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Giant Lymphatic Malformations In Children – Challenges In Treatment – Cases Series
P Stefanova, D Dachev, S Lupanov, B Ivanov, N Mavrev
Medical University Plovdiv - Bulgaria, Department of Pediatric Surgery
Aim of the study: Lymphatic malformations (LMs) are rare benign vascular lesions that vary in anatomic localization and size. They are difficult in diagnosis and treatment.
Case description: Case 1. A newborn boy at a gestational age of 36 weeks and weight 3200 g with a large lower face and cervical region large mass, compress the trachea. Despite the partial excision the mass extended. Doxacyclin has been applied. After the partial resection of the tongue, he underwent continued intensive respiratory care. Case 2. A boy at a gestational age of 37 weeks and weight 2450 gr. with a cervical mass extended to the mediastinum and occupied upper half of the thoracic cavity. Except for partial resection a sclerotherapy with doxycycline was used. Case 3 A newborn girl – weight 1260 gr. with a huge neck lymphatic malformation. She underwent a partial excision for a cervico - mediastinal mass with a severe respiratory difficulty requiring ventilator care. Now she is 3 years old. Case 4 A newborn boy at a gestational age of 34 weeks and weight 2200 g with a large mass, which compresses the trachea with severe respiratory problems. After aspiration of the lymph and application of Bleomicyn in the LM the symptoms are reduced, and partial excision was applied as second step. During the treatment Sirulimus has been used, causing reduction. Following the child a good outcome has been achieved till the age of two years.
Conclusions: The giant LMs are difficult for treatment. The combination of surgical methods, sclerotherapy, chemotherapy, immune suppression and intensive respiratory supportive care give good results.