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

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Presentation on theme: "LYMPHANGIOMA OF NECK Dr. C. Anjaneyulu Senior Consultant Dept. of Otorhinolaryngology Global Hospital Hyderabad."— Presentation transcript:

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


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