[size=20px]A 14-month-old girl has a 7 cm left axillary, macrocystic lymphatic malformation. The most appropriate initial management is: ​

 

A Observation

 

B Percutaneous sclerotherapy

 

C Excision

 

D Intravenous Sirolimus​[/size]

B

C

A

B

B

B

B

B

B

C

B

B

B

B

I think it depend on the physical exam and further radiological findings.

 

The deferential diagnosis for a 7 cm left axillary, macrocystic lymphatic malformation in a 14-month-old girl may include:

 

1. Lymphangioma: A benign tumor of the lymphatic vessels.

2. Hemangioma: A benign tumor of blood vessels.

3. Cystic hygroma: A congenital malformation of the lymphatic system.

4. Lipoma: A benign tumor composed of adipose tissue.

5. Neurofibroma: A tumor that arises from nerve tissue.

B

Correct Answer

B Percutaneous sclerotherapy

 

Lymphatic malformations should be managed using a multidisciplinary approach. In a recent systematic review by the Outcomes and Quality Committees, percutaneous sclerotherapy was associated with a 51% complete or near-complete response rate (defined as >90% radiologic response). Furthermore, 97% of patients showed some response to treatment. The review also highlighted that macrocystic lesions respond better to sclerotherapy compared to mixed cystic or microcystic lesions. Systemic medical therapy also has a role in the management of lymphatic malformations, particularly in cases where the lesions are extensive or have failed previous treatments. Surgical excision and observation can also be considered, particularly if sclerotherapy is unsuccessful.