gms | German Medical Science

81st Annual Meeting of the German Society of Oto-Rhino-Laryngology, Head and Neck Surgery

German Society of Oto-Rhino-Laryngology, Head and Neck Surgery

12.05. - 16.05.2010, Wiesbaden

Acute distress in adults – case report of an endolaryngeal lymphangioma

Meeting Abstract

  • corresponding author presenting/speaker Peggy Lange - Otorhinolaryngology, University Giessen, Germany
  • Frank Driever - Pathology, University Giessen, Germany
  • Christoph Arens - Otorhinolaryngology, University Madgeburg, Germany
  • Jens Peter Klu▀mann - Otorhinolaryngology, University Giessen, Germany

German Society of Oto-Rhino-Laryngology, Head and Neck Surgery. 81st Annual Meeting of the German Society of Oto-Rhino-Laryngology, Head and Neck Surgery. Wiesbaden, 12.-16.05.2010. DŘsseldorf: German Medical Science GMS Publishing House; 2010. Doc10hno007

DOI: 10.3205/10hno007, URN: urn:nbn:de:0183-10hno0072

Published: July 6, 2010

© 2010 Lange et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by-nc-nd/3.0/deed.en). You are free: to Share – to copy, distribute and transmit the work, provided the original author and source are credited.


Outline

Text

Lymphangiomas are rare congenital malformations of the lymphatic system. Over 90% of patients present in clinic with isolated swellings in the head and neck area in early childhood. In contrast endolaryngeal lymphangiomas in adult coming up with acute distress are a rarity in otorhinolaryngology. On the basis of a clinical case we discuss symptoms, diagnostics, acute airway management and therapy strategies of this disease.

The 26-year old patient presenting in the emergency service with acute dyspnea complained about inspiratory stridor since 2 weeks and an altered speech since the day before. Past medical history revealed an occasional asthma and a nicotine abuse of 5 pack years. During examination the increasingly somnolent patient showed loud breathing noises. Laryngoscopy revealed an exophytic tumor of the right aryepiglottic region with nearly complete obstruction of the endolaryngeal lumen.

Immediate monitoring of the patient, application of cortisone and inhalation of sympathomimetics were started. After fiberoptic guided intubation we performed a laser surgical debulking of the tumor. The histopathological processing revealed a lymphangioma.

We agreed with the patient in frequent follow-up with possible tumor debulking in the case of growth progression. To decrease recurrency rate complete excision would be necessary, which is often not practicable in particular in the endolaryngeal region. Sclerotherapy (for example Picibanil) could be an alternative treatment. Picibanil is a product of Streptococcus A. Injected in the cystic lesions of the lymphangioma it induces an inflammatory reaction leading to agglutination of the cystic parts of the lymphangioma. A high recurrency rate of nearly 100% is described in literature after this treatment. After incomplete excision of lymphangioma a recurrency rate of 40% and after complete resection a recurrency rate of 17% is described.

In conclusion a conservative laser surgical debulking of endolaryngeal lymphangioma with frequent follow-up in adults is an adequate therapy for this rare disease.


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