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Cystic lymphangioma in the pediatric population: experience and outcomes from a surgical unit
Senda Houidi, Fatma Thamri, Skander Smaoui, Nour El Houda Ben Alaya, Yosra Kerkeni, Riadh Jouini
children hospital Bechir Hamza, Pediatric surgery department A Tunis Tunisia
Introduction:
Cystic lymphangioma (CL) is a rare, benign congenital malformation of the lymphatic system, during early childhood. It can become symptomatic due to their potential for rapid growth with risk of compression, infection or hemorrhage. We report our experience in management of CL in children.
Methods:
We retrospectively reviewed all cases of CL between May 2019 and May 2025. Clinical data were collected from medical records of the department of pediatric surgery in the children’s hospital of Tunis.
Results:
Eleven patients were treated for CL. The mean age at diagnosis was 5 years (1 month- 16 years). The discovery was incidental or abdominal pain. Lesion locations included the abdomen (4 cases), thorax (3 cases), cervical region (2 cases), inguino-scrotal (1case), and bilateral scrotal involvement (1case). In one case, the mass was compressive, leading to respiratory distress, another patient presented with infected lesion requiring hospitalization and antibiotic therapy. The bilateral scrotal location was misdiagnosed initially as a communicating hydrocele. Ultrasound confirmed the diagnosis in 10 patients, revealing a well-defined, multiloculated, non-vascularized cystic mass. The average size of lesions was 8 cm. For 5 cases, MRI was performed to better evaluate the relationship between the mass and adjacent anatomical structures. Surgical resection was performed for intra-abdominal/thoracic and scrotal lymphangiomas. In 4 patients, the lesions were intimately adherent and extended into the cervical and thoracic regions. Sclerotherapy using bleomycin was done with good outcomes. Complete regression noted in one patient after three injections and more than 50% regression in size for the remaining patients following two injections. No recurrences were observed.
Conclusion:
CL is a benign tumor that can impact a child’s quality of life and, become life-threatening in some cases. Management remains challenging due to the lesion’s infiltrative nature and risk of recurrence.