Bleomycin Sclerotherapy in Massive Macrocystic Lymphatic Malformation: Minimal Complications with Maximum Results

INTRODUCTION: Cystic lymphangioma (CL) is a multiloculated congenital malformation of the lymphatic system occurring in approximately 1 in 6,000–12,000 births, and it mostly presents at birth. The CL is of a variable size and it can be found at any age and in any part of the body. This study was carried out to observe the effect of intralesional aqueous bleomycin on giant CL presenting in adult and pediatric cases. MATERIALS AND METHODS: This is an observational study conducted in the department of pediatric surgery and plastic surgery from January 2012 to January 2020. All the diagnosed cases of lymphangioma measuring more than 5 cm in size and managed during this period were reviewed. The cases who had lesions with a vascular component or who had any history of previous surgery or any form of treatment were excluded from the study. A total of 19 cases were included in the study. The primary mode of management of CL at the present center is intralesional bleomycin sclerotherapy (IBS). This is the standard protocol followed at our center to treat the cases with CL. Relevant demographic and clinical data of all the included patients were collected on a structured proforma, and data were analyzed. RESULT: Four cases had a favorable outcome in a single session, seven cases showed a favorable response after the second session, and three cases showed a favorable response after the third session. Two cases showed a partial response even after the fourth session and were considered nonresponders, one of whom was operated on and the other who was satisfied with a partial response and was not willing to undergo surgical excision. No major complications were observed in the present series. A few cases developed mild pain with or without fever, but none of them required hospitalization. CONCLUSION: Intralesional bleomycin sclerotherapy (IBS) is a safe, effective, and economical treatment option for the management of large cystic lymphangiomas and it avoids surgery-related complications. Level of Study: IV evidence study Type of Study: Retrospective observational study