ROLE OF INTRALESIONAL INJECTION OF BLEOMYCIN SCLEROTHERAPY IN THE MANAGEMENT OF PERIPHERAL LYMPHANGIOMA

Abstract

BACKGROUND: Lymphangioma is a benign hamartomatous lymphatic tumuor. The surgical excision
remained mainstay of the therapy, but due to its infiltration along the nerves and muscles, total excision
is not possible. In the present study, we have evaluated the clinical profile of all the cases of
lymphagiomas coming to our hospital and evaluated the efficacy of intralesional bleomycin as a
sclerosing agent in its management.
OBJECTIVE: To evaluate the effectiveness of the intralesional bleomycin as a sclerosing agent in the
management of lymphangioma in children.
MATERIAL & METHODS: This study was performed at Khalifa Gul Nawaz Teaching Hospital
Bannu from May 2011 to September 2013. A total of 12 patients including 7 males and 6 females with a
ratio of 1.4:1, were treated with intralesional injection of bleomycin. The age range of the patients
treated were 2 months to 12years. Those patients who had lymphangioma both macro- cystic and mixed
type were included in the study. The microcystic variety and those patients who were treated surgically
were excluded from the study. The diagnosis was based on clinical examination and ultrasonography.
The dose used was 0.1- 0.5 mg/kg body weight. The patients selected were either on the parent’s request
to avoid general anesthesia and surgical complications or children with the lesion in an area where the
surgical approach would be otherwise difficult and challenging and the surgical excision might lead in
injuries to vital structures like nerves and vessels.
RESULTS: The overall success rate recorded as 75% which was significant. Ten patients responded to
two injections while 2 patients received three injections. The response was assessed with 9(75%) out of
12 had complete resolution (Excellent response) and the remaining 3(25%) cases had partial (Fair)
response only because of mixed macrocystic and microcystic lesions. There was no case with poor
response.
We observed minimal complications and found post injection haematoma in one patient with a
lymphangioma over the cheek and post injection abscess on the gluteal region.
CONCLUSION: Intralesional bleomycin injection is a safe and effective method for the treatment of
lymphangioma. It is a preferable alternative to surgical excision in selected cases. This therapy may be
used as primary modality instead of surgery in selected group of patients.
KEY WORDS: Lymphangioma, Sclerosing agent, Intralesional Bleomycin.