Cystic Hygroma in a 4 day old baby
A 4 day old newborn presented to me with a large swelling (cystic hygroma : lymphatic malformation ) in the neck (as large as the baby’s head ) and another swelling in the right axilla. The swellings was tense and was causing pressure effects on the skin leading to ulcers in the skin. Also the baby was having some difficulty in breathing as the swelling was pressing on the airway. The baby was denied surgery in a couple of hospitals. The baby underwent the surgery for excision of both the swellings. The surgery lasted for 4 ½ hours. The baby did well and was discharged after a few days. This news was published in the Times Of India . Above everything else, it was a very fulfilling experience to operate on a newborn successfully!
CYSTIC HYGROMA or LYMPHANGIOMA
What is cystic Hygroma ?
Cystic hygromas or Lymphangiomas are abnormal growths that usually appear on a baby’s neck or head. They consist of one or more cysts and tend to grow larger over time. This disorder most often develops while the baby is still in the womb. Cystic hygromas are fluid-filled sacs caused by blockages in the lymphatic system. This system is a network of organs and tissues that helps move fluids through the body and transport white blood cells.
According to The Fetal Medicine Foundation, cystic hygromas affect 1 in 800 pregnancies and 1 in 8,000 live births. In 80 percent of cases, cystic hygromas appear on the face, including the head, neck, mouth, cheek, or tongue. The growths can also occur in other areas of the body, including the armpits, chest, legs, buttocks, and groin.
Cystic hygromas are usually benign, meaning they are not harmful. However, they can be disfiguring, grow to be very large, and affect a child’s breathing and ability to swallow.
What is the cause of Cystic Hygroma ?
Cystic hygromas can develop due to genetic disorders or environmental factors
Common environmental causes of cystic hygromas are:
- viral infections passed from the mother to the baby during pregnancy
- exposure to drugs / alcohol during pregnancy
Cystic hygromas are seen more often in infants with Genetic diseases. Some genetic conditions associated with hygromas include:
- Turner’s Syndrome
- Trisomy 13, 18, or 21
- Noonan syndrome
What are the symptoms of Cystic Hygromas ?
Symptoms of a cystic hygroma vary depending on the location of the cysts. Some children may not experience any symptoms other than the growth i.e a soft and spongy lump under the skin.
If a child has symptoms, they may include:
- fluid-filled sacs on the tongue
- large cysts that appear blue
- breathing and feeding difficulties
- failure to thrive
- bone and teeth abnormalities
In rare cases, the hygromas may bleed or become infected and suddenly increase in size and become painful.
How is Cystic Hygroma diagnosed ?
Cystic hygroma is diagnosed clinically i.e by examination. To know the extent of the lesion the pediatric surgeon would request some investigations like :
- Ultrasound
- CT Scan, or
- MRI
How is Cystic Hygroma treated ?
Treatment involves surgical removal of the abnormal tissue whenever possible. However, cystic hygromas can often invade other parts of the neck, making the surgery a complex one. In certain cases where the surgery is associated with significant morbidity other treatment modalities have been attempted only limited success, including:
- Chemotherapy medications
- Injection of sclerosing medications
- Radiation therapy
- Steroids
Your pediatric surgeon would evaluate your child and advise you regarding the best modality of treatment.
FAQ regarding Cystic Hygroma :
Q. Is this a cancer ?
A. No , it is a benign lesion.
Q. Does it require surgery immediately after birth ?
A. No (in most of the cases). It can be treated once the baby is 3 – 6 months old, has gained weight and can tolerate the surgery well. In certain conditions when the lesion is causing a problem at birth like pressure effects or breathing difficulty, it will require intervention right then.
Your pediatric surgeon would evaluate your child and advise you regarding the best modality of treatment.