Adult axillary lymphangioma removal using indocyanine green fluorescence imaging system: A case report. (2020)

• Record Type: Journal Article
• Authors: Kubota, Osamu; Uchiyama, Takashi; Nakamura, Koichi; Hayashi, Yoshiro; Onuki, Yoshinori; Baba, Satoshi
• Is Part Of: International journal of surgery case reports. Volume 72(2020)
• Page Start: 255
• Page End: 259
• Publication Date: 2020
• Subjects: ICG indocyanine green -- MMG mammography -- US ultrasound -- MRI magnetic resonance imaging -- PDE photodynamic eye -- NIR near-infrared ray; Cystic lymphangioma -- Indocyanine green fluorescence -- Near-infrared fluorescence -- Case report; Surgery -- Periodicals; Surgical Procedures, Operative -- Periodicals; Surgery; Electronic journals; Periodicals; 617.005
• DOI: 10.1016/j.ijscr.2020.05.090
• Languages: English
• ISSNs: 2210-2612

Abstract

Highlights: Adult cystic lymphangioma is extremely rare. Diagnosis of lymphangioma is relatively easy based on the clinical image findings. Complete surgical excision is the most effective treatment for lymphangioma. The ICG fluorescence imaging system is very useful for performing complete excision. Abstract: Introduction: Lymphangiomas are benign cystic tumors which arise from congenital malformations of the lymphatic system and are extremely rare in adulthood. We report a case of adult lymphangioma of the axilla that was removed after identifying the feeding lymphatic vessel using an indocyanine green (ICG) fluorescence imaging system. Presentation of case: A 35-year old woman presented to our hospital with a rapidly growing mass on her left axilla. She had been pregnant once before and delivered at 34 years of age. Mammography, ultrasonography, and magnetic resonance imaging revealed a tumor that consisted of multiple cysts, which led to a diagnosis of cystic lymphangioma. The ICG fluorescence imaging system indicated that only one lymphatic vessel, which was completely removed with ligation of the feeding lymphatic vessel, was flowing to the tumor. An immunohistological study demonstrated that the cystic endothelia were positive for podoplanin (D2-40), a marker of lymphatic vessels. Discussion: In addition to congenital factors, mechanical obstruction to lymphatic vessels by an external force, such as trauma or congestion of the lymphatic flow caused by increasing venous pressure during pregnancy or delivery might lead to lymphangioma in adulthood. Therefore, our patient's pregnancy and delivery one year prior to discovery of the tumor seems to be the cause of her lymphangioma. Conclusion: Based on our findings, we recommend the complete excision to successfully treat adult-onset lymphangioma. We also suggest that visualization with ICG fluorescence imaging system is very useful for detecting the feeding lymphatic vessel and performing complete excision of the lymphangioma.