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Intralesional Bleomycin injections of cystic hygromas in pediatric patients
Sarah Arafat1, Moutaz Ragab2, Gamal El-Tagy2
1Oral and Maxillofacial Surgery, Faculty of Oral and Dental Medicine, Delta University for Science and Technology, Al Mansurah, Egypt.
Background:
Cystic hygromas are congenital macrocystic lymphatic malformations. Most cystic hygromas present at birth, during infancy or early childhood. Sclerotherapy is the main treatment, and Bleomycin is the most frequently used sclerosing agent.
Objectives:
To evaluate if intralesional Bleomycin (BLM) injection is a safe and effective treatment of cystic hygromas in pediatric patients.
Study Design:
retrospective cohort study.
Patients And Methods:
This case series includes 30 pediatric patients who had cystic hygromas and underwent intralesional Bleomycin injections.
Interventions:
The cystic lymphatic fluid was aspirated from each cystic hygroma, and then the lesion was simultaneously injected with Bleomycin during the first treatment session, then, the lesions were injected at 4-week intervals until satisfactory results were obtained. The Bleomycin 15 IU vial was freshly prepared on each session; 15 mg powdered BLM was dissolved in 15 mL of 0/9% normal saline (1 IU BLM equals 1 mg/mL BLM), with 0.5 IU/kg body weight safe pediatric dose; and 15 IU/session maximum dose. Clinical response was assessed as complete response (>90% reduction of lesion size), marked improvement (>70%), moderate improvement (50 - 70%), slight improvement (<50%), and no response (<10%). Patients were followed up for one year.
Outcome Measures:
reduction of lesion size clinically.
Results:
The 30 patients included 11 males and 19 females; their ages ranged from one month to 5 years; 17/30 patients had a complete response, 7/30 had marked improvement, 6/30 had a moderate improvement, stayed under observation every 12 months, and surgery was delay to after puberty onset. All patients who had a moderate response presented for treatment at age above 1.5 years old and required more treatment sessions. No recurrence was noticed in this study.
Conclusion:
Intralesional Bleomycin injection is a safe, effective, minimally invasive treatment and can be used as a first-line treatment option of cystic hygromas in pediatric patients. Long-term follow-up should be maintained, as recurrence may take place in the future during puberty due to hormonal effects.
Clinical Relevance:
This study highlights the importance of proper diagnosis and early treatment of cystic hygromas to achieve better clinical outcomes and to reduce treatment duration.