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Published in: Aesthetic Plastic Surgery 5/2013

01-10-2013 | Case Report

A Rare Case of Lymphangioma in the Gluteal Region: Surgical Treatment Combined With Sclerotherapy and Laser Therapy

Authors: Paolo Fioramonti, Michele Maruccia, Martina Ruggieri, Maria G. Onesti

Published in: Aesthetic Plastic Surgery | Issue 5/2013

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Abstract

Background

Lymphangioma, a rare benign malformation of lymphatic channels, is among the surgically treatable diseases of the lymphatic vessels. However, damage to surrounding structures together with incomplete resection due to adjacent organ infiltration and a high recurrence rate have encouraged the search for alternative treatments. This study aimed to identify the best therapeutic management for this difficult-to-treat disease.

Methods

This report describes a case of congenital lymphangioma in the gluteal region in a young woman. First, sclerotherapy of the lymphangioma was performed and then surgical excision of residual lesions. Finally, as a third therapeutic step, the patient also was subjected to a cycle of laser therapy with the aim of further improving the appearance of the gluteal region. Pulsed dye laser was used to remove cutaneous dyschromias, and an erbium:yttrium–aluminum-garnet laser was used to remove surface irregularities and obtain better skin smoothness. The outcome assessments included standardized photography, the physician’s global assessment, the patient’s satisfaction scores, and magnetic resonance imaging of the gluteal region.

Results

All the lesions of lymphangioma were removed. After the last laser treatment, the skin of the entire treated region was eutrophic and uniform in color, and it appeared to be smooth and soft when palpated. The patient was satisfied with the clinical and aesthetic results achieved.

Conclusions

The combination of sclerotherapy with surgery can be a good solution for the treatment of lymphangioma. The authors also propose laser therapy as an additional therapeutic approach that may follow surgery or sclerotherapy with the aim of improving the skin trophism and the appearance of the affected region.

Level of Evidence V

This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.​springer.​com/​00266.
Literature
1.
go back to reference Banieghbal B, Davies MR (2003) Guidelines for the successful treatment of lymphangioma with OK-432. Eur J Pediatr Surg 13:103–107PubMedCrossRef Banieghbal B, Davies MR (2003) Guidelines for the successful treatment of lymphangioma with OK-432. Eur J Pediatr Surg 13:103–107PubMedCrossRef
2.
go back to reference Berwald C, Salazard B, Casanova D, Bardot J et al (2006) Indications of lasers treatment for lymphatic malformations. Ann Chir Plast Esthet 51:429–432PubMedCrossRef Berwald C, Salazard B, Casanova D, Bardot J et al (2006) Indications of lasers treatment for lymphatic malformations. Ann Chir Plast Esthet 51:429–432PubMedCrossRef
3.
go back to reference Bhattacharyya NC, Yadav K, Mitra SK, Pathak IC (1981) Lymphangiomas in children. Aust N Z J Surg 51:296–300PubMedCrossRef Bhattacharyya NC, Yadav K, Mitra SK, Pathak IC (1981) Lymphangiomas in children. Aust N Z J Surg 51:296–300PubMedCrossRef
4.
go back to reference Bossert T, Gummert JF, Mohr FW (2002) Giant cystic lymphangioma of the mediastinum. Eur J Cardiothorac Surg 21:340PubMedCrossRef Bossert T, Gummert JF, Mohr FW (2002) Giant cystic lymphangioma of the mediastinum. Eur J Cardiothorac Surg 21:340PubMedCrossRef
6.
go back to reference Chait D, Yonkers AJ, Beddoe GM, Yarington CT Jr (1974) Management of cystic hygromas. Surg Gynecol Obstet 139:55–58PubMed Chait D, Yonkers AJ, Beddoe GM, Yarington CT Jr (1974) Management of cystic hygromas. Surg Gynecol Obstet 139:55–58PubMed
7.
go back to reference Di Maio L, Baldi A, Dimaio V, Barzi A (2011) Use of flashlamp-pumped pulsed dye laser in the treatment of superficial vascular malformations and ulcerated hemangiomas. In Vivo 25:117–123PubMed Di Maio L, Baldi A, Dimaio V, Barzi A (2011) Use of flashlamp-pumped pulsed dye laser in the treatment of superficial vascular malformations and ulcerated hemangiomas. In Vivo 25:117–123PubMed
8.
go back to reference Dubois J, Garel L, Abela A, Laberge L et al (1997) Lymphangiomas in children: percutaneous sclerotherapy with an alcoholic solution of zein. Radiology 204:651–654PubMed Dubois J, Garel L, Abela A, Laberge L et al (1997) Lymphangiomas in children: percutaneous sclerotherapy with an alcoholic solution of zein. Radiology 204:651–654PubMed
9.
go back to reference Emery PJ, Bailey CM, Evans JN (1984) Cystic hygroma of the head and neck: a review of 37 cases. J Laryngol Otol 98:613–619PubMedCrossRef Emery PJ, Bailey CM, Evans JN (1984) Cystic hygroma of the head and neck: a review of 37 cases. J Laryngol Otol 98:613–619PubMedCrossRef
10.
go back to reference Emran MA, Dubois J, Laberge L, Al-Jazaeri A et al (2006) Alcoholic solution of zein (Ethibloc) sclerotherapy for treatment of lymphangiomas in children. J Pediatr Surg 41:975–979PubMedCrossRef Emran MA, Dubois J, Laberge L, Al-Jazaeri A et al (2006) Alcoholic solution of zein (Ethibloc) sclerotherapy for treatment of lymphangiomas in children. J Pediatr Surg 41:975–979PubMedCrossRef
11.
go back to reference Fonkalsrud EW (1986) Disorders of the lymphatic system. In: Welch KJ, Randolph JG, Ravitch MM et al (eds) Pediatric surgery, 4th edn. Year Book Medical, Chicago, pp 1506–1507 Fonkalsrud EW (1986) Disorders of the lymphatic system. In: Welch KJ, Randolph JG, Ravitch MM et al (eds) Pediatric surgery, 4th edn. Year Book Medical, Chicago, pp 1506–1507
12.
go back to reference Fonseca V, Hinson J, Pappas A, Waner M et al (1997) An erbium:YAG laser to obtain capillary blood samples without a needle for point-of-care laboratory testing. Arch Pathol Lab Med 121:685–688PubMed Fonseca V, Hinson J, Pappas A, Waner M et al (1997) An erbium:YAG laser to obtain capillary blood samples without a needle for point-of-care laboratory testing. Arch Pathol Lab Med 121:685–688PubMed
13.
go back to reference Gallagher PG, Mahoney MJ, Gosche JR (1999) Cystic hygroma in the fetus and newborn. Semin Perinatol 23:341–356PubMedCrossRef Gallagher PG, Mahoney MJ, Gosche JR (1999) Cystic hygroma in the fetus and newborn. Semin Perinatol 23:341–356PubMedCrossRef
14.
go back to reference Grasso DL, Pelizzo G, Zocconi E, Schleef J (2008) Lymphangiomas of the head and neck in children. Acta Otorhinolaryngol Ital 28:17–20PubMed Grasso DL, Pelizzo G, Zocconi E, Schleef J (2008) Lymphangiomas of the head and neck in children. Acta Otorhinolaryngol Ital 28:17–20PubMed
15.
go back to reference Gross RE (1953) The surgery of infancy and childhood. Saunders, Philadelphia7 Gross RE (1953) The surgery of infancy and childhood. Saunders, Philadelphia7
16.
go back to reference Hancock BJ, St-Vil D, Luks FI, Di Lorenzo M et al (1992) Complications of lymphangiomas in children. J Pediatr Surg 27:220–224 discussion 224–6PubMedCrossRef Hancock BJ, St-Vil D, Luks FI, Di Lorenzo M et al (1992) Complications of lymphangiomas in children. J Pediatr Surg 27:220–224 discussion 224–6PubMedCrossRef
17.
go back to reference Harashima T, Hossain M, Walverde DA, Yamada Y et al (2001) Treatment of lymphangioma with Nd:YAG laser irradiation: a case report. J Clin Laser Med Surg 19:189–191PubMedCrossRef Harashima T, Hossain M, Walverde DA, Yamada Y et al (2001) Treatment of lymphangioma with Nd:YAG laser irradiation: a case report. J Clin Laser Med Surg 19:189–191PubMedCrossRef
18.
go back to reference Lai CH, Hanson SG, Mallory SB (2001) Lymphangioma circumscriptum treated with pulsed dye laser. Pediatr Dermatol 18:509–510PubMedCrossRef Lai CH, Hanson SG, Mallory SB (2001) Lymphangioma circumscriptum treated with pulsed dye laser. Pediatr Dermatol 18:509–510PubMedCrossRef
19.
go back to reference Landthaler M, Hohenleutner U (2006) Laser therapy of vascular lesions. Photodermatol Photoimmunol Photomed 22:324–332PubMedCrossRef Landthaler M, Hohenleutner U (2006) Laser therapy of vascular lesions. Photodermatol Photoimmunol Photomed 22:324–332PubMedCrossRef
20.
go back to reference Levine C (1989) Primary disorders of the lymphatic vessels: a unified concept. Pediatr Surg 24:233–240CrossRef Levine C (1989) Primary disorders of the lymphatic vessels: a unified concept. Pediatr Surg 24:233–240CrossRef
21.
go back to reference Luzzatto C, Midrio P, Tchaprassian Z, Guglielmi M (2000) Sclerosing treatment of lymphangiomas with OK-432. Arch Dis Child 82:316–318PubMedCrossRef Luzzatto C, Midrio P, Tchaprassian Z, Guglielmi M (2000) Sclerosing treatment of lymphangiomas with OK-432. Arch Dis Child 82:316–318PubMedCrossRef
22.
go back to reference Mansingani S, Desai N, Pancholi A, Prajapati A et al (2005) A case of axillary cystic hygroma. Indian J Radiol Imaging 15:517–519CrossRef Mansingani S, Desai N, Pancholi A, Prajapati A et al (2005) A case of axillary cystic hygroma. Indian J Radiol Imaging 15:517–519CrossRef
23.
go back to reference Marshall MB, Oliveira T (2009) Thoracic outlet lymphangioma. Interact Cardiovasc Thorac Surg 9:372–373PubMedCrossRef Marshall MB, Oliveira T (2009) Thoracic outlet lymphangioma. Interact Cardiovasc Thorac Surg 9:372–373PubMedCrossRef
24.
go back to reference Molitch HI, Unger EC, Witte CL, Van Sonnenberg E (1995) Percutaneous sclerotherapy of lymphangiomas. Radiology 194:343–347PubMed Molitch HI, Unger EC, Witte CL, Van Sonnenberg E (1995) Percutaneous sclerotherapy of lymphangiomas. Radiology 194:343–347PubMed
25.
go back to reference Okoro PE, Anyaeze CM, Ngaikedi C (2009) Recurrent lymphangioma: what are the treatment options? Afr J Paediatr Surg 6:44–46PubMedCrossRef Okoro PE, Anyaeze CM, Ngaikedi C (2009) Recurrent lymphangioma: what are the treatment options? Afr J Paediatr Surg 6:44–46PubMedCrossRef
26.
go back to reference Orvidas LJ, Kasperbauer JL (2000) Pediatric lymphangiomas of the head and neck. Ann Otol Rhinol Laryngol 109:411–421PubMed Orvidas LJ, Kasperbauer JL (2000) Pediatric lymphangiomas of the head and neck. Ann Otol Rhinol Laryngol 109:411–421PubMed
27.
go back to reference Ozen IO, Moralioglu S, Karabulut R, Demirogullari B et al (2005) Surgical treatment of cervicofacial cystic hygromas in children. ORL J Otorhinolaryngol Relat Spec 67:331–334PubMedCrossRef Ozen IO, Moralioglu S, Karabulut R, Demirogullari B et al (2005) Surgical treatment of cervicofacial cystic hygromas in children. ORL J Otorhinolaryngol Relat Spec 67:331–334PubMedCrossRef
28.
go back to reference Remlova E, Dostalová T, Michalusová I, Vránová J et al (2011) Hemangioma curative effect of PDL, alexandrite, Er:YAG and CO(2) lasers. Photomed Laser Surg 29:815–825PubMedCrossRef Remlova E, Dostalová T, Michalusová I, Vránová J et al (2011) Hemangioma curative effect of PDL, alexandrite, Er:YAG and CO(2) lasers. Photomed Laser Surg 29:815–825PubMedCrossRef
29.
go back to reference Sadler TW (2004) In: Sadler TW (ed) Langman’s Medical Embryology, 9th edn. Lippincott Williams and Wilkins, Philadelphia, pp 269–270 Sadler TW (2004) In: Sadler TW (ed) Langman’s Medical Embryology, 9th edn. Lippincott Williams and Wilkins, Philadelphia, pp 269–270
30.
go back to reference Saijo M, Munro IR, Mancer K (1975) Lymphangioma: a long-term follow-up study. Plast Reconstr Surg 56:642–651PubMedCrossRef Saijo M, Munro IR, Mancer K (1975) Lymphangioma: a long-term follow-up study. Plast Reconstr Surg 56:642–651PubMedCrossRef
31.
go back to reference Sánchez Carpintero I, Mihm MC, Waner M (2004) Laser and intense pulsed light in the treatment of infantile haemangiomas and vascular malformations. An Sist Sanit Navar 27(Suppl 1):103–115PubMed Sánchez Carpintero I, Mihm MC, Waner M (2004) Laser and intense pulsed light in the treatment of infantile haemangiomas and vascular malformations. An Sist Sanit Navar 27(Suppl 1):103–115PubMed
32.
go back to reference Srinivas CR, Kumaresan M (2011) Lasers for vascular lesions: standard guidelines of care. Indian J Dermatol Venereol Leprol 77:349–368PubMedCrossRef Srinivas CR, Kumaresan M (2011) Lasers for vascular lesions: standard guidelines of care. Indian J Dermatol Venereol Leprol 77:349–368PubMedCrossRef
33.
go back to reference Sivarajan V, Mackay IR (2005) Noninvasive in vivo assessment of vessel characteristics in capillary vascular malformations exposed to five pulsed dye laser treatments. Plast Reconstr Surg 115:1245–1252PubMedCrossRef Sivarajan V, Mackay IR (2005) Noninvasive in vivo assessment of vessel characteristics in capillary vascular malformations exposed to five pulsed dye laser treatments. Plast Reconstr Surg 115:1245–1252PubMedCrossRef
34.
go back to reference Tanzi EL, Lupton JR, Alster TS (2003) Lasers in dermatology: four decades of progress. J Am Acad Dermatol 49:1–31PubMedCrossRef Tanzi EL, Lupton JR, Alster TS (2003) Lasers in dermatology: four decades of progress. J Am Acad Dermatol 49:1–31PubMedCrossRef
35.
go back to reference Weingold DH, White PF, Burton CS (1990) Treatment of lymphangioma circumscriptum with tunable dye laser. Cutis 45:365–366PubMed Weingold DH, White PF, Burton CS (1990) Treatment of lymphangioma circumscriptum with tunable dye laser. Cutis 45:365–366PubMed
36.
go back to reference Yazbeck S, Di Lorenzo M (2004) Lymphangioma. In: Stringer MD (ed) Pediatric surgery and urology: long-term outcomes. WB Saunders Co Ltd, Philadelphia7, pp 72–81 Yazbeck S, Di Lorenzo M (2004) Lymphangioma. In: Stringer MD (ed) Pediatric surgery and urology: long-term outcomes. WB Saunders Co Ltd, Philadelphia7, pp 72–81
Metadata
Title
A Rare Case of Lymphangioma in the Gluteal Region: Surgical Treatment Combined With Sclerotherapy and Laser Therapy
Authors
Paolo Fioramonti
Michele Maruccia
Martina Ruggieri
Maria G. Onesti
Publication date
01-10-2013
Publisher
Springer US
Published in
Aesthetic Plastic Surgery / Issue 5/2013
Print ISSN: 0364-216X
Electronic ISSN: 1432-5241
DOI
https://doi.org/10.1007/s00266-013-0201-6

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