The Treatment of Lymphangiomas with Bleomycin in Childhood: A Retrospective Observational Study

Abstract

Introduction: Lymphangioma is defined as the congenital malformation of the lymphatic system. According to morphological classifications, there are macrocystic, microcystic and mix types. Treatments vary from one clinic to another given that there are no commonly accepted guidelines. This study aims to present the results of ultrasonography-guided intralesional bleomycin treatment of lymphangioma. Methods: Retrospective evaluation was conducted on 20 patients with lymphangioma who were treated with intralesional bleomycin. Under local anesthetic and aseptic conditions, 0.4-0.6 mg per kg bodyweight of bleomycin was injected under ultrasonography guidance. The response was graded as "excellent response" (>90% reduction), "good response" (>50% reduction in size) and "poor response" (<50% reduction or no change in size). Results: The 20 cases comprised eleven female and nine male patients with a mean age of 3.1 years. The lymphangioma was located on the neck in eight cases, on the trunk in seven cases, on the axillary region in two cases, the mass extended from the neck to the mediastinum and retropharynx in one case. Also, it was on the anterior surface of the thigh in one case and on the anterior surface of the leg in one patient. Excellent response was seen in 50% of the patients, a good response in 40% and a poor response in one patient. Discussion and Conclusion: Bleomycin injection is very effective for the treatment for macrocystic and mixed type lymphangioma of the neck and on any other surface area of the body. It is an appropriate treatment choice for cases that have previously undergone surgery and then show recurrence or incomplete resection.

Therapeutic effects of intralesional bleomycin sclerotherapy for non-invasive management of low flow vascular malformations - A prospective clinical study

“…[ 25 ] In another study, lymphangiomas were treated by percutaneous bleomycin sclerotherapy and it was found to be an effective treatment for lymphangiomas. [ 9 ]…”

“…[ 6 – 8 ] Percutaneous sclerotherapy is a safe and effective treatment modality to reduce bleeding during surgery and shrink the size of the lesion. [ 9 ]…”

“…Traditional management involving surgical treatment may result in complications including wound infection, haemorrhage, unsightly scar, postoperative fluid accumulations, various nerve palsies and lymphorrhoea. [ 9 ] Bleomycin was developed as a cytotoxic antitumour agent in 1966 by Umezawa. [ 10 ] Intralesional bleomycin injection has been recently shown to be an effective treatment for vascular lesions and used extensively as a nonsurgical treatment because of its low cost, easy availability, low toxicity and high sclerosing effect on vascular endothelium.…”

Intralesional Bleomycin Sclerotherapy in Children with Lymphangiomas: A Review Article

“…wound infection, hemorrhage, unsightly scar, postoperative fluid accumulations, various nerve palsies and lymphorrhea [6]. Due to above mentioned situations, intralesional sclerotherapy of lymphangiomas has been popularized recently.…”