Cystic hygroma in adults-a rare case report.
Cystic hygroma can be classified into septated (multiloculated) or non-septated single cavity (non-loculated) types. Presentation in adulthood is rare and the cause is uncertain, although trauma and upper respiratory tract infection have both been suggested as possible triggers for onset. (6, 7)
Diagnosis in adults is considered to present a greater challenge than in children and initial misdiagnosis, frequently as branchial cleft cysts as in the case reported here, is common. (6, 8) Definitive diagnosis is usually based on post-operative histological findings.
Here we present a case of cystic hygroma in an adult patient and discuss the management options for such a presentation.
CASE REPORT: A 52-year-old woman was referred to our clinic with history of a slowly enlarging mass on the left side of her neck (Figure 1) since last ten months. She noted discomfort and mild pain while turning her head to the left side. She was further asymptomatic. Physical examination revealed a soft, smooth and mobile mass measuring about 10 cm, in the left supraclavicular fossa and left lateral side of neck. In fine needle aspiration cytology (FNAC), yellowish fluid was aspirated and showed the presence of mature lymphocytes and histiocytes. Computed tomography of the neck revealed presence of a lobulated cystic mass extending from the root of neck to the upper part of lateral neck, deep to the left sternomastoid and lateral to the carotid and jugular vessels (Figure 2). Excision of the mass was performed under general anesthesia. Histopathological diagnosis was cystic lymphangioma which was supported with massively dilated lymphatic spaces lined by endothelial cells and separated by intervening connective tissue containing lymphoid aggregates (Figure 3). Follow-up at 12, 24 and 36 months showed no recurrence.
DISCUSSION: Cystic hygromas believed to arise from a congenital malformation of the lymphatic system. Failure of communication between the lymphatic and the venous pathways leads to accumulation of lymph. Most cystic hygromas present in-utero or in infancy. Therefore most of the literatures on management consider pediatric cases. The effect of these lesions depends on their position and relationship to surrounding structures. Although the most common adult presentation is of a painless lump in an otherwise asymptomatic patient (6), rapid enlargement over a short period of time has frequently been reported (8) and major structures such as the larynx, trachea, esophagus, brachial plexus and great vessels have known to be compressed or incorporated within the lesion (9). In this case the lesion had doubled in size over a period of 4 months and had caused a restriction of neck movement; others have reported presentation with pain, hoarseness, dysphagia and breathlessness. (1, 9 10)
Lymphangiomas are best visualized by magnetic resonance imaging (MRI). The high water content allows lymphangiomas to appear hyperintense on T2-weighted Images. (10) The other imaging methods are Doppler ultrasonography and computed tomography (CT).Complete surgical excision has traditionally been considered the treatment of choice for cystic hygroma. (11-14) However, several authors have suggested that sclerotherapy (with alcohol, bleomycin and OK-432) may be a more appropriate first-line therapy. (15, 16) Intravenous cyclophosphamide has also been used, with some success, in recurrent lesions following surgery. (17)
This case was unusual in that a large cervical cystic hygroma presented de-novo in an adult with no history of trauma or upper respiratory infection. This presented a diagnostic challenge due to the rarity of the lesion in adults. Complete excision was successful and the prognosis is good. The authors would like to emphasize the importance of pre-operative imaging and surgical excision in the management of these lesions.
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Krushna Chandra Mallick , Rabindra Kumar Khatua , Subhalaxmi Routray , Anasuya Lenka 
[1.] Krushna Chandra Mallick
[2.] Rabindra Kumar Khatua
[3.] Subhalaxmi Routray
[4.] Anasuya Lenka
PARTICULARS OF CONTRIBUTORS:
[1.] Associate Professor, Department of E. N. T, S. C. B. Medical College and Hospital, Cuttack.
[2.] Senior Resident, Department of E. N. T, S. C. B. Medical College and Hospital, Cuttack.
[3.] Assistant Professor, Department of E. N. T, S. C. B. Medical College and Hospital, Cuttack.
[4.] Post Graduate Student, Department of Pathology, S. C. B. Medical College and Hospital, Cuttack.
NAME ADDRESS EMAIL ID OF THE CORRESPONDING AUTHOR:
Dr. Rabindra Kumar Khatua, C/o. Laxmidhar Dash, Malhasahi, Mangalbag, Cuttack--753001, Odisha.
Date of Submission: 01/02/2014.
Date of Peer Review: 03/02/2014.
Date of Acceptance: 20/02/2014.
Date of Publishing: 05/03/2014.
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|Title Annotation:||CASE REPORT|
|Author:||Mallick, Krushna Chandra; Khatua, Rabindra Kumar; Routray, Subhalaxmi; Lenka, Anasuya|
|Publication:||Journal of Evolution of Medical and Dental Sciences|
|Article Type:||Case study|
|Date:||Mar 10, 2014|
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