Hemolymphangioma of the lower extremities in children: two case reports

Abstract

Background and purposeHemo-lymphangiomas are rare benign tumors that arise from congenital malformation of the vascular system. They are usually diagnosed at birth or early in childhood. The management of hemo-lymphangiomas in children remains challenging because complete resection is often difficult to be achieved and recurrences are common.MethodsWe present the case of two children with a mass on their left tibia. Imaging modalities, plain radiograph, Ultrasonography and Magnetic Resonance were used to investigate the nature of the mass, the anatomical relationship to the neighboring tissues and help planning the surgical resection. The dominant diagnosis was hemo-lymphangioma. Both lesions increased in size in a short period of follow-up thus we decided to proceed to surgical excision.The diagnosis of hemo-lymphangioma was confirmed by histological examination of the surgical specimen.Post-operatively, seroma was formed to the first patient, managed by placing a drainage and immobilizing the limb on a splint.The second patient experienced no complications post-operatively.After 12 months of follow-up both patients had no complications or recurrence.ConclusionsVery few cases of hemo-lymphangiomas of the extremities have been reported in the literature. Those tumors can grow slowly and remain asymptomatic for a long period of time or may become aggressive and enlarge rapidly, without invasive ability though.Radical resection is the choice of treatment offering the lowest recurrence rates. Other therapeutic methods are: aspiration and drainage, cryotherapy, injection of sclerotic agents and radiotherapy; although none of those offers better results that the surgical excision.

Hemolymphangioma of the waist: A case report and review of the literature

“…Hemolymphangioma has been previously detected at the pancreas (5,7-12), spleen (13)(14)(15)(16), stomach (1,17), rectum (18), mediastinum (19)(20)(21), chest wall (22)(23)(24)(25), small intestine (26), extremities (3,27,28), cervix (29,30), pericardium (31), oral region (32), esophagus (33), axilla (34), retroperitoneal space (35,36), adrenal gland (37), abdomen (38), duodenum (4) and hepatica (39), as well as on the tongue (40,41) and orbit (42,43). However, to the best of our knowledge, no studies have reported this type of tumor in the waist region, as determined by a review of the medical literature until June 2014 using the PubMed database (http://www.ncbi.nlm.nih.gov/pubmed; accessed on 9th June 2014).…”

“…Hemolymphangioma is a congenital malformation that may be asymptomatic for a long period of time (3). This lesion is typically considered to be a benign and noninvasive disorder, characterized by the presence of dilated lymphatic spaces, extravasation of red blood cells, hemosiderin deposition and fibrosis (4).…”

“…Complete excision is considered the optimal treatment for hemolymphangioma, which exhibits a low recurrence rate. Non-surgical treatments are also used, including aspiration and drainage, cryotherapy, injection of sclerotic agents, laser therapy and radiotherapy, however, to date, the outcomes of such treatments have been unsatisfactory (3,22). In cases of tumor recurrence, conservative treatment methods such as laser therapy, may be applied (3,44).…”

“…In cases of tumor recurrence, conservative treatment methods such as laser therapy, may be applied (3,44). Generally, the prognosis of hemolymphangioma is good (3,4,13,17,18), however, careful follow-up is required.The present study reported the case of a 17-year-old male patient with hemolymphangioma on the waist and reviewed the characteristics of this disease based on the existing literature. …”

“…Non-surgical treatments are also used, including aspiration and drainage, cryotherapy, injection of sclerotic agents, laser therapy and radiotherapy, however, to date, the outcomes of such treatments have been unsatisfactory (3,22). In cases of tumor recurrence, conservative treatment methods such as laser therapy, may be applied (3,44). Generally, the prognosis of hemolymphangioma is good (3,4,13,17,18), however, careful follow-up is required.…”