Adult-onset giant cervical cystic hygroma with pressure manifestations on aerodigestive tract, managed surgically: reporting of a rare case

Abstract

Cystic hygroma is a benign congenital malformation of the lymphatic system that occurs in children younger than two years of age. Hygroma commonly presents in head and neck but can be present anywhere. It is rarely seen in adults. We report the case of a 28-year-old woman who presented with a huge painless right-sided cystic neck swelling of 11 months duration, associated with progressive dysphagia and difficulty in breathing when lying supine or on her left side. Clinically, the swelling occupied both right anterior and posterior triangles of her neck with impalpable right carotid pulsations. Computed tomography revealed a cystic mass lesion. The mass was excised totally through right supraclavicular incision, after identification of the great auricular, spinal accessory and phrenic nerves. Paraffin section confirmed the diagnosis of cystic hygroma. After an uneventful postoperative period the patient was discharged and has had no recurrence to date.

Cystic lymphangioma in adult: a case report and a review of the literature

“…Adults are instead rarely affected [ 2 ]. Precise etiology remains unclear but it is supposed to be congenital or to be a result of obstruction and lymph fluid retention of developing lymphatic vessels caused by certain acquired factors [ 4 , 5 ]. Infection, trauma (included surgery) and neoplasms are considered as more common causes.…”

“…In 1993, McGill et al. [ 5 ] proposed a classification based on computed tomography (CT) scan, anatomical sites and histology: Type 1 are macrocystic and below mylohyoid muscle involving anterior and posterior triangles of the neck and Type 2 are microcystic and above mylohyoid muscle involving lip, tongue and oral cavity. In 1995, based on the location and on the extension of the mass, De Serres et al.…”

“…Otherwise, extensive masses can lead to compressive symptoms related to location, size and growing rate. The more encountered symptoms are dysphagia and dyspnea due to the compression of respectively esophagus and trachea or larynx [ 1 , 5 ].…”

Ultrasonographic diagnosis, classification, and treatment of cervical lymphatic malformation in paediatric patients: a retrospective study

“…Surgical and other trauma can destroy the lymphatic drainage system, leading to acquired lymphatic malformation; other causes are also possible [ 4 , 5 ]. Its clinical manifestations depend on the infiltration location and growth rate, and approximately 15–70% of patients have mild symptoms [ 6 – 8 ]. Ultrasonographic diagnosis and differential diagnosis are based on intracystic fluid echoic, the thickness of cyst wall, and the cyst location; additionally, medical history and clinical manifestations are helpful for diagnosis.…”

Ultrasonographic diagnosis, classification, and treatment of cervical lymphatic malformation in paediatric patients: a retrospective study

“…4,5 Its clinical manifestations depend on the in ltration location and growth rate, and approximately 15-70% of patients have mild symptoms. [6][7][8] Diagnosis is based on intracystic uid echoic, a thick of cystic wall, and the cyst location; additionally, medical history and clinical manifestations are helpful for diagnosis.…”