Results of the Treatment of Cystic Hygroma with Intralesional Bleomycin Injection: A Preliminary Report in 20 Pediatric Patients
Abstract
Introduction: Cystic hygroma is a malformation of lymphatic vessels. Surgical excision is the treatment of choice but it has a high risk of recurrence and injury to the major organs. Bleomycin injection into the cysts can be used in cases of large cystic masses in order to avoid nerve injury and scar formation.
Method: A prospective study was performed during the period of 1 992- 1 998. Twenty pediatric patients with cystic bygroma wexe treated with intralesional bleomycin injection. Fifteen were male and 5 were female. Their age ranged from I month to ll years. Ten patients had recurrence of the disease post surgical excision before this man agement. The site of cystic hygroma was predominantly in the neck. The size of these lesions was larger than 5 cm in diameter in every case. After aspiration of the cyst contents, 3-10 mg of bleomycin was administered into the cavities. Repeated injections were performed at an interval of 2 to 6 weeks in some cases.
Results: An excellent response (complete clinical resolution) was obtained in 9 cases (45%). A good response (partial reduction of the size of the masses) was achieved in 7 patients (35% ). A poor result (no clinical improvement) was noted in 4 cases (20% ). Adverse reactions including fever, local swelling, redness and pain at the site of injection were found in 12 patients (60%) and they were present only for a few days. Leucopenia was noted in 3 infants below one year of age (15% ).
Conclusion: Our data from this study suggested that intralesional bleomycin injection was an effective therapy in some cases of cystic hygroma. It should be used in the patients with large cystic masses, in which a surgical excision might be incomplete and risk of vital organ injuries may be high.
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