Treatment of Cystic Hygroma by Intralesional Bleomycin Injection: Experience in 70 Patients

Background/Aim: Cystic hygroma is a congenital malformation of the lymphatic system. Surgical excision is the treatment of choice, but injection of a sclerosing agent into the cyst is an alternative procedure. The aim of this study was to review the results after cystic hygroma treatment using intralesional bleomycin injection over a 16-year period at a tertiary hospital for pediatric patients in Thailand. Materials and Methods: Medical records of patients with cystic hygroma treated by intralesional bleomycin injection between 1992 and 2007 were reviewed. Bleomycin at dosages of 0.3-0.6 mg/kg was injected into the cysts and repeated injections were performed at an interval of 2-6 weeks. Clinical outcomes were reviewed and analyzed. Results: Seventy patients, 42 males and 28 females aged between one month and 14 years were treated with intralesional bleomycin injections. An excellent response (complete clinical resolution) was obtained in 33 cases (47.1%). A good response (partial reduction > 50% of the mass) was achieved in 25 cases (35.8%). A poor result (no clinical response or mass reduction < 50%) was noted in (17.1%). Adverse reactions including fever, local swelling, redness and pain at the site of injection occurred in 30 cases (42.9%). These reactions persisted for only a few days. Three cases died. Two girls in the poor results group died from pneumonia, respiratory failure and septicemia after bleomycin injection and partial surgical removal. The third one in the excellent results group developed thyroid carcinoma with metastasis at the opposite side to the first cystic hygroma. She died at another hospital from intracarotid artery injury with uncontrolled bleeding during left radical neck dissection. Conclusion: Intralesional bleomycin injection is useful for the treatment of cystic hygroma. It should be used in patients with large cystic masses and extensive invasion to reduce the risk of injury to vital organs.