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

2. Introduction Benign congenital proliferation of lymphatic tissue.
3 groups 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.

3. Etiology
Congenital - Blockage or arrest of the primordial lymph channels
Acquired – Trauma
Infection
Tumor

4. Common site - Cervical region
Lymphatic system is more complex and extensive in the cervical region.

5. 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

6. 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.

7. FNAC - Lymphangioma
Routine investigations - Normal

8. Surgery - Transcervical excision under general anaesthesia
Tumor was found in subcuticular plane.

9. Multilobulated cystic swelling in carotid triangle and posterior triangle.

10. Tumor removed from retropharyngeal space and between great vessels.
Another separate cystic mass removed from supraclavicular fossa.

11. POSTOPERATIVE COURSE -
Uneventful

12. FOLLOW UP
At 6 months
Asymptomatic
Clinically no
recurrence of
disease

13. FOLLOW UP
CECT Scan –
No residual or
recurrent disease

14. 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.

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

16. 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.

17. 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

18. FOLLOW UP
At 18 Months –
Asymptomatic
No recurrence of disease

19. DISCUSSION Symptoms Common - Painless swelling
Rare - Dysphagia, Dyspnoea, Pain,
Sudden increase in size

20. Examination Soft Fluctuant Lobuted Transilluminent
Not attached to skin

21. 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

22. FNAC - Confirm the diagnosis

23. Treatment Wait and Watch policy Aspiration
Injection of Sclerosing agents
Radiotherapy
Surgical excision

24. Recurrence More with incomplete excision
Less or absent after complete excision

25. Conclusion
Complete surgical excision is the treatment of choice

26. Thank you