Cystic Hygroma - Quiz 35 Solution

Cystic hygroma (CH) is a cystic lymphatic malformation that can affect any anatomic subsite in the human body although head and neck are affected in 3/4 of the cases. Interestingly CH is more common on left than on right. They arise from failure of lymphatics to connect to the venous system, abnormal budding of lymphatic tissue, and sequestered lymphatic rests that have retained their embryonic growth potential.

More than half of CHs are evident at birth and prenatal diagnosis is increasingly becoming common. The cysts are typically large and thick walled and have little involvement of surrounding tissue. CHs often present after a sudden increase in size secondary to infection or intralesional bleeding. Airway compromise can be a presentation of CH. On examination CH appears as a soft, painless, compressible (doughy) mass that is transilluminable.

The medical treatment of CH consists of the administration of sclerosing agents such as OK-432 (an inactive strain of group A Streptococcus pyogenes), bleomycin, pure ethanol, bleomycin, sodium tetradecyl sulfate, and doxycycline. Most CHs however require surgery.