LYMPHANGIOMA OF NECK Dr. C. Anjaneyulu Senior Consultant Dept. of Otorhinolaryngology Global 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

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