Treatment and prognosis of fetal lymphangioma

To investigate the treatment and prognosis of fetal lymphangioma and factors that inform treatment selection.

Retrospective analysis of 79 patients with fetal lymphangioma treated at our hospital. Treatment methods included medical termination (death in-utero), expectant treatment, surgery, and interventional sclerotherapy (including ex utero intrapartum treatment, EXIT). Methods of treatment were selected according to the location and size of the lymphangioma.

Among the 133,322 fetuses, in 130,202 pregnant women, examined at our hospital, a lymphangioma was identified in 79. The lymphangioma was confirmed by ultrasound, magnetic resonance imaging and post-natal computed tomography, as appropriate, and pathological results obtained postoperatively or on autopsy. Septation of the mass was identified in 66 of the 79 cases (83.54%). With regard to location, the lymphangioma was located in the neck in 50 fetuses (63.29%). Interventional sclerotherapy, using bleomycin, was performed in 22 neonates, of which 3 underwent ex utero intrapartum treatment (EXIT), due to evidence of airway or esophageal obstruction, 16 underwent expectant management and 7 surgical treatment. Medical termination of the pregnancy was performed in 32 cases, and 2 fetuses died in-utero. Of the 16 cases of expectant treatment, the lesions retrogressed during the intra-uterine period in 7 cases, before the post-natal age of 6 months in 4 neonates, and before the age of 2 years in 3 neonates, with no change in the size of the lymphangioma identified in 2 cases. Of the 7 neonates who were treated surgically, relapse occurred in 1 case, which required re-operation.

Several treatment options for lymphangioma are available, with treatment selection being based on the location and size of the lymphangioma.