Giant Macrocystic Lymphatic Malformation in a Neonate

Mónica Andrea Pinzón Uresti; Jorge Tadeo Palacios Zertuche; Ana Luisa Carrión García; Julio Cesar Lopez Rodriguez; Juan Pablo Benavides Rodríguez; Ulises de Jesús Garza Luna; Isaías Rodríguez Balderrama*

Correspondence: *. Correspondence: Isaías Rodríguez Balderrama, Av. Francisco I. Madero y Gonzalitos S/N, Colonia Mitras Centro Monterrey, Nuevo León, México, C.P. 64460 E-mail: E-mail:

Received: 2016 May 3; Accepted: 2016 May 29

J Neonat Surg. 2017 Jan 1; 6(1): 21
doi: 10.21699/jns.v6i1.383

Copyright

Copyright: © 2017 JNS


Dear Sir

Cystic hygroma or macrocystic lymphatic malformation is a well-known entity and its diagnosis and management is also well described in literature. Rarely its size and location may pose management challenges.[1-3] We managed a case of humongous macrocystic lymphatic malformation of axilla and chest wall in a newborn. At 25 weeks of gestation, a 16cm mass was reported by antenatal ultrasound around left chest wall and arm. At 34.4 weeks of gestation, the baby boy was born by cesarean section. On examination, a 16x16cm mass was noted at the left chest wall with involvement of the skin and subcutaneous tissue; the tumor was soft, mobile and without adherence to deep layers (Fig.1). The baby had respiratory distress because of the location of the tumor and was transferred to the neonatal intensive care unit where ventilatory and hemodynamic support was provided. Plain and contrast magnetic resonance angiography of the neck and arm reported a large mass with characteristics of a hemolymphangioma in the axilla with multiple macrocysts and thin septa having contrast enhancement; the mass did not invade structures or vessels (Fig. 2), surgical resection was performed. An incision was made around the tumor dissecting to the fascia of the pectoral muscle and the serratus anterior. The tumor was gradually dissected to its base to avoid injury to the axillary neurovascular bundle and subsequently removed with skin adnexa. Local skin flaps were made to cover the defect and a closed drainage was placed (Fig. 3). Histopathological study reported a cystic hemolymphangioma. Postoperative recovery was uneventful.


[Figure ID: F1] Figure 1: Giant lymphatic malformation.

[Figure ID: F2] Figure 2: Magnetic resonance angiography that shows mass with characteristics of a hemolymphangioma.

[Figure ID: F3] Figure 3: Steps of surgery.

The index case is management challenge. The huge size of the mass led to respiratory distress which was managed by mechanical ventilation in ICU. After initial respiratory and hemodynamic stabilization, the other challenge was excision. Fortunately, the lymphatic malformation was not invading the neurovascular bundle of the axilla and excision went smooth and meticulous.

Footnotes

Source of Support: Nil

Conflict of Interest: None


References
1. Calis M, Konas E, Takci S, Yurdakok M, Tuncbilek G. Aggressive giant cystic lymphatic malformation in a newborn. Turk J Pediatr. 2013; 55:447-5.
2. Lu D, Wang Y, Zeng W, Peng B. Giant fetal lymphangioma at chest wall and prognosis: case report and literature review. Taiwanese J Obstet Gynecol. 2015; 54:62-5.
3. Song TB, Kim CH, Kim SM, Kim YH, Byun JS, Kim EK. Fetal axillary cystic hygroma detected by prenatal ultrasonography: a case report. J Korean Med Sci. 2002;17:400-2.

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