Successful Treatment of a Case with Cervical Lymphatic Malformation: Repeated Bleomycin Sclerotherapy

Abstract

Lymphatic malformations (LM) are benign congenital malformations of the lymphatic system. They are frequently seen in the neck and sometimes can be life-threatening due to compression to the airway. Treatment modalities are widespread including surgical excision, radiotherapy, laser therapy, and application of intralesional sclerosing agents. We report the successful treatment of cervical LM in a 3-year-old boy who presented with a sudden onset of a large cystic mass in the posterior cervical triangle and was treated with repeated injections of intralesional bleomycin.

Inflow Occlusion Combined With Bleomycin Sclerotherapy for Management of Macro/Mixed Cystic Lymphatic Malformation in Children

“…Bleomycin, an antibiotic derivative with cytostatic properties, induces obliteration and fibrosis of cysts by its sclerosant effect on lymphatic endothelium (33,34). However, therapeutic responses of bleomycin are always delayed for >3 months after initial treatment, and posttreatment accumulation of lymph may cause multiple sessions of treatment (35)(36)(37). Thus, for cLMs connecting to the lymphatic system, we think that inflow occlusion can inhibit lymph accumulation after sclerotherapy, so as to improve curative effect and reduce treatment frequency.…”

Laryngeal Venous Malformation

“…Sclerotherapy has been used as an adjunct or alternative to surgery. Several sclerosing agents are available including absolute ethanol, ethanolamine oleate, 5 sodium tetradecyl sulfate, 6 polidocanol, 7 bleomycin, 2,8 and OK 432, 9 and all have been reported to be effective. Currently, there is no consensus on the best sclerosing agent.…”

Bleomycin sclerotherapy for large diffuse microcystic lymphatic malformations

“…LMs are more commonly seen in lymphatic-rich areas, such as the head and neck (45-52%), axilla, mediastinum, groin, and retroperitoneum (2). Histologically, the cysts are lined with a single layer of lymphatic endothelial cells and abnormal smooth and skeletal muscular structures, and filled with eosinophilic, technique, and combinations of these treatments (5)(6)(7)(8). Macrocystic LMs respond well to sclerotherapy and surgical resection (9,10).…”