Lymphangioma

1. LYMPHANGIOMA OVER RIGHT SHOULDER - AN UNUSUAL
SITE OF PRESENTATION
PRESENTING AUTHOR: DR.RAKSHITH M S
CO AUTHOR: DR.RAJASHEKHAR T PATIL
DEPARTMENT OF GENERAL SURGERY, GADAG INSTITUTE OF MEDICAL SCIENCES,
GADAG.
EPIDEMIOLOGY:
• Lymphangiomas are rare. Its incidence in India has
been estimated at 1.2- 2.8 cases per 1000
newborns.
INTRODUCTION:
• Lymphangiomas are congenital malformations
of the lymphatic system that involve skin and
subcutaneous tissues.
• They represent isolated, sequestered segments
of lymphatic system, that retain the ability to
produce lymph
• Types:
• simple/capillary lymphangioma
• Cavernous lymphangioma
• Cystic lymphangioma/cystic hygroma.
• They account for 4% of all vascular tumors and 25%
of all benign vascular tumors in children .
• Majority of these tumors are present at birth, and
90% can be identified by the end of first year of life.
SITES OF LYMPHANGIOMAS:
• It is commonly located in order of frequency in the
head and neck, axilla, chest, and proximal upper
extremity.
• Rarely, the can be found in the mediastinum, mucous
membrane, pelvis, extremities and chest wall.

2. CASE REPORT:
• A 4 year old female child presented with a
painless swelling over right shoulder since 3 years
which was insidious in onset and gradually
progressive.
• Increased to the present size of 7cm x 5 cms.
• No history of trauma/ fever /any other swellings in
neck/axilla present.
Fig 1 and 2: 4 y/o girl with the lesion
EXAMINATION:
• a solitary 7*5cm horizontally oval subcutaneous
swelling present over right shoulder.
• It has well defined borders, smooth surface ,
normal overlying skin.
• The swelling was non tender, fluctuant, brilliantly
transilluminant, in subcutaneous plane.
• Right shoulder movements normal
• Other systemic examination were normal.

3. INVESTIGATIONS.:
• Routine blood investigations were normal.
• USG revealed a multilocular anechoic cystic lesion
with internal echoes, of size 4 x 2.5 cm in the deep
subcutaneous plane, with lymphatic malformation.
INTRAOPERATIVE FINDINGS
• A 7*5 multicystic lesion was present in
subcutaneous plane over right shoulder and
superficial to muscles.
• The lesion was excised in toto and sent for
histopathology.
• Post-operative course was uneventful
Fig 4: Elliptical incision taken
over the swelling
TREATMENT
• After the work up, the patient was taken for excision
biopsy under General anaesthesia.
Fig. 6: Bed of region once mass
was excised
Fig 3: MRI of right shoulder Fig 3: MRI of right shoulder

4. HISTOPATHOLOGY:
• Sections showed normal skin, dermis and epidermis
• Skin with underlying irregularly dilated lymphatic
channel lined by endothelial cells. Also seen focal
lymphoid aggregates and red cells
• Lymphangioma – Right shoulder region
OUTCOME AND FOLLOW-UP.
• The patient was followed up, and currently, the
patient is doing well and asymptomatic.
• We were able to successfully manage
Lymphatic cyst and achieve complete excision
of the swelling.
Fig 7: Gross Specimen Fig 9: Smooth muscle wall
Fig 8: Cystic dilated spaces with
flat endothelial lining.

5. DISCUSSION:
• These malformations arise from sequestrations of
lymphatic tissue which fail to communicate
normally with the lymphatic system
• The site of primitive lymph sacs are the region for
these malformations, however in this case the site
was not explained by this hypothesis.
• This lesion was probably acquired as HPE showed
inflammatory changes and fibrosis.
• Lymphatic cyst are more prone for local
recurrence.
• Recurrence is less after Complete excision of
lymphangioma
• IHC : antibodies targeted against lineage-specific
substances, basal lamina and pericytes : confirms
the diagnosis.
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Cutaneous lymphangioma circumscriptum: The relevance
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ÜNİVERSİTESİ VETERİNER FAKÜLTESİ
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