1. Management of Peripheral Lymphatic Malformations By Joe Brancheck, MS4 University of Illinois

2. Patient AM CC: Lump on Right ankle HPI: Pt is a 21 m/o male presenting to clinic for a 3 month history of a lump on the medial aspect of the Right ankle. No pain or discomfort is noted from the lump. The mother thinks the mass is growing quicker than AM is growing. Birth Hx: Term birth and normal development PMHx: None PSHx: None Fam Hx: Noncontributory Soc Hx:Noncontributory Meds: None All: NKDA

3. Physical Exam VSS Gen: Healthy appearing boy in NAD CV: RRR No MRG Lungs: CTA B/L No WRR Abd: Soft, NT, No masses Right Lower Extremity: On the medial aspect of his Right leg just above the medial malleolus is a soft, spongy mass roughly 2 cm in diameter. Not mobile. No overlying skin discoloration. Imaging Ultrasound

4. Classification of Vascular Anomalies Tumors – Congenital Hemangioma – Infantile Hemangioma – Kaposiform Vascular Malformations – Slow Flow Venous Lymphatic Capillary – Fast Flow Arteriovenous – Mixed

5. Lymphatic Malformations

6.  Incidence is 1/2000-1/4000 live births  Can be classified as macrocystic, microcystic, or mixed  Described as truncal vs. extratruncal  Presentation: Can occur anywhere on the body  Symptoms are dependent on location

8. Diagnosis  History  Physical Exam  Imaging: Ultrasound and MRI

11. AM’s Ultrasound

15. Management  Conservative or Supportive Management  Surgical Excision  Sclerotherapy  Carbon dioxide laser therapy  Interferon alpha therapy

16. Conservative/Supportive

17. Surgical Therapy Can offer definitive cure Can be limited by anatomic location of LM Complications include fistula, infection, scarring and recurrences.

18. Sclerotherapy Several Agents can be used including ethanol, bleomycin, dextrose, sodium tetradecyl, OK- 432 (Picibanil), or doxycycline. Indications: Similar to Surgical Side effects: erythema and swelling, fistula, leakage, failure of therapy

19. Doxycycline sclerotherapy in children with lymphatic malformations: outcomes, complications and clinical efficacy

21. Works Cited Blei, Francine. "Congenital Lymphatic Malformations. Ann. N.Y. Acad. Sci. 1131: 185–194 (2008).“Academic Search Complete. EBSCO, 2008. Web. 21 Aug. 2012 Boon, Laurence, Odile Enjolras, and John Mulliken. "Vascular Malformations.” Harper's Textbook of Pediatric Dermatology Chapter 112 (2011). Academic Search Complete. EBSCO, n.d. Web. 21 Aug. 2012. Cohen, Meir. "Lymphatic Vascular Malformations Treatment & Management." Lymphatic Vascular Malformations Treatment & Management. Medscape, 30 Sept. 2011. Web. 21 Aug. 2012.. Perkins, Jonathan, Et al. "Lymphatic Malformations: Review of Current Treatment." Otolaryngology–Head and Neck Surgery (2010) 142, 795-803 Academic Search Complete. EBSCO, 2010. Web. 21 Aug. 2012. Richter, Gresham, and Adva Friedman. "Hemangiomas and Vascular Malformations: Current Theory and Management.“ (2012). Academic Search Complete. EBSCO, n.d. Web. 21 Aug. 2012. Shergill, Arvind, Philip John, and Joao Amaral. "Doxycycline Sclerotherapy in Children with Lymphatic Malformations: Outcomes, Complications and Clinical Efficacy." Pediatric Radiology 42 (2012): 1080-088. Academic Search Premier. Web. 21 Aug. 2012.

22. Questions?