Infusion Sclerotherapy of Microcystic Lymphatic Malformation: Clinico-Radiological Mid-Term Results

Abstract

Purpose:A new sclerotherapy technique by slow mechanical infusion of sclerosant was validated for treatment of microcystic lymphatic malformation (mLM). Materials and Methods: Seventeen consecutive patients with mLM in extremities, cervicofacial area, and trunk were included (21.8 ± 21.5 years old, male:female = 5:12). All patients diagnosed as mLM were included. A total 4-32 mL 20-38% OK-432 solution was mechanically infused at the rate of 10 mL/hour into the mLM lesions. The treatment effect was estimated clinic-radiologically at the 4-month follow-up. Repeated sclerotherapy followed in the 6th month, if required. The therapeutic effect was evaluated using quantitative ultrasonographic examination including soft tissue thickness, cyst size and number. Results: In 17 patients, total 31 infusion sclerotherapy sessions were performed and monitored for 425 ± 266 days. Fifteen patients (88%) showed improvement in all symptoms, signs, and ultrasonographic findings. In all cases, at least one finding presented improvement. The maximal number of cysts per ultrasonographic window and maximal diameter of the largest cyst decreased by 57 ± 57% and 51 ± 67%, respectively (p = 0.102, 0.004). The soft tissue thickness decreased by 18 ± 15% (p < 0.01). No significant complications such as distal lymphedema or skin necrosis occurred. Conclusion: Infusion sclerotherapy is a safe and effective treatment technique for microcystic LM, with improved outcome.

Liposuction-Like Sclerotherapy Technique for Microcystic Lymphatic Malformation

“…Moreover, we performed fluoro-guided imaging for mLMs, and confirmed the interconnection among microcysts (unpublished data). These findings have been reported recently by other authors [7]. Therefore, this interconnection-based infusion sclerotherapy may be an effective treatment technique for mLMs.…”

“…Based on the above principles and compared with traditional percutaneous sclerotherapy, the LS-LS technique achieves more extensive treatment area and ensures more efficient management for extensive lymphatic lesions. Several percutaneous techniques have been described for the treatment of microcystic lesions, including intralesional injection of sclerosant and lymphographic-like sclerotherapy with doxycycline, bleomycin, or OK-432 [4][5][6][7]. However, multiple sessions of therapy are often required, especially for extensive lesions with very small cysts.…”

“…The microcystic lesion typically consists of multiple small cysts ( 1 cm), in which traditional sclerotherapy and direct injection are less effective due to the small size of the lumen. Recently, encouraging results were obtained in microcystic LMs (mLM) with intralesional bleomycin sclerotherapy [4][5][6][7]. In traditional percutaneous sclerotherapy, the cyst was accessed and then sclerosant was injected with or without imaging guidance.…”

Lymphographic-Like Technique for the Treatment of Microcystic Lymphatic Malformation Components of <3 mm

“…A similar technique was recently described by Lee et al, 8 with good results in safety and efficacy for the treatment of mLMs. However, picibanil (OK-432) was used in this study, and this agent is not currently available on the European market.…”

“…However, our findings confirm the value of percutaneous bleomycin sclerotherapy for alleviation of the symptoms of craniofacial mLMs, with complication rates similar to those reported in previous studies. 8 Nonetheless, a prospective study comparing bleomycin infusion with the lymphographic-like technique with other treatment modalities should be considered to provide more reliable data.…”