A lymphangioma is a benign growth that develops in the lymphatic vessels.
Lymphangioma is caused by a disorder in the lymphatic vascular system.
Although lymphangioma is rare, it appears in many cases among newborns or during the first year of life.
It is relatively common in the head, neck, or floor of the mouth, also referred to as a cystic malignant tumor.
In most cases, the skin cells retain almost all of their color, and sometimes they tend to turn cyanotic as well.
These tumors can vary in size but usually do not regress.
There are several ways to treat them in Turkey, including surgery, injections of drugs, or lasers.
Causes of lymphangioma and cystic hygroma
The known cause of the condition is the blockage of the lymphatic system, although the direct cause cannot always be determined.
It is thought to develop due to a genetic disorder of the lymphatic vessels.
If the malformation prevents the lymphatic vessels from merging into the veins, the lymph fluid cannot drain, and the vessels in the area enlarge, forming a thickening with cavities inside (cysts).
Hemangioma and lymphangioma are similar, but hemangioma affects blood vessels rather than lymph vessels.
In the neck area, the condition is also called a hygroma (cystic hygroma).
In most cases, these growths are skin-colored to light-colored.
In particular, cystic hygroma often occurs in the context of other genetic disorders such as Down syndrome (trisomy 21).
Symptoms of lymphangioma
A disorder of the lymphatic system causes a lymphoma.
This condition and a wet cystic tumor are both benign tumors.
It is often already present at birth or is often noticed by the age of one.
It can develop in different areas of the body, but is most common in the throat, the floor of the mouth, the back of the neck, or the head.
Three types of this condition can be distinguished:
- A cystic tumor (cystic angioma) can be found not only in and around the neck, but also in the armpit or in the middle of the chest cavity (mediastinum).
This type is characterized by enlarged vessels that are often connected to each other in a malignant tumor. - The cavernous form is characterized by the presence of cavities in which bleeding can often occur.
In such a case, the findings in the affected area will be darker.
Benign cavernous forms often occur on the face, extremities, or armpits. - The capillary type (peripheral form) is a small tumor to detect.
It can generally be observed as a fragile vesicle and can be found in the mouth, genitals, or groin.
The latter type of tumor, sometimes referred to as lymphatic gigantism, often results in an overgrowth of lymphatic vessels.
This condition affects several areas and can lead to the displacement of organs.
Among other things, it can narrow the airways and lead to significant breathing disorders.
Depending on its size, it can also cause aesthetically disfiguring deformities.
Lymphangioma diagnosis
Children are physically examined by a doctor, and then the results are evaluated.
The doctor takes the parents’ medical history (interviews and examines them).
The most important tool in the examination is ultrasound.
This method can be used to distinguish between other diseases and also to assess whether there are other important organs in the child’s body in the vicinity.
When further examination is needed, magnetic resonance imaging (MRI) can be used; sometimes it may be necessary.
How are lymphangioma and cystic hygroma treated in Turkey?
Treatment depends on the structure and size of the lymphangioma. Surgery is often performed.
Conservative treatment
Treatment can be carried out with the active substance Picibanil (it is a combination of group A streptococcus with antitumor properties and is used in the treatment of lymphangioma). The active ingredient is injected into the body (in children, it is injected under general anesthesia).
The substance provokes an inflammatory reaction inside the lymphangioma.
This leads to the erasure of cavities (abscesses) because the walls stick together and the swelling shrinks.
As a rule, treatment with (OK-432) Picibanil should be performed several times.
Although many side effects have been reported for OK-432 injections (fever, injection site discomfort, swelling, and fever in patients with penicillin allergy) in one of the actual symptomatic trials, the side effects of Picibanil were limited: Relevant side effects were represented by a single case of anemia which was resolved by a red blood cell concentrate transfusion.
Laser therapy in Turkey
Another possibility for treating lymphangioma or hygroma, which is less common, is laser therapy.
A carbon dioxide laser vaporizes the underlying tissue and closes the lymphatic channels.
If the laser energy does not penetrate deep enough into the dermis and subcutaneous tissue, the patient will only achieve short-term symptom relief, and the condition will recur.
In addition, the energy delivered to deep tissues requires large amounts of local anesthesia due to the severe pain it causes in newborns and may require a long healing period with the possibility of scarring and swelling, prolonged erythema multiforme, or post-inflammatory hyperpigmentation.
The pulsed dye laser (PDL) emits high-energy laser light in ultra-short pulse durations, allowing for specific targeting of chromium-bearing hemoglobin in and around vessels without damaging surrounding tissue.
Sclerotherapy
Sclerotherapy involves injecting foamy sclerosants, chemical irritants, or highly osmotic agents into the lymphatic malformations to destroy the affected vessels.
Injectable corticosteroids, tetracyclines, 50% dextrose solution, and hypertonic saline have been used in case reports and preliminary trials.
Sclerotherapy with tetradecyl sodium sulfate can be considered a successful minimally invasive option for the treatment of lymphangioma.
Lymphangioma surgery
Surgery can also be performed to remove a lymphangioma, where the surgical removal of the tumor is done under general anesthesia.
You should be aware of the possible complications that can occur during the surgery.
Surgical excision is the most effective treatment, giving the highest chance of cure with a recurrence rate of 17% to 23%, by completely excising the subcutaneous cavities and removing the source of the vesicles.
While surgical removal offers a definitive cure, it also carries significant risks, including scarring, hematoma, infection, and nerve injury.
Surgery has the lowest recurrence rates but carries a higher risk of complications.
However, this may not be possible in some situations when the injury is extensive. Doctors should discuss treatment goals with patients when designing a treatment plan.
Possible complications of lymphangioma
Lymphomas do not usually resolve on their own. Therefore, effective treatments such as surgery are necessary to eliminate it. After surgery, the tumor can come back (relapse) if not all parts of the lymphangioma are removed.
Lymphangioma is a benign tumor that does not form metastases (satellite tumors, i.e., migrating cancer cells).
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