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Unusual cystic hygromas: Case report
Aachal Barma1, Sarjan Kunwar1, Nabin Kumar Yadav1
1Gandaki Medical College Teaching Hospital and Research Center, Pokhara 33700, Nepal.
Insights
Cystic hygromas, rare congenital lymphatic anomalies, can present in unusual locations and later in childhood. Surgical excision is a safe and effective treatment for these pediatric swellings.
Area of Science:
- Pediatric Surgery
- Congenital Malformations
- Lymphatic System Abnormalities
Background:
- Cystic hygromas are congenital lymphangiomas resulting from lymphatic system developmental anomalies.
- Typically diagnosed in early childhood, they are rare in adolescents and on the chest wall or axilla.
Observation:
- Two pediatric cases are presented: a 14-year-old male with an axillary hygroma and a 1-year-old male with a chest wall hygroma.
- One case presented with hemorrhage into the cyst, complicating diagnosis.
- Diagnosis involved correlating patient history, clinical findings, and radiological investigations.
Findings:
- Histopathology confirmed cystic hygroma in both surgically treated cases.
- Surgical excision was performed without complications in both patients.
- Diagnosis requires thorough history, clinical examination, and radiological/histopathological correlation.
Implications:
- Unusual locations and delayed presentations of cystic hygromas can occur, extending beyond typical early childhood cervicofacial manifestations.
- Cystic hygroma should be considered in the differential diagnosis of pediatric swellings.
- Surgical excision is confirmed as a safe and effective treatment for cystic hygromas.
Introduction And Importance:
Cystic hygromas are congenital lymphangiomas that arise from a developmental anomaly in the lymphatic system. Typically detected in early childhood, their incidence in adolescents and at the chest wall or axillary area is rare.
Case Presentation:
We report two cases, a 14-year-old male child (Case I) and a 1-year-old male infant (Case II), who presented with swelling in unusual locations, the right axillary region and the right anterolateral chest wall respectively. Local examination findings were indicative of a cystic hygroma in the first case, while in the second case, characteristic transillumination was not seen due to a complication: hemorrhage within the cyst. The diagnoses were established after a correlation of the patient's history, and clinical findings with radiological investigations. Both underwent surgical intervention and had no complications. Histopathology of the post-operative specimens confirmed the diagnoses.
Discussion:
The diagnosis of cystic hygroma is made in the totality of thorough history taking, clinical examination, and radiological and histopathological investigations. Though most cases typically manifest before the age of two years and in the cervicofacial area, unusual locations and delayed presentation can occur. Surgical excision is a safe and effective treatment modality for these lesions.
Conclusion:
Although a rare entity, cystic hygroma should be considered a possible differential diagnosis of any swelling in the pediatric population.
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