Cystic lymphangioma of neck
Introduction
Introduction to cystic lymphangioma of the neck Lymphangioma is not a true tumor, but a congenital benign sulcus. Tumor-like malformations occur during the development of the embryo during the development of certain parts of the original lymphatic sac that are isolated from the lymphatic system. About half of them existed at birth, and more than 90% were found within 2 years of age. The incidence rate of men and women is roughly the same. Cystic lymphangioma occurs in the neck, also known as cystic water tumor, which is the most common in clinical practice, accounting for about 3/4. The rest are found in the ankle, mediastinum, posterior peritoneum and pelvic cavity. The mesoderm fissures in the embryonic venous plexus fuse to form a large primitive lymphatic sac, which drains into the central venous system. Later, the lymphatic sac gradually degenerates or develops into a lymphatic system parallel to the vein. If the primary lymphatic sac is not connected to the venous system, The cystic lymphangioma is produced. If it is not connected with the trunk of the lymphatic system, a cavernous lymphangioma can occur. If a small number of lymphoid sacs are separated during the formation of the lymphatic system, a simple lymphangioma is formed due to the jugular vein. Cystic lymphoid formation is the earliest and largest, and cystic lymphangioma is most common in the neck. basic knowledge The proportion of illness: 0.002% Susceptible people: within 2 years of age Mode of infection: non-infectious Complications: dysphagia, speech and language disorders in children, dyskinesia, muscle atrophy
Cause
The cause of cystic lymphangioma in the neck
The mesoderm fissures in the embryonic venous plexus fuse to form a large primitive lymphatic sac, which drains into the central venous system. Later, the lymphatic sac gradually degenerates or develops into a lymphatic system parallel to the vein. If the primary lymphatic sac is not connected to the venous system, The cystic lymphangioma is produced. If it is not connected with the trunk of the lymphatic system, a cavernous lymphangioma can occur. If a small number of lymphoid sacs are separated during the formation of the lymphatic system, a simple lymphangioma is formed due to the jugular vein. Cystic lymphoid formation is the earliest and largest, and cystic lymphangioma is most common in the neck.
Pathological changes:
Lymphangioma is composed of lymphatic vessels that are hyperplastic, dilated, and structurally disordered. It can grow invasively around, and can be divided into three types according to its shape and distribution:
(1) Simple lymphangioma: consists of an expanded irregular capillary lymphatic plexus with less interstitial, mainly occurring in the skin, subcutaneous tissue and mucosal layer.
(2) Cavernous lymphangioma: the lymphatic vessel is enlarged into a sinus shape, which is filled with lymph fluid, which is a multi-atrial cyst, with more interstitial surrounding, lesions invading the skin, mucous membranes, subcutaneous tissue and deep structure muscles. Posterior peritoneum, mediastinum, etc.
(C) cystic lymphangioma: its cystic cavity is large, can be single or multi-room, mutual traffic, covered with endothelial cells, interstitial is rare.
In fact, lymphangiomas that are clinically seen are often mixed. If there is a mixture of hemangiomas in lymphangioma, it is called lymphangioma.
Prevention
Cervical cystic lymphangioma prevention
For this disease, there is no relevant effective method to prevent it. Early detection and early diagnosis are the key to treatment.
The actual lesion range of cystic lymphangioma often exceeds the original estimate. It is often difficult to completely remove the surgery. It requires careful dissection of the important nerves, blood vessels and other structures of the neck to prevent facial nerve paralysis and lingual nerves, recurrent laryngeal nerve, and radial nerve injury. It causes difficulty in breathing and hoarseness. For the remaining wall, 0.5% iodine can be rubbed to destroy endothelial cells to prevent recurrence.
Complication
Cervical cystic lymphangioma complications Complications, dysphagia, speech and language disorders, dyskinesia, muscle atrophy
When the cystic tumor is involved in the bottom of the mouth, tongue or pharynx, there may be language, breathing or dysphagia. When the cystic tumor is located on the collarbone, there may be dyskinesia or muscle atrophy in the brachial plexus, and sometimes the trachea is displaced.
Symptom
Symptoms of cystic lymphangioma in the neck Common symptoms Lymph node puncture has grass... Cystic necrosis Cervical cystic disease Tracheal compression Muscle atrophy Swallowing disorder Slow growth cystic mass
The presence of a huge cystic water tumor in the neck can cause difficulty in the delivery of the fetus. Generally, a soft cystic mass can be seen in the lateral side of the neck after birth, with obvious fluctuation and positive light transmission test. The boundaries are often unclear, not easily compressed, and without pain. The tumor and the skin have no adhesion, the growth is slow, and the size does not change significantly. However, it is easy to be infected and difficult to control. It can also occur in the capsule. At this time, the tumor suddenly increases, the tension is increased, and it is blue-purple. Compressing the surrounding organs can produce corresponding symptoms. Some can extensively invade the mouth, throat or mediastinum, oppress the trachea, esophagus, cause respiratory distress and difficulty in swallowing, and even life-threatening.
Some lymphangiomas will degenerate by self-embolization during the development process, or after infection, due to the destruction of endothelial cells in the wall of the capsule, they will resolve spontaneously after the infection is controlled.
The mesoderm fissures in the embryonic venous plexus fuse to form a large primitive lymphatic sac, which drains into the central venous system. Later, the lymphatic sac gradually degenerates or develops into a lymphatic system parallel to the vein. If the primary lymphatic sac is not connected to the venous system, The cystic lymphangioma is produced. If it is not connected with the trunk of the lymphatic system, a cavernous lymphangioma can occur. If a small number of lymphoid sacs are separated during the formation of the lymphatic system, a simple lymphangioma is formed due to the jugular vein. Cystic lymphoid formation is the earliest and largest, and cystic lymphangioma is most common in the neck.
Examine
Examination of cystic lymphangioma of the neck
Physical examination:
1. The cystic mass in the posterior triangle of the neck has the characteristics of spreading to four strokes (upper and lower clavicle, bottom of the mouth, tracheal esophagus and mediastinum). The boundary is often unclear. It is more common in infants and young children. It is huge at birth and can grow gradually. Big.
2. The cystic tumor is soft, generally non-compressive, can transmit light, the surface of the skin is normal, and it does not stick.
3. The contents are light yellow transparent or chyle-like, occasionally bloody, and a large number of lymphocytes containing cholesterol crystals can be seen under the microscope.
4. When the cystic tumor is involved in the mouth, tongue or pharynx, there may be language, breathing or dysphagia. When the cystic tumor is located on the collarbone, there may be dyskinesia or muscle atrophy in the brachial plexus, sometimes the trachea is under pressure. Bit.
Inspection Method
The subject is sitting, his arms are drooping and his head is slightly low. Check the stroke from the back with two finger tips to touch the neck, both sides of the control. The stroke was examined in the following order: 1 lower and submandibular lymph nodes; 2 deep cervical lymph nodes; 3 anterior and cervical deep middle and posterior lymph nodes; 4 occipital lymph nodes; 5 acromioclavicular lymph nodes. The lymph node group belonging to the posterior segment of the nasal cavity and the nasopharynx has the deep cervical lymph node and the posterior group of the sternocleidomastoid attachment; the submandibular lymph node, the sublingual lymph node, and the deep cervical lymph node in the oropharynx and hypopharynx And the deep cervical lymph node group. The anterior laryngeal lymph nodes are sometimes touched on the anterior ring of the neck.
Diagnosis
Diagnosis and differentiation of cystic lymphangioma of the neck
diagnosis
1. The cystic mass in the posterior triangle of the neck has the characteristics of spreading to four strokes (upper and lower clavicle, bottom of the mouth, tracheal esophagus and mediastinum). The boundary is often unclear. It is more common in infants and young children. It is huge at birth and can grow gradually. Big.
2. The cystic tumor is soft, generally non-compressive, can transmit light, the surface of the skin is normal, and it does not stick.
3. The contents are light yellow transparent or chyle-like, occasionally bloody, and a large number of lymphocytes containing cholesterol crystals can be seen under the microscope.
4. When the cystic tumor is involved in the mouth, tongue or pharynx, there may be language, breathing or dysphagia. When the cystic tumor is located on the collarbone, there may be dyskinesia or muscle atrophy in the brachial plexus, sometimes the trachea is under pressure. Bit.
Differential diagnosis
It should be differentiated from thyroid gland cyst, cleft palate cyst, dermoid cyst, and lipoma.
