Hemolymphangioma of the lower extremities in children: two case reports

Abstract

Background and purpose: Hemo-lymphangiomas are rare benign tumors that arise from congenital malformation of the vascular system. They are usually diagnosed at birth or early in childhood. The management of hemo-lymphangiomas in children remains challenging because complete resection is often difficult to be achieved and recurrences are common.

Methods: We present the case of two children with a mass on their left tibia. Imaging modalities, plain radiograph, Ultrasonography and Magnetic Resonance were used to investigate the nature of the mass, the anatomical relationship to the neighboring tissues and help planning the surgical resection. The dominant diagnosis was hemo-lymphangioma. Both lesions increased in size in a short period of follow-up thus we decided to proceed to surgical excision.The diagnosis of hemo-lymphangioma was confirmed by histological examination of the surgical specimen.Post-operatively, seroma was formed to the first patient, managed by placing a drainage and immobilizing the limb on a splint.The second patient experienced no complications post-operatively.After 12 months of follow-up both patients had no complications or recurrence.

Conclusions: Very few cases of hemo-lymphangiomas of the extremities have been reported in the literature. Those tumors can grow slowly and remain asymptomatic for a long period of time or may become aggressive and enlarge rapidly, without invasive ability though.Radical resection is the choice of treatment offering the lowest recurrence rates. Other therapeutic methods are: aspiration and drainage, cryotherapy, injection of sclerotic agents and radiotherapy; although none of those offers better results that the surgical excision.

Figure 1

Case 1- Plain radiograph of the left tibia, demonstrating the mass in the inner-upper part.

Figure 2

Case 1- In a six month follow-up, pre-operative Ultrasound measures the tumor 23 mm × 6 mm.

Figure 3

Case 1- MRI defines the margins of the tumor.

Figure 4

Case 1- Perioperative aspect of the mass.

Figure 5

Histological examination of the mass. Collapsed and infolded cyst wall.

Figure 6

Histological examination. Cyst wall structure showing loose connective tissue stroma lined by flat endothelial cells, beneath which is obvious a lymphocytic infiltration.

Figure 7

Case 2- A Doppler Sonography demonstrating the blood flow in the mass.

Figure 8

Case 2- The Ultrasound verifies the absence of recurrence .