Expectant management of pediatric lymphatic malformations: A 30-year chart review

Thorburn, Casey; Price, David

doi:10.1016/j.jpedsurg.2021.12.053

Cited by 12 publications

(4 citation statements)

References 11 publications

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“…It could be explained by the additional costs of medications during conservative treatments in patients with preoperative hemorrhage or infection. Although asymptomatic lymphatic malformations at other sites can be treated conservatively, no study has reported the efficacy of expectant treatment in ML patients ( 20 ). Therefore, to avoid related preoperative complications, we recommended that ML patients be treated as soon as possible after diagnosis rather than conservative observation, even if they are asymptomatic.…”

Section: Discussionmentioning

confidence: 99%

Preoperative complications in children with mesenteric lymphatic malformations: Incidence, risk factors and outcomes

et al. 2022

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BackgroundPreoperative complications of mesenteric lymphatic malformations (ML) in children are various and complex. We aim to analyze the incidences and risk factors of three major preoperative complications (hemorrhage of the cyst, infection of the cyst and intestinal volvulus) in ML patients, and explore their influence on the outcomes.MethodsThis retrospective cohort study enrolled ML patients undergoing surgery at Beijing Children's Hospital between June 2016 and June 2022 and classified them according to different preoperative complications, preoperative hemorrhage or infection, and preoperative intestinal volvulus. The groups were examined and compared according to sex, age at admission, presenting symptoms, laboratory examinations, imaging examinations, preoperative treatments, cyst characteristics, surgical details, perioperative clinical data, and follow-up. Logistic regression analysis was performed to identify the independent risk factors for preoperative hemorrhage or infection, and preoperative intestinal volvulus.ResultsOf the 104 enrolled ML patients, 27 (26.0%) had preoperative hemorrhage or infection, and 22 (21.2%) had preoperative intestinal volvulus. Univariate analysis showed that patients with preoperative hemorrhage or infection had a higher rate of ML in the mesocolon (44.4 vs. 23.4%, p < 0.038) and larger cysts (10 vs. 8 cm, p = 0.042) than patients without preoperative hemorrhage or infection. Multivariable logistic regression analysis found that the location (OR, 3.1; 95% CI, 1.1–8.6; p = 0.026) and size of the cyst (≥7.5 cm) (OR, 6.2; 95% CI, 1.6–23.4; p = 0.007) were independent risk factors for preoperative hemorrhage or infection. Preoperative intestinal volvulus was only found in ML at the intestinal mesentery. Further analysis showed that ML in the jejunal mesentery was an independent risk factor for preoperative intestinal volvulus (OR, 3.3; 95% CI, 1.1–10.0; p = 0.027). Patients with preoperative hemorrhage or infection spent more on hospitalization costs than patients without preoperative hemorrhage or infection (3,000 vs. 2,674 dollars, p = 0.038).ConclusionsML patients should be treated as soon as possible after diagnosis. The location and size of the cyst were independent risk factors for preoperative hemorrhage or infection. ML in the jejunal mesentery was an independent risk factor for preoperative intestinal volvulus.

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Section: Discussionmentioning

confidence: 99%

Preoperative complications in children with mesenteric lymphatic malformations: Incidence, risk factors and outcomes

et al. 2022

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“…In the present study, 5 cases were misdiagnosed as lymphangioma, 3 cases as cyst, 2 cases as TGDC, and 1 case as CPSF before surgery ( Figures 3 – 5 ). The head and neck lymphatic malformations (HNLMs) are usually diagnosed within 2 years old, almost half of which occur in neonates, and usually occur in the posterior triangle of the neck ( 14 ). CT findings of HNLMs were mostly poorly defined, multilocular and low-density masses ( 15 , 16 ).…”

Section: Discussionmentioning

confidence: 99%

Pediatric bronchogenic cysts in the head and neck region: A study of 10 surgical cases and a review of the literature

Chen

Wang

et al. 2022

Front. Pediatr.

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ObjectiveTo explore the clinical characteristics and surgical treatment of children with bronchogenic cysts (BCs) in the head and neck region.MethodsA retrospective study of 10 pediatric patients with BCs in the head and neck region treated in Shanghai Children's Hospital during 2011 to 2022 was performed.ResultsBased on their pathological diagnosis, 10 patients with BCs in the head and neck were identified. The most common location was the neck (8 patients, 80%; 2 midline neck, 6 lateral neck), followed by the ventral tip of tongue (1 patient), and the posterior pharyngeal wall (1 patient). Misdiagnosed as lymphangioma in 5 cases, cyst in 3 cases, thyroglossal duct cyst (TGDC) in 2 cases and congenital pyriform sinus fistula (CPSF) in 1 case preoperative. The median follow-up period after surgery was 4.68 (range, 0.67–9.25) years. All 10 patients underwent complete resection without recurrence or other complications.ConclusionsAlthough extremely rare, BCs should be considered in the differential diagnosis of midline and lateral neck masses or intraoral cysts in children. Surgical excision is recommended in BCs, and the diagnosis is definitively confirmed by histopathology.

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“…Adolescents were particularly at the greatest risk for progression, so this process is hypothesized to be hormone modulated [ 13 ]. While high rates of regression have been noted in asymptomatic head and neck lymphatic malformations [ 14 ], the true progression or regression rate in abdominal lymphatic malformations is unknown due to their overall rarity. Many tend to be symptomatic at presentation and so are treated at the time of diagnosis.…”

Section: Discussionmentioning

confidence: 99%

Tumor or Inflammatory Myofibroblastic Reaction in an Adolescent With an Abdominal Lymphatic Malformation?

Lee¹,

Ignacio²,

Vicente³

et al. 2022

Cureus

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We report the case of a 17-year-old male who presented with intractable nausea and vomiting. Cross-sectional imaging revealed a large retrogastric abdominal mass. Fine needle aspiration done via endoscopic ultrasound (EUS) was nondiagnostic. Exploratory laparotomy revealed a large inflammatory mass densely adherent to the stomach and retroperitoneum. Incisional biopsy frozen section revealed spindle cells, and subsequent resection of the mass with en-bloc subtotal gastrectomy with Roux-en-y gastrojejunostomy reconstruction was performed. Final pathology demonstrated a lymphatic malformation with reactive myofibroblastic proliferation. Inflammatory abdominal lymphatic malformations are especially rare and not well described in the literature. These masses may present diagnostic challenges until the specimen is sent for pathologic analysis.

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Expectant management of pediatric lymphatic malformations: A 30-year chart review

Cited by 12 publications

References 11 publications

Preoperative complications in children with mesenteric lymphatic malformations: Incidence, risk factors and outcomes

Preoperative complications in children with mesenteric lymphatic malformations: Incidence, risk factors and outcomes

Pediatric bronchogenic cysts in the head and neck region: A study of 10 surgical cases and a review of the literature

Tumor or Inflammatory Myofibroblastic Reaction in an Adolescent With an Abdominal Lymphatic Malformation?

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