OK-432 is not Suitable for Abdominal Lymphatic Malformations

Sir,

In their article [1] on the management of abdominal lymphatic malformations (ALM), the Authors state that the literature on OK-432 as a primary treatment for AML is scarce. In fact, in our understanding, no literature is available on this topic. The Authors mention 2 references [2] [3], but Güvenç et al. treated a single case of retroperitoneal lymphatic malformation with surgery, and in the articles by Ogita et al. [3] [4] no intra-abdominal case is reported.

In our experience [5] [6]:

following the injection of OK-432 marked swelling of the lesion may occur which may last up to 3 or 4 weeks before regression begins. large and multiple cysts generally require repeated injections, performed at 2 month intervals, to obtain complete regression. a local inflammatory response is expected, and nothing is known about its consequences for surrounding structures.

For the above reasons OK-432 is not suitable and may be dangerous if injected into visceral lymphatic malformations, and we advise careful selection of only retroperitoneal lesions for this sclerosing treatment.

References

• 1 Oliveira C, Sacher P, Meuli M. Management of prenatally diagnosed abdominal lymphatic malformations.  Eur J Pediatr Surg. 2010;  20 ((5)) 302-306 . Epub 2010 Jun 24
• 2 Güvenç BH, Ekingen G, Tuzlaci A. et al Diffuse neonatal abdominal lymphangiomatosis: management by limited surgical excision and sclerotherapy.  Pediatr Surg Int. 2005;  21 ((7)) 595-598 . Epub 2005 Jun 2
• 3 Ogita S, Tsuto T, Nakamura K. et al OK-432 therapy for lymphangioma in children: why and how does it work?.  J Pediatr Surg. 1996;  31 ((4)) 477-480
• 4 Ogita S, Tsuto T, Nakamura K. et al OK-432 therapy in 64 patients with lymphangioma.  J Pediatr Surg. 1994;  29 ((6)) 784-785
• 5 Luzzatto C, Midrio P, Tchaprassian Z. et al Sclerosing treatment of lymphangiomas with OK-43.  Arch Dis Child. 2000;  82 ((4)) 316-318
• 6 Luzzatto C, Lo Piccolo R, Fascetti Leon F. et al Further experience with OK-432 for lymphangiomas.  Pediatr Surg Int. 2005;  21 ((12)) 969-972 . Epub 2005 Oct 25

Correspondence