The “Lymphographic-Like” Technique for the Treatment of <3mm Microcystic Lymphatic Malformations Component

Background: The treatment of micro-cystic lymphangiomas (mLMs) remains a challenge.

Purpose: To describe a new modality of slow bleomycin infusion for the treatment of <3 mm micro-cysts component, the “Lymphographic-like technique” (LL-T) performed at our institution.

Materials: and Materials A retrospective analysis of a prospectively collected Lymphatic Malformations database was performed. Patients with at least a mLM component demonstrated at Magnetic resonance imaging (MR) treated with LL-T bleomycin infusion, were included in the study. Patients’ interviews and MR-imaging were performed to assess subjective and objective (mLM size decrease >30%) clinical improvement respectively. The follow-up was scheduled three months after each sclerotherapy session. LL-T safety and efficacy were assessed.

Results: Between January 2012 and July 2016, 16 patients (5 males; 11 females; mean age 15 years old (range 1–47), underwent bleomycin LL-T for mLMs. Overall 60 sclerotherapy sessions were performed, mean of 4 sessions per patient (range 1–8) with mean follow-up of 26 months (range 5–58 months). No major and three minor complications were observed: one palpebral edema, one post-procedural severe nausea and vomiting and one skin discoloration. One patient was lost at follow-up. Overall MR objective improvement was observed in 5/15 (33%) patients; overall clinical symptoms improvement were referred from 93% of treated patients.

Conclusions: Bleomycin LL-T for mLMs is safe and feasible with an objective improvement in around one third of cases. MR signal intensity changes after LL-T is associated with a subjective improvement of patients’ symptoms.