.

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Surgery - Transcervical excision under general
anaesthesia

• Tumor was found in subcuticular plane.
• Lobulated,soft, cystic mass extended from mastoid
  tip to middle one third of sternocleidomastoid
  muscle.
• Tumor was removed between great vessels.
• Cranial nervas in the neck were identified and
  preserved
• Post operative events - Normal

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FOLLOW UP

• At 18 Months
• Asymptomatic
• No recurrence of disease

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DISCUSSION

• Symptoms
• Common - Painless swelling
• Rare - Dysphagia, Dyspnoea, Pain,
• Sudden increase in size

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Examination

• Soft
• Fluctuant
• Lobuted
• Transilluminent
• Not attached to skin

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Radiology - Extent of lesion

• Ultra sound - Multi locular cystic mass
  containing septa of variable thickness and solid
  components.
• CECT Scan - Low density mass with thin capsule.
• MRI - Hypo intense on T1W1 and Hyper intense on
  T2W1

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• FNAC - Confirm the diagnosis

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Treatment

• Wait and Watch policy
• Aspiration
• Injection of Sclerosing agents
• Radiotherapy
• Surgical excision

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Recurrence

• More with incomplete excision
• Less or absent after complete excision

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Conclusion

• Complete surgical excision is the treatment of
  choice

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Thank you