LYMPHANGIOMA OF NECK

Dr. C. Anjaneyulu Senior Consultant

Dept. of OtorhinolaryngologyGlobal Hospital

Hyderabad

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.

Etiology

Congenital - Blockage or arrest of the primordial lymph channels

Acquired – Trauma

Infection

Tumor

Common site - Cervical region

Lymphatic system is more complex and extensive in the cervical region.

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

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.

FNAC - Lymphangioma

Routine investigations - Normal

Surgery - Transcervical excision under general anaesthesia

Tumor was found in subcuticular plane.

Multilobulated cystic swelling in carotid triangle and posterior triangle.

Tumor removed from retropharyngeal space and between great vessels.

Another separate cystic mass removed from supraclavicular fossa.

POSTOPERATIVE COURSE - Uneventful

FOLLOW UP

At 6 months Asymptomatic

Clinically no

recurrence of

disease

FOLLOW UP

CECT Scan –

No residual or

recurrent disease

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.

Investigations

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

FNAC - Lymphangioma

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.

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

FOLLOW UP

At 18 Months – Asymptomatic

No recurrence of disease

DISCUSSION

Symptoms Common - Painless swelling

Rare - Dysphagia, Dyspnoea, Pain,

Sudden increase in size

Examination

Soft

Fluctuant

Lobuted

Transilluminent

Not attached to skin

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

FNAC - Confirm the diagnosis

Treatment

Wait and Watch policy

Aspiration

Injection of Sclerosing agents

Radiotherapy

Surgical excision

Recurrence

More with incomplete excision

Less or absent after complete excision

Conclusion

Complete surgical excision is the treatment of choice

Thank you