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Yoshida S, Imai H, Roh S, Mese T, Koshima I. Cystic Lymphatic Malformation with Lymphedema Treated by Lymphaticovenular Anastomosis Combined with Ethanol Sclerotherapy. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2023; 11:e4871. [PMID: 36936462 PMCID: PMC10022848 DOI: 10.1097/gox.0000000000004871] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Accepted: 01/27/2023] [Indexed: 03/19/2023]
Abstract
The incidence of cystic lymphatic malformation (CL) in an extremity is very rare. CL can be a cause of lymphedema in a lower limb. The most effective treatment for CL is sclerotherapy or excision; however, these treatments have the potential to cause fibrosis and obliteration of ruptured lymphatic vessels, which impairs lymphatic drainage and increases the risk of lymphedema. Lymphaticovenular anastomosis (LVA) combined with sclerotherapy may be a minimally invasive treatment option for CL in a lower limb. In this report, we describe a patient with CL complicated by lymphedema in a lower extremity, who we treated using LVA and ethanol sclerotherapy with satisfactory results. The patient was a 60-year-old man with a CL measuring 16 cm in diameter in the thigh region above the knee with lower limb lymphedema. The percentage of excess volume of the affected lower leg was 24.7%, preoperatively. Combined treatment using LVA with sclerotherapy was performed under general anesthesia. At 2 years after surgery, the reduction of excess volume of affected lower leg between preoperative and postoperative was 85.4%. In our previous report, the same combination therapy was used to treat CL and prevent lymphedema; however, in the present case, it was used to treat CL and lymphedema at one stage. LVA combined with sclerotherapy is a complementary minimally invasive treatment for CL accompanied by lymphedema.
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Affiliation(s)
- Shuhei Yoshida
- From The International Center for Lymphedema, Plastic and reconstructive Surgery, Hiroshima University Hospital, Hiroshima, Japan
| | - Hirofumi Imai
- From The International Center for Lymphedema, Plastic and reconstructive Surgery, Hiroshima University Hospital, Hiroshima, Japan
| | - Solji Roh
- From The International Center for Lymphedema, Plastic and reconstructive Surgery, Hiroshima University Hospital, Hiroshima, Japan
| | - Toshiro Mese
- From The International Center for Lymphedema, Plastic and reconstructive Surgery, Hiroshima University Hospital, Hiroshima, Japan
| | - Isao Koshima
- From The International Center for Lymphedema, Plastic and reconstructive Surgery, Hiroshima University Hospital, Hiroshima, Japan
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Berenstein A, Bazil MJ, Sorscher M, Blei F, De Leacy R, Shigematsu T, Waner M, Fifi JT. Percutaneous sclerotherapy of microcystic lymphatic malformations: the use of an innovative gravity-dependent technique. J Neurointerv Surg 2023; 15:272-275. [PMID: 35347057 DOI: 10.1136/neurintsurg-2021-018526] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Accepted: 03/19/2022] [Indexed: 11/04/2022]
Abstract
BACKGROUND In the last few decades there has been development of innovative therapies for the treatment of craniofacial lymphatic malformations. Percutaneous sclerotherapy has demonstrated efficacy in the management of macrocystic lymphatic lesions, but it is less suitable for microcystic lesions given their size. The gravity-dependent technique is a novel augmentation of standard percutaneous sclerotherapy: the technique enables a sclerosing agent to permeate the small microchannels seen in microcystic lesions that would otherwise be difficult to treat. METHODS Between 2005 and 2021, 124 patients with microcystic or mixed lymphatic malformations were treated using a novel gravity-dependent sclerotherapy technique. Bleomycin at a maximum dose of 15 IU per session was used as the main sclerosing agent. Fluoroscopy and ultrasound were used to ensure proper positioning of the catheter prior to injecting the sclerosing agent. The response to treatment was assessed clinically and with cross-sectional imaging. RESULTS Nearly all cases showed significant improvement after the gravity-dependent technique. There have been no permanent complications from sclerotherapy treatment. There was a mild transient adverse effect from bleomycin in one case of erythema and tenderness that lasted several weeks then ameliorated. CONCLUSIONS The gravity-dependent sclerotherapy technique is a suitable treatment option for microcystic lymphatic malformations.
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Affiliation(s)
| | | | - Michelle Sorscher
- Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Francine Blei
- Otolaryngology, Hofstra University North Shore LIJ School of Medicine, Hempstead, New York, USA
| | - Reade De Leacy
- Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | | | - Milton Waner
- Otolaryngology, Hofstra University North Shore LIJ School of Medicine, Hempstead, New York, USA
| | - Johanna T Fifi
- Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA
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Sclerosing agents in the management of lymphatic malformations in children: A systematic review. J Pediatr Surg 2022; 57:888-896. [PMID: 35151497 DOI: 10.1016/j.jpedsurg.2021.12.056] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Accepted: 12/30/2021] [Indexed: 11/23/2022]
Abstract
PURPOSE Sclerotherapy is frequently employed in treating lymphatic malformations (LMs), and multiple agents, practitioners and strategies exist. This review investigates the reported efficacy and safety of sclerosants in the pediatric population. METHODS Adhering to PRISMA guidelines, multiple databases were queried without linguistic or temporal restriction. Inclusion criteria were patients aged 0-18 exclusively receiving injection sclerotherapy for the treatment of LMs with follow-up data. Data abstracted included agent, dose, anatomic site and key outcome measures including complications (major/minor) and resolution rates (>95% reduction in volume). Critical appraisal was undertaken using the MINORS tool. RESULTS Forty-eight studies met the inclusion criteria with a mean MINORS score of 0.65 ± 0.08. Included studies yielded 886 patients, across nearly 30 years. The overall observed rate of success was 89%, with variable follow-up across publications (6 weeks - 10 years). Most reported LMs were macrocystic (82%) and had a higher resolution rate than mixed/microcytic variants (89%, 71%, 34%, p<0.01) For head/neck LMs, rates of complete regression for OK-432, bleomycin, and doxycycline were 67% ± 27% (n = 26), 91% ± 53% (n = 34) and 85% ± 16% (n = 52) respectively. Major complications were most commonly reported with OK-432, including airway compromise or subsequent operation. CONCLUSIONS In pediatric patients treated for LM by sclerotherapy, complication rates were low. Macrocystic lesions respond well but success rates were modest at best for microcystic disease. Differences in agent utilization were noted between high and low resourced contexts; despite its lack of federal approval, OK-432 was the most reported agent. Further prospective research is warranted. LOE: 3a.
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Efficacy and Clinical Outcomes of Bleomycin in the Treatment of Lymphangiomas: A Multicenter Experience. Dermatol Surg 2021; 47:948-952. [PMID: 33625132 DOI: 10.1097/dss.0000000000002976] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Bleomycin sclerotherapy became a popular nonsurgical option for the management of lymphangiomas. However, its efficacy has not been thoroughly evaluated. The purpose of this study was to assess the clinical outcomes and the effectiveness of bleomycin injection for the treatment of lymphangioma. METHODS This retrospective study was conducted in 4 centers and included 47 infants and children. All patients had bleomycin sclerotherapy between November 2005 and September 2020. Men presented 53.2% of the study sample (n = 25), and the most common site was the head and neck (n = 29, 61.7%). RESULTS Two injections were required in 11 patients (23.4%), and 7 patients (14.9%) required 3 or more injections. Excellent response was achieved in 63.8% (n = 30), 14 patients (29.8%) had a good response, and 4 had a poor response (8.5%). There was no difference in the response according to the site of the lesion (p = .75). The most frequent complication was recurrence (n = 11, 23.4%), and swelling occurred in 5 patients (10.6%). No patient had facial or phrenic nerve palsy or hoarseness. Two patients had persistent pain, and 2 had an infection (4.3%). CONCLUSION Intralesional bleomycin injection could be an effective therapy for lymphangiomas. The procedure has a low complication profile, and long-term study is recommended to evaluate the systemic and late bleomycin injection complications.
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Lymphatic malformations in children: treatment outcomes of sclerotherapy in a large cohort. Eur J Pediatr 2021; 180:959-966. [PMID: 33051716 PMCID: PMC7886713 DOI: 10.1007/s00431-020-03811-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2019] [Revised: 08/03/2020] [Accepted: 09/14/2020] [Indexed: 11/12/2022]
Abstract
This retrospective study examines the outcomes of sclerotherapy in children with (veno)lymphatic malformations who received sclerotherapy between 2011 and 2016 (116 children, 234 procedures). Complication severity was classified using the Society of Interventional Radiology classification. Clinical response was rated on a scale of 0 (no change) to 3 (good improvement). The sclerosants used were bleomycin (n = 132; 56%), lauromacrogol (n = 42; 18%), doxycycline (n = 15; 6%), ethanol (n = 12; 5%), or a combination (n = 33; 14%). Four major and 25 minor complications occurred without significant differences between the agents. The median response rate per procedure was 2-some improvement-for all sclerosants. However, in pure LMs (67%), bleomycin and a combination of agents resulted in the best clinical response. On patient level, all had some or good clinical response. Mixed macrocystic and microcystic lesions showed a significantly lower clinical response (median 2 versus 3; p = 0.023 and p = 0.036, respectively) and required significantly more procedures (median 2 versus 1; p = 0.043 and p = 0.044, respectively) compared with lesions with one component.Conclusion: Sclerotherapy for (V)LMs in children is safe and effective. Bleomycin is the most frequently used agent in this clinic and seemed most effective for pure LMs. Mixed macrocystic and microcystic lesions are most difficult to treat effectively. What is Known: • A variety of agents can be used for sclerotherapy of lymphatic malformations in children. • Macrocystic lesions have favorable outcomes compared with microcystic and mixed lesions. What is New: • Bleomycin and a combination of agents seem to be most effective to treat lymphatic malformations in children. • Mixed macrocystic and microcystic lesions are more difficult to treat effectively compared with lesions with either one of these components.
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Reghunath A, Ghasi RG, Kushvaha S. The Curious Case of Fibrofatty Conversion of Cystic Hygroma Treated with Bleomycin Sclerotherapy. J Cutan Aesthet Surg 2020; 13:229-232. [PMID: 33209001 PMCID: PMC7646422 DOI: 10.4103/jcas.jcas_152_19] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Cystic hygroma is a congenital malformation of the lymphatic system that mostly presents at birth. Though the classic treatment of this condition is surgical excision, recent alternative treatment modalities such as injection of sclerotherapeutic agents (e.g., bleomycin and OK-432) into the lesion has gained popularity due to its safe and effective response profile with minimal side effects. We report a rare complication of repeated bleomycin sclerotherapy in a follow-up patient of cystic hygroma, where the lesion underwent fibrolipomatous conversion with insinuation into multiple fascial planes, causing mass effect by encasement and compression of major vascular and airway structures. This is the first time such a complication of bleomycin sclerotherapy has been reported in literature. Such an unusual presentation reminds us that, in any patient presenting with recurrent gradually increasing swelling with worsening of symptoms following bleomycin sclerotherapy, a possibility of fibrolipomatous conversion of cystic hygroma should be borne in mind.
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Affiliation(s)
- Anjuna Reghunath
- Department of Radiodiagnosis, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India
| | - Rohini G Ghasi
- Department of Radiodiagnosis, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India
| | - Suchana Kushvaha
- Department of Radiodiagnosis, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India
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Chen WL, Liao JK, Zhou B, Chen R, Yuan KF. Comprehensive treatment of massive macroglossia due to venous and lymphatic malformations. Int J Oral Maxillofac Surg 2020; 49:874-881. [PMID: 31974007 DOI: 10.1016/j.ijom.2020.01.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2019] [Revised: 11/08/2019] [Accepted: 01/06/2020] [Indexed: 11/25/2022]
Abstract
This study evaluated the outcomes of comprehensive treatment for massive macroglossia. Eleven patients with massive macroglossia due to venous malformations (VMs) and lymphatic malformations (LMs) underwent incision excision of two-thirds of the central wedge of the tongue; two of these patients underwent resection of lesions in the lower lip or floor of the mouth during initial treatment. In subsequent treatment, three patients underwent orthognathic surgery or resection of lesions in the lower lip and submental region, and four patients underwent one or two sclerotherapies. No patient had complications resulting from anaesthesia or surgery. Patients were followed up at 6 months postoperative, and all signs associated with the lesions had disappeared. The mean follow-up duration was 30.8 months. The aesthetic outcome was excellent for nine patients and satisfactory for two. Nine patients could take a soft diet and two a solid diet. Eight patients presented normal speech and three presented intelligible speech. Comprehensive treatment including incision excision of two-thirds of the central wedge of the tongue, as well as orthognathic surgery, the resection of lesions in the oral and maxillofacial region, and sclerotherapy, is effective for patients with massive macroglossia due to VMs and LMs.
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Affiliation(s)
- Wei-Liang Chen
- Department of Oral and Maxillofacial Surgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China.
| | - Juan-Kun Liao
- Department of Oral and Maxillofacial Surgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Bin Zhou
- Department of Oral and Maxillofacial Surgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Rui Chen
- Department of Oral and Maxillofacial Surgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Kai-Fang Yuan
- Department of Oral and Maxillofacial Surgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
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Rubis B, Luczak MW, Krawic C, Zhitkovich A. Vitamin C increases DNA breaks and suppresses DNA damage-independent activation of ATM by bleomycin. Free Radic Biol Med 2019; 136:12-21. [PMID: 30926564 PMCID: PMC6488359 DOI: 10.1016/j.freeradbiomed.2019.03.026] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2019] [Revised: 02/25/2019] [Accepted: 03/25/2019] [Indexed: 01/07/2023]
Abstract
Bleomycin is a redox-active drug with anticancer and other clinical applications. It is also frequently used as a tool in fundamental research on cellular responses to DNA double-strand breaks (DSBs). A conversion of bleomycin into its DNA-breaking form requires Fe, one-electron donors and O2. Here, we examined how a major biological antioxidant ascorbate (reduced vitamin C), which is practically absent in standard cell culture, impacts cellular responses to bleomycin. We found that restoration of physiological levels of vitamin C in human cancer cells increased their killing by bleomycin in 2D cultures and 3D tumor spheroids. Higher cytotoxicity of bleomycin occurred in cells with normal and shRNA-depleted p53. Cellular vitamin C enhanced the ability of bleomycin by produce DSBs, which was established by direct measurements of these lesions in three cell lines. Vitamin C-restored cancer cells also showed a higher sensitivity to killing by low-dose bleomycin in combination with inhibitors of DSB repair-activating ATM or DNA-PK kinases. The presence of ascorbate in bleomycin-treated cells suppressed a DSB-independent activation of the ATM-CHK2 axis by blocking superoxide radical. In vitro studies detected a greatly superior ability of ascorbate over other cellular reducers to catalyze DSB formation by bleomycin. Ascorbate was faster than other antioxidants in promoting two steps in activation of bleomycin. Our results demonstrate strong activation effects of vitamin C on bleomycin, shifting its toxicity further toward DNA damage and making it more sensitive to manipulations of DNA repair.
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Affiliation(s)
- Blazej Rubis
- Department of Pathology and Laboratory Medicine, Brown University, 70 Ship Street, Providence, RI, 02912, USA
| | - Michal W Luczak
- Department of Pathology and Laboratory Medicine, Brown University, 70 Ship Street, Providence, RI, 02912, USA
| | - Casey Krawic
- Department of Pathology and Laboratory Medicine, Brown University, 70 Ship Street, Providence, RI, 02912, USA
| | - Anatoly Zhitkovich
- Department of Pathology and Laboratory Medicine, Brown University, 70 Ship Street, Providence, RI, 02912, USA.
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Hasan HYA, Rizwan MA. Efficacy of OK-432 Therapy for the Incisionless Treatment of Head and Neck Cystic Masses: Case series. Sultan Qaboos Univ Med J 2018; 18:e88-e92. [PMID: 29666687 DOI: 10.18295/squmj.2018.18.01.014] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2017] [Revised: 11/26/2017] [Accepted: 12/21/2017] [Indexed: 11/16/2022] Open
Abstract
Head and neck masses can present in different pathologies that usually vary according to the age of the patient. We report five cases of benign head or neck masses occurring among patients of different ages who were managed at the Bahrain Defence Force Royal Medical Services Hospital, Ar-Rifaa, Bahrain, between 2005-2014. All of the patients were treated using the sclerotherapeutic agent OK-432. Although surgical removal is usually considered optimal treatment in the management of such cases, OK-432 appears to be a promising alternative.
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Affiliation(s)
- Hesham Y A Hasan
- Department of Otorhinolaryngology, Bahrain Defence Force Hospital, Ar-Rifaa, Bahrain
| | - Muhammad A Rizwan
- Department of Otorhinolaryngology, Bahrain Defence Force Hospital, Ar-Rifaa, Bahrain
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Yamaki T, Sasaki Y, Hasegawa Y, Osada A, Konoeda H, Hamahata A, Nozaki M, Sakurai H. Percutaneous ultrasound-guided sclerotherapy with polidocanol microfoam for lymphatic malformations. J Vasc Surg Venous Lymphat Disord 2017; 5:707-714. [DOI: 10.1016/j.jvsv.2017.03.017] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2017] [Accepted: 03/28/2017] [Indexed: 01/22/2023]
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Chen AW, Wang T, Huang YY, Liu SH. Multistage Sclerotherapy for Extensive Lymphatic Malformations With Airway Involvement in Infant: A Protocol to Prevent Tracheotomy. J Oral Maxillofac Surg 2017; 75:1882-1890. [DOI: 10.1016/j.joms.2017.03.006] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2016] [Revised: 03/08/2017] [Accepted: 03/09/2017] [Indexed: 11/30/2022]
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Gentileschi S, Servillo M, Salgarello M. Supramicrosurgical lymphatic-venous anastomosis for postsurgical subcutaneous lymphocele treatment. Microsurgery 2015; 35:565-8. [DOI: 10.1002/micr.22478] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2015] [Revised: 07/26/2015] [Accepted: 08/10/2015] [Indexed: 11/09/2022]
Affiliation(s)
- Stefano Gentileschi
- Department of Plastic and Reconstructive Surgery; Catholic University Sacred Heart, Policlinico Agostino Gemelli; Rome Italy
| | - Maria Servillo
- Department of Plastic and Reconstructive Surgery; Catholic University Sacred Heart, Policlinico Agostino Gemelli; Rome Italy
| | - Marzia Salgarello
- Department of Plastic and Reconstructive Surgery; Catholic University Sacred Heart, Policlinico Agostino Gemelli; Rome Italy
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Chen WL, Zhang LP, Huang ZQ, Zhou B. Percutaneous sclerotherapy of sialoceles after parotidectomy with fibrin glue, OK-432, and bleomycin. Br J Oral Maxillofac Surg 2013; 51:786-8. [DOI: 10.1016/j.bjoms.2013.04.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2012] [Accepted: 04/04/2013] [Indexed: 10/26/2022]
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