Results of the Treatment of Cystic Hygroma with Intralesional Bleomycin Injection : An Experience in 70 Patients

Background/Aim : Cystic hygroma is a congenital malformation of lymphatic system. Surgical excision is the treatment of choice and sclerosing agent injection into the cysts is an alternative one. The aim of this study was to review results of the treatment of cystic hygroma with intralesional bleomycin injection in a 16 year period at a tertiary hospital for pediatric patients in Thailand. Materials and Methods : Medical records of the patients with cystic hygroma treated by intralesional bleomycin injection between 1992 to 2007 were reviewed. Bleomycin dosage of 0.3 – 0.6 mg/kg was injected into the cysts and repeated injections were performed at the interval of 2 – 6 weeks. Clinical outcomes were reviewed and analyzed. Results : Seventy patients, 42 males and 28 females with age between one month to 14 years old, were treated with intralesional bleomycin injections. An excellent response (complete clinical resolution) was obtained in 33 cases (47.1%). A good response (partial reduction > 50 % of the mass) was achieved in 25 cases (35.8 %). A poor result (no clinical response or mass reduction < 50 %) was noted in (17.1 %). Adverse reactions including fever , local swelling, redness and pain at the sites of injection were found in 30 cases (42.9 %). These reactions persisted only a few days. Three cases died due to pneumonia, respiratory failure and septicemia after bleomycin injection and partial surgical removal in 2 girls of the poor-result group. The third one in the excellent – result group developed thyroid carcinoma with metastasis at the opposite site of the first cystic hygroma. She died at another hospital because of intraoperative carotid artery injury with uncontrolled bleeding during left radical neck dissection. Conclusions : Intralesional bleomycin Injection is useful for treatment of cystic hygroma. It should be used in the patients with large cystic masses and extensive invasion in order to reduce the risk of vital organ injuries.