EFFICACY OF INTRALESIONAL BLEOMYCIN INJECTION SCLEROTHERAPY IN MACROCYSTIC LYMPHANGIOMA IN PAEDIATRIC PATIENTS

Authors

Abstract

Background This study is aimed to assess the efficacy of intralesional Bleomycin sclerotherapy in macrocystic lymphangioma in children Methods: This prospective observational study included 40 children diagnosed with macrocystic lymphangioma and treated with intralesional injection of Bleomycin from March 2016 to Dec 2018. We excluded all the patients above 12 years of age, lesions with size less than 2 cm, and post-surgical recurrent lesions. The response to the treatment was monitored clinically by assessing length, breadth and area of the lesion and ultrasonographically. Mean follow-up period was 2 years. Study variables were analysed by simple descriptive statistics. Mean and standard deviation were calculated for numerical variables (age). Frequency and percentage were calculated for gender, site, size and type of cystic lymphangioma and total number of treatment sessions. Results: The mean age of patients was 3.51±2.98 years. Out of 40 patients, there were 26 (65%) male and 14 (35%) females with female to male ratio of 1:1.8. The commonest site and type of cystic lymphangioma was neck and macrocystic, i.e., 77.5% and 85% respectively.  The pre and post procedure size of lesion was 9.71±3.95cm and 3.11±1.02 cm, respectively. Outcome was excellent in 20% patients, good in 72.5% and poor in 7.5% patients. Conclusions: Intralesional Bleomycin sclerotherapy is effective in the treatment of macrocystic lymphangioma and is found to be harmless as there was no grave complication observed in this study.Keywords: Lymphangioma; Intralesional; Bleomycin

Author Biographies

Shahzada Abdullah Muhammad Khuzaemah Saalim Hashmi, Children hospital and institute of child health Multan

Assistant professor of  general surgery , surgical unit 2 , Holy Family  hospital, Rawalpindi medical university , Rawalpindi.

Mukhtar Hussain, children hospital and institute of child health multan.

professor and head of department of paediatric surgery , children hospital and institute of child health multan.

Shahnab Ahmad, children hospital and institute of child health multan.

assistant professor of paeds surgery, department of paeds surgery children hospital and institute of child health multan.

Kashmala Gillani, children hospital and institute of child health multan.

medical officer , department of anaesthesia , children hospital and institute of child health multan.

References

Faul JL, Berry GJ, Colby TV, Ruoss SJ, Walter MB, Rosen GD, et al. Thoracic lymphangiomas, lymphangiectasis, lymphangiomatosis, and lymphatic dysplasia syndrome. Am J Respir Crit Care Med 2000;161(3):1037–46.

Abiodun MT, Oluwafemi RO, Fabunmi O, Ajimuda T. Cervical Teratoma and Cystic Hygroma in Nigerian Infants: Case Studies of Two Differential Diagnoses of Neonatal Neck Mass and Review of the Literature. J Neonatal Biol 2015;4(184):2167–897.

Swarnakar RN, Hazarey JD, Dhoble C, Vaghani B, Ainsley AS, Khargie JF, et al. A 36-year-old female with recurrent left sided pleural effusion: A rare case of mediastinal lymphangioma. Am J Case Rep 2016;17:799–804.

Grasso DL, Pelizzo G, Zocconi E, Schleef J. Lymphangiomas of the head and neck in children. Acta Otorhinolaryngol Ital 2008;28(1):17–20.

Muir T, Kirsten M, Fourie P, Dippenaar N, Ionescu GO. Intralesional bleomycin injection (IBI) treatment for haemangiomas and congenital vascular malformations. Pediatr Surg Int 2004;19(12):766–73.

Sanlialp I, Karnak I, Tanyel FC, Senocak ME, Büyükpamukçu N. Sclerotherapy for lymphangioma in children. Int J Pediatr Otorhinolaryngol 2003;67(7):795–800.

Konen O, Rathaus V, Dlugy E, Freud E, Kessler A, Shapiro M, et al. Childhood abdominal cystic lymphangioma. Pediatr Radiol 2002;32(2):88–94.

Molitch HI, Unger EC, Witte CL, van Sonnenberg E. Percutaneous sclerotherapy of lymphangiomas. Radiology 1995;194(2):343–7.

Riechelmann H, Muehlfay G, Keck T, Mattfeldt T, Rettinger G. Total, subtotal, and partial surgical removal of cervicofacial lymphangiomas. Arch Otolaryngol Head Neck Surg 1999;125(6):643–8.

Lei ZM, Huang XX, Sun ZJ, Zhang WF, Zhao YF. Surgery of lymphatic malformations in oral and cervicofacial regions in children. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2007;104(3):338–44.

Chen WL, Zhang B, Wang JG, Ye HS, Zhang DM, Huang ZQ. Surgical excision of cervicofacial giant macrocystic lymphatic malformations in infants and children. Int J Pediatr Otorhinolaryngol 2009;73(6):833–7.

Nehra D, Jacobson L, Barnes P, Mallory B, Albanese CT, Sylvester KG. Doxycycline sclerotherapy as primary treatment of head and neck lymphatic malformations in children. J Pediatr Surg 2008;43(3):451–60.

Yoo JC, Ahn Y, Lim YS, Hun Hah J, Kwon TK, Sung MW, et al. OK-432 sclerotherapy in head and neck lymphangiomas: long-term follow-up result. Otolaryngol Head Neck Surg 2009;140(1):120–3.

Kullendorff CM. Efficacy of bleomycin treatment for symptomatic hemangiomas in children. Pediatr Surg Int 1997;12(7):526–8.

Ogita S, Tsuto T, Nakamura K, Deguchi E, Iwai N. OK-432 therapy in 64 patients with lymphangioma. J Pediatr Surg 1994;29(6):784–5.

Brewis C, Pracy JP, Albert DM. Treatment of lymphangiomas of the head and neck in children by intralesional injection of OK‐432 (Picinabil). Clin Otolaryngol Allied Sci 2000;25(2):130–4.

Orvidas LJ, Kasperbauer JL. Pediatric lymphangiomas of the head and neck. Ann Otol Rhinol Laryngol 2000;109(4):411–21.

Ainippully AM, Ranjit P, Prathap S. Efficacy of intralesional bleomycin in treatment of lymphangiomas in children: an observational study. Int Surg J 2017;5(1):238–42.

Erikçi V, Hosgör M, Yildiz M, Örnek Y, Aksoy N, Okur Ö, et al. Intralesional bleomycin sclerotherapy in childhood lymphangioma. Turk J Pediatr 2013;55(4):396–400.

Bhatnagar A, Upadhyaya VD, Kumar B, Neyaz Z, Kushwaha A. Aqueous intralesional bleomycin sclerotherapy in lymphatic malformation: Our experience with children and adult. Natl J Maxillofac Surg 2017;8(2):130–5.

Pan P. Ultrasound guided intralesional bleomycin therapy for cystic lymphangioma in childhood. Int J Contemp Pediatr 2017;4(4):1496–500.

Kumar V, Kumar P, Pandey A, Gupta DK, Shukla RC, Sharma SP, et al. Intralesional bleomycin in lymphangioma: an effective and safe non-operative modality of treatment. J Cutan Aesthet Surg 2012;5(2):133–6.

Published

2020-02-08

Issue

Vol. 32 No. 1 (2020): JOURNAL OF AYUB MEDICAL COLLEGE, ABBOTTABAD

Section

ORIGINAL ARTICLE

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