New Treatment Options for Lymphangioma in Infants and Children

Abstract

Lymphangiomas are congenital malformations of the lymphatic system. These lesions occur most often in the head and neck area, and their treatment continues to be a challenge. Fortunately, a number of advances have occurred in the diagnosis and management of lymphatic malformations in the past decade. The purpose of this article is to clarify the embryology, pathogenesis, histopathology, and classification of these lesions, as well as to describe their various forms of clinical presentation. We provide a complete review of the diagnostic measures available and thoroughly discuss new therapeutic interventions proposed to treat lymphangiomas.

Uso de OK-432 em crianças com linfangioma

“…This being so, there is no increase in difficulty for later surgery. 1,5,8 All of this drug s side effects are reversible. In a sample taking in 30,000 cases treated with OK-432 there were no reported deaths and remission from fever and local inflammation was achieved in a maximum of 14 dias.…”

“…Depending on the size of these cysts, they are classified as macrocystic (cystic hygroma), microcystic (cavernous and capillary) and intermediary, in which cases both forms are presented. [1][2][3][4][5][6] The natural history of a lymphangioma is characterized by progressive growth, compression and infiltration of adjacent structures, resulting in an overall clinical picture which depends on location. Spontaneous remission can occur although it is rare.…”

“…1 The pathophysiology of these lesions is not fully established, having been classified as hamartomas, lymphatic malformations or benign tumors. 1,2,[4][5][6] Lymphangioma treatment depends on size and clinical presentation, location and the risk of complications. The most widely accepted therapy is surgery that attempts to preserve the nervous and vascular structures involved, which is, however, not always possible.…”

“…[1][2][3][4][5][6][7][8] The limitations of surgical solutions have awoken interest in other therapeutic methods, such as the administration of sclerosing agents such as bleomycin and hypotonic salt solutions that provoke an inflammation of the vascular endothelium leading to total or partial remission of the lymphangioma. [1][2][3][4][5][6]8 These substances can be diffused, via the walls of the cyst, to adjacent tissues, which can provoke an inflammatory reaction and scar retraction, which may extend beyond the limits of the original lymphangioma, with unsatisfactory aesthetic results and increased difficulties for future surgery. 4 Despite the limitations that make sclerosing agents unsatisfactory for the treatment of lymphangioma, a new agent, OK-432, produced by lyophilization of a culture of low virulence Su strains of group A Streptococcus pyogenes treated with penicillin G potassium, has been used with good results.…”

“…4 Despite the limitations that make sclerosing agents unsatisfactory for the treatment of lymphangioma, a new agent, OK-432, produced by lyophilization of a culture of low virulence Su strains of group A Streptococcus pyogenes treated with penicillin G potassium, has been used with good results. [1][2][3][5][6][7][8][9][10] It has been approved for use by the Japanese Health Ministry for use as a biological response modifier and was initially used in clinical trials for neoplasms of the head and neck. 11 Since 1987, OK-432 has been used for lymphangioma treatment in counties such as Japan.…”