Massive unilateral fetal axillary lymphangioma: A case report

Prenatal and differential diagnosis of fetal thoracolumbar lymphangioma

We present a case of a woman in her mid-30s at 21 weeks of gestation referred to our tertiary medical center by an outside clinic with an ultrasound finding of a cystic septated lesion on the left side of the fetal chest.The differential diagnosis included, among others, foetal nuchal oedema, cystic hygroma, meningocele, encephalocele, cervical teratoma, haemangioma and subchorionic placental cyst. The sonographic finding of lack of intralesional vascularity on Doppler, seemingly without communication with the spinal canal, pointed us towards a diagnosis of foetal cystic lymphangioma. Our diagnosis was confirmed postnatally.Foetal cystic lymphangiomas are rare benign congenital tumours of the vascular and lymphatic systems. The differential diagnosis is broad, and a timely diagnosis positively affects the prognosis. If a lymphangioma is suspected, we suggest referral to specialists in maternal-foetal medicine with expertise in the field.

Fetal Cystic Lymphatic Malformations: Systematic Review on Pregnancy and Neonatal Outcomes

OBJECTIVE

Evaluate pregnancy and neonatal outcomes with fetal cystic lymphatic malformations (LMs), excluding those arising from the posterior neck, to facilitate patient counseling.

METHOD

A systematic review was performed in accordance with PRISMA guidance. Case series and case reports published between 2000 and 2022 were included.

RESULTS

Sixty-five studies (96 fetuses) met the inclusion criteria. The average gestational age at diagnosis was 25.5 weeks with the commonest location being the anterior neck (28%). All patients were diagnosed with LM using two-dimensional (2D) ultrasound. Prenatal progression in LM size, presence of intralesional bleeding, or fetal hydrops occurred in 70% (41/59), 9% (5/59), and 3% (2/59), respectively. Chromosomal and structural abnormalities were reported in 4% (2/52) and 2% (2/96), respectively. Overall livebirth rate was 94% (79/84); 12/96 resulted in termination and 5/84 in in utero demise. The average gestational age of delivery was 37.7 weeks. Exactly 19% (15/79) had a vaginal birth, of which shoulder dystocia occurred in one infant. Ex utero intrapartum treatment (EXIT) procedure was performed in 13% (10/79). Postnatal treatment commonly involved surgical excision 38% (30/79), sclerotherapy in 21.5% (17/79), or combination of both in 11.4% (9/79). Of those with reported follow-up, 4 died within 1 year, 1 developed heart failure at 2 years of life, and the remaining 44 had normal developmental outcomes.

CONCLUSION

Fetal cystic LMs, excluding those in the posterior neck, are not commonly associated with chromosomal, or additional structural abnormalities. They usually increase in size before delivery with only a minority developing complications. The good developmental outcome was reported in all survivors.

Efficiency and clinical results of bleomycin injection in the treatment of lymphatic malformations

BACKGROUND

Lymphatic malformations (LMs) are rare congenital anomalies. The traditional treatment is surgical excision, but intralesional sclerosing agent injection is also preferred as the first-choice treatment because of postoperative frequent recurrences, poor cosmetic results, and high complication rate. We aimed to evaluate the efficacy of sclerosing agent injection used in the treatment of LMs in children.

MATERIALS AND METHODS

We retrospectively analyzed the children who were treated for LM between January 2011 and January 2022. The lesion sizes of the patients who were injected with sclerosant (Bleomycin) under sedation anesthesia, measured by ultrasound before and after the treatment, were recorded, and the difference between them was statistically evaluated.

RESULTS

Fifteen patients were retrospectively analyzed. The mean age was 45.2 ± 14.1 months. Of these, ten (66.6%) were male and five (33.3%) were female (F/M = 1/2). The mean age of male patients was 55 ± 20.1 months; the mean age of female patients was 25.8 ± 11. Seven patients had a single dose, two had twice, and six had three and more. The mean measurable size of macrocystic lesions before treatment was 55.2 ± 28.4 mm; after treatment, it was 23.8 ± 18.2 mm. Although no measurable shrinkage was detected in microcystic lesions, it was observed that the lesion shrank to allow surgical resection. With the statistical analysis, it was seen that there was a statistically significant difference between the dimensions before and after the treatment (P < 0.05) and the sclerosant injection had a great effect on the treatment (R: 0.89).

CONCLUSION

Intralesional injection of bleomycin is less effective for microcystic or mixed-type LMs, but provides an effective reduction for a safe surgical procedure. It is an effective treatment for macrocystic lesions.