Extensive cervical-mediastinal cystic lymphatic malformation treated with sclerotherapy in a child with Klippel-Trenaunay syndrome

Klippel-Trenaunay syndrome is a rare congenital disorder characterized by combined vascular malformations, varicosities, and limb enlargement. A child case of Klippel-Trenaunay syndrome with a large cervicomediastinal cystic lymphatic malformation and a vascular mass on the chest wall has been presented to demonstrate combined use of conservative and surgical approaches in this syndrome. Cystic lymphatic malformation was treated by sclerotherapies including ultrasound-guided transthoracic bleomycin injection into mediastinal cyst, which was tried for the first time in the literature, and vascular chest wall tumor necessitated surgical excision.     

Giant cystic hygroma associated with venous aneurysm.

Complete excision of giant cystic hygroma requires meticulous dissection of the multilocular lymphatic cysts from the adjacent vascular and neural structures. The association of venous aneurysms with cystic hygroma is extremely rare. We report two infants with cystic hygroma in whom preoperative diagnosis of venous aneurysm was helpful in planning complete excision of the lymphatic lesions.     

Unilateral lower limb swelling secondary to cavernous lymphangioma.

INTRODUCTION: We report an unusual case of unilateral leg swelling secondary to cavernous lymphangioma (cystic hygroma), which normally affects the head and neck regions. CASE REPORT: A 25 year gentleman presented to our department with a 13-year history of gradually increasing unilateral leg swelling and recurrent infections. Investigations showed appearances consistent with cavernous lymphangioma, and partial excision of the lesion led to resolution of symptoms. DISCUSSION: The most common sites for cystic hygroma are the head and neck areas, but the extremities can be affected as demonstrated. Complete surgical excision is often difficult, and there is a tendency for recurrence. This case acts as an illustration of an uncommon yet important cause for unilateral leg swelling.     

Cystic hygroma in Saudi Arabian children

Seven cases of cystic hygroma in Saudi Arabian children were treated in King Khalid University Hospital, Riyadh between 1984 and 1987. One newborn child had bilateral giant cystic hygroma. Investigation included ultrasound and computed tomographic scan. All patients but one underwent single or multiple surgical procedures for excision of the cystic hygroma.     

A case of cystic hygroma of the chest wall

Hygroma is generally regarded as a benign tumor occurring favoritely in the cervical region of a child. Recently we have experienced a case of hygroma which was initially detected as a right chest wall tumor in a 16-year-old man, then was surgically diagnosed as cystic hygroma; chest roentgenography on a check up examination in his senior high school pointed out some anomaly, leading to his hospitalization. On admission, he had no subjective symptom, but chest roentgenography and CT confirmed an abnormal shadow in the right pulmonary area and a tumor with calcification on the right chest wall, respectively, so he was operated on for excisional biopsy. The tumor was extirpated together with the 7th intercostal muscle adhered to the tumor, and postoperative pathohistological examination led to diagnosis as cystic hygroma. Cystic hygroma of the chest wall is so rare that we would like to report this case, together with some addition consideration of related literature.     

Concurrent cysts of the mediastinum, pleura and neck.

A 14-year-old male was found to have a mediastinal mass on chest radiograph. Chest computed tomography scans showed a cystic lesion behind the left main bronchus. Magnetic resonance imaging revealed additional cystic lesions in the left chest and root of the neck. He underwent excision of mediastinal mass and a pleural cyst. The neck lesion was presumed to be a cystic hygroma. Histological examination of the two lesions resected showed them to be a foregut cyst and a benign mesothelial cyst. We know of no other report of concurrent multicystic lesions in the chest and neck and hypothesize that these cysts may have a common embryonic origin.     

Cystic lymphangioma. Our experience

ObjectiveTo comment on the most relevant aspects and to review the literature on this unusual pathology.Material and MethodsWe present two cases of cystic lymphangioma, their clinical, diagnosis, therapy and development, and we review the actual literature. The first case is a young man with the diagnosis of cystic lymphangioma of the scrotum and pelvis. The second case is one patient with a cystic lymphangioma of the retroperitoneum.DiscussionCystic lymphangioma is a congenital lymphatic hamartoma of the lymphatic system that usually appears at childhood like a big mass at soft tissues that has a tendency to grow unless a completed excision is performed.ConclusionsThere are few cases of scrotal cystic lymphangioma in the literature; they are often misdiagnosed as other common cystic scrotal conditions leading to an improper surgical approach and an incomplete surgery that predisposes later recurrence. Cystic lymphangioma of the retroperitoneum is a rare entity diagnosis in most cases as an incidentaloma.     

Isolated cystic lymphangioma of the mediastinum

Cystic lymphangiomas are relatively uncommon benign tumours of the lymphatic system. These lesions frequently are apparent at birth and more than 90% are detected before the end of the second year of life. More commonly cystic lymphangioma presents as a soft tissue mass in the neck and only rarely does it extend into the mediastinum. Isolated mediastinal lymphangiomas are exceedingly rare and have been reported infrequently. Herein we have reported two cases of mediastinal cystic lymphangioma, one in a child and the other in an adult patient, who were treated successfully by complete surgical excision     

Trigonal cavernous angiomas: report of three cases and review of literature

BACKGROUND: Intraventricular cavernous angiomas are very rare. Only few cases of trigonal angiomas have been reported. CASE DESCRIPTION: We report three cases of trigonal cavernous angiomas who presented with raised intracranial pressure or seizures and who underwent total excision with a good recovery. We also review the literature and discuss surgical approaches. CONCLUSION: On magnetic resonance imaging, intraventricular cavernous angiomas lack the hemosiderin ring characteristically seen around parenchymal cavernous angiomas. This explains why trigonal cavernous angiomas can mimic malignant neoplasm on imaging, and they should be considered in the differential diagnosis of intraventricular masses. Total excision should be the goal of surgery.     

Lymphangioma of small bowel in adults: A rare cause of abdominal symptoms

BackgroundLymphangioma is unusual malformation of the lymphatic system and rarely occurred in adults below diaphragm. Lymphangioma in small intestine sometimes caused unspecific symptoms and even bleeding, however, this area was most difficult for endoscopic examination and worth investigation.MethodsFrom 1999 to 2019, we retrospectively collected eighteen adult patients with the pathological diagnosis of lymphangioma from duodenum to terminal ileum. The clinical symptoms, origin site, predisposing factor, pre-operative image surveillance, surgical intervention, histopathological findings, follow-up period, and outcome were reviewed and analyzed.ResultsThe mean age of diagnosis was 50.11 years old with female predominance. The most common symptoms were abdominal pain (77.78%), palpable mass (27.78%) and intestinal bleeding (16.67%). With the different gross and microscopic findings, the adult intestinal lymphangioma could be classified as “simple”, “polyposis”, and “cystic cavernous”.ConclusionIntestinal lymphangioma in adults is a rare cause of abdominal discomfort but should be listed in differential diagnosis during daily practice. The morphology and classification may be different from pediatric group, and more large-scale studies are need for thorough investigation.     

Congenital oropharyngeal tumors in the newborn: problems in team diagnosis and treatment

There are a great variety of lesions of oral cavity which may require surgical intervention in neonatal period. The differential diagnoses include tumors (malignant, teratoma, cystic hygroma, lymphangioma, hemangioma), congenital epulis, dermoid cysts, ranula. Congenital epulis of the newborn is a rare tumour which is usually benign. Epulis is also known as a congenital gingival granular cell tumour because of its histological features. Female babies are affected 8-10 times more often than males. Epulis is located on the maxillary ridge twice as often as on the mandible, mostly as single tumours but rarely as multiple tumours. The histogenesis of the tumour is unknown. Spontaneous regression of congenital epulis has been reported in a few cases. However, surgical excision is generally indicated due to interference with feeding or respiration. Recurrence of the tumour after surgery has not been reported yet. We report two cases of congenital epulis, one in 2 hour female neonate and one in a 7 days male neonate. In spite of the rarity of this pathology, the interval between presentation in this two cases was ten days. In one case it was an antenatal diagnosis by ultrasonography, in the other it was associated a genital anomalies (hypospadias). The treatment was surgical excision. The intra- and postoperative course was uneventful.     

Infections of congenital cervical neck masses associated with bacteremia

Congenital cervical neck masses are usually benign lesions. However, cystic hygromas and cervical teratomas are associated with a high risk for potentially life-threatening complications, primarily that of respiratory distress secondary to tracheal compression. Children with unoperated teratomas are also at high risk for malignant changes. A third potential complication is that of infection of the lesion. We present two newborns with infections of cervical neck masses associated with bacteremia. One lesion was a teratoma, the other a cystic hygroma. In both infants, surgical excision had been delayed. These cases illustrate the need for prompt, accurate diagnosis and treatment of congenital cervical neck masses.     

Successful excision of an isolated mediastinal cystic lymphangioma with bilateral thoracoscopic surgery

Lymphangioma is a well-known benign tumor and its cystic abnormalities of the lymph vessels are predominantly congenital. Cystic lymphangioma usually occurs in the neck, axillary region, and rarely in the mediastinum, which frequently occurs in children and young adults. A 20-year-old woman had symptoms of palpitation, cough, and dyspnea during the recent 1 month. Both chest comuted tomography and magnetic resonance imaging of the chest revealed a well-defined, 13 × 10-cm cystic lesion in the anterior mediastinum. The patient underwent bilateral video-assisted thoracoscopic excision of the cyst and lymphangioma was confirmed based on histopathologic examination. Here, we report a rare case of isolated mediastinal cystic lymphangioma that was successfully excised using a minimally invasive technique.     

Cavernous-venous malformation of brain stem--report of a case and review of literature.

BACKGROUND: Because of improved imaging techniques, the association of cavernous and venous malformations is now being seen more often in neurosurgical practice. However, only a few cases have been subjected to surgery. Surgical excision of the cavernous malformation, sparing the venous component, has been the method of choice advocated by most authors. This, however, is not possible when the components are intimately associated with each other. It thus becomes important to predict the surgical outcome in such lesions, especially when they are located in an eloquent area. A surgically excised case of cavernous-venous malformation in the dorsal pontomedullary region is presented here; the histology confirmed the intimate association of both components. The relevant literature is also discussed. CASE DESCRIPTION: This 20-year-old male presented with episodic vomiting, giddiness, and persistent cerebellar signs over a six-year period. Neuroimaging studies-computed tomography scan/magnetic resonance imaging (CT/MRI) were suggestive of a cavernous malformation. MRI also showed a draining vein close to the lesion. Following total excision, histopathology confirmed the intimate association of both cavernous and venous malformations. The patient made an uneventful recovery. MRI at follow up confirmed total excision. CONCLUSIONS: The presence of venous channels draining into a lesion that otherwise appears to be a cavernous malformation may indicate an intimately associated venous component. Selective surgical excision of the cavernous component may be difficult in such cases. Surgical outcome, though favorable in this case, will be difficult to comment upon unless more such cases are reported. This may be of greater significance in lesions located in eloquent areas.     

Surgical management of parapharyngeal cystic hygroma causing sudden airway obstruction

Parapharyngeal cystic hygroma is a rare tumor of the neck. This report describes two cases in which surgical resection was necessary to overcome sudden airway obstruction and details the surgical technique. These cases were considered "near misses" for sudden infant death syndrome (SIDS) and were revealed by computed tomography (CT) and echography to be parapharyngeal cystic hygroma. The location of this malformation could have produced sudden airway collapse and be erroneously diagnosed as SIDS. The postoperative follow-up was satisfactory and no recurrence was detected. We believe CT and echography should be included in the evaluation of such cases.     

Mature cystic teratoma with malignant transformation to adenocarcinoma

An anterior mediastinal tumor had been found in a 65-year-old woman 10 years previously, and she had been followed-up under the diagnosis of a mature cystic teratoma. Changes in the structure of the inside of the mediastinal cystic tumor were observed on a chest computed tomography image, and she was referred to our hospital for surgical intervention. The tumor was removed and was determined to be a mature teratoma. An adenocarcinoma was also observed in part of this cystic lesion. From these findings, the lesion was diagnosed as a malignant change in a mediastinal mature teratoma. Because few if any changes tend to be observed in the cystic wall of such cases, an aggressive resection of such mature cystic teratomas is therefore recommended.     

Hémangiome intramusculaire du pied

Intramuscular hemangioma is rare benign neoplasm usually seen in children, adolescents and young adults. Although lower extremities are the commonest localization, the localization at the foot is extremely rare since only a few cases have been reported. We report a case of cavernous hemangioma of the interosseous muscles in a 24-year-old man who was treated with surgical excision.     

Scrotal lymphangioma

Congenital malformations of the intrascrotal lymphatic system may form cystic masses. A case of a lymphangioma arising in Colles fascia is presented. This rare clinical entity should be included in the differential diagnosis of cystic lesions of the external male genitalia. Total surgical excision is the treatment of choice.     

An unusual case of neurogenic thoracic outlet syndrome

IntroductionNeurogenic thoracic outlet syndrome (nTOS) is the most common manifestation of thoracic outlet syndrome (TOS), accounting for more than 95% of cases. It is usually caused by cervical ribs, anomalies in the scalene muscle anatomy or post-traumatic inflammatory changes causing compression of the brachial plexus.Case presentation: We present an unusual case of nTOS caused by a cystic lymphangioma at the thoracic outlet, with only one case reported previously in the literature. We used a combined supraclavicular and transaxillary approach for complete removal, which resulted in excellent recovery of the patient.DiscussionThough lymphatic cysts may be commonly encountered in surgical practice, compression causing nTOS is extremely rare. The location of the lymphatic cyst with compression of the brachial plexus may provide a challenge for treatment. Surgical excision is the preferred method of management, with higher success rates than sclerotherapy.ConclusionSurgical excision to ensure complete removal of the cyst is recommended. Sclerotherapy may be used in cases where complete excision of the cyst wall may not be possible.     

Post-traumatic Intramuscular Hemangioma of the Chest Wall

Intramuscular hemangioma originated in chest wall is a rare benign tumor, with no relevant reports in Korea. In most cases, the tumor is discovered before the age of 30 years and it is reported that trauma operates as the initiation factor. It is essential to concern the clinical suspicion and conduct a CT scan for diagnosis. The principle of treatment is surgical excision with clear resection margin. The authors of this study report a case of surgical excision for post-traumatic intramuscular hemangioma of the chest wall with review of literature.