Cystic hygroma exacerbated by pregnancy.

A 26-year-old woman was examined in the emergency room for a 2-month history of a progressively enlarging left neck mass that had developed immediately after a normal spontaneous vaginal delivery (figure 1). Approximately 1 year earlier during a prior pregnancy, a smaller mass had arisen in the same location; findings on fine-needle aspiration biopsy at that time were nondiagnostic.

[FIGURE 1 OMITTED]

We obtained magnetic resonance imaging (MRI), which identified an 18 x 10-cm homogeneous cystic structure in the lateral neck; the mass extended from the tail of the parotid gland to the clavicle (figure 2). After an attempt at aspiration had failed, the mass was excised through a MacFee incision without complication (figure 3). On gross examination intraoperatively, the tumor exhibited thin walls and a venous hue (figure 4). Findings on pathologic analysis were consistent with a cystic hygroma.

[FIGURES 2-4 OMITTED]

Cystic hygromas are lymphatic malformations. Approximately 65 to 75% of these macrocystic, well-circumscribed lesions appear in newborns, and 80 to 90% appear within 3 years of birth. Fewer than 100 cases of adult cystic hygroma have been reported in the literature.

Approximately 75 to 80% of all lymphangiomas arise in the posterior cervical triangle. These mobile, doughy masses are fluctuant on palpation. Their exact etiology is unclear; some have postulated an association with trauma, infection, and hormonal changes.

The differential diagnosis of a cystic hygroma includes lipoma, hemangioma, branchial cleft cyst, lymphoma, hamartoma, dermoid cyst, and malignant diseases with cystic degeneration. Complications include airway obstruction, infection, and spontaneous hemorrhage. Treatment consists of observation, sclerosing agents, and partial or complete surgical excision; the latter is the treatment of choice as long as morbidity can be minimized.

Suggested reading

de Casso Moxo C, Lewis NJ, Rapado F. Lymphangioma presenting as a neck mass in the adult. Int J Clin Pract 2001;55:337-8.

Karapantzos I, Mpouras N, Huber I. [Cervical cystic hygroma]. HNO 2002;50:1014-16.

Sherman BE, Kendall K. A unique case of the rapid onset of a large cystic hygroma in the adult. Am J Otolaryngol 2001;22:206-10.

From the Department of Otolaryngology, Charles R. Drew University of Medicine and Science (Dr. Avitia and Dr. Osborne), and the Head and Neck Cancer Center, Cedars-Sinai Medical Center (Dr. Osborne), Los Angeles.