Spontaneous Resolution of Lymphatic and Venous Malformations

Introduction

Vascular anomalies are broadly divided into two categories: vascular tumors and vascular malformations [8]. The former are characterized by growth during infancy and involution during childhood, while the latter, including venous (VM) and lymphatic malformations (LM), are considered developmental errors and are composed of dysmorphic vessels that “almost never regress” [8].This classification essentially dismisses the possibility of spontaneous resolution of these malformations, with surgical resection considered the only way to “cure” them [8].

Cervical LM, previously referred to as cystic hygroma, is a relatively rare lesion that is usually diagnosed in infancy or early childhood. Complete surgical extirpation, long considered the mainstay of treatment for these lesions, may be impossible without sacrificing important neurovascular structures, resulting in significant morbidity [1] [3] [4] [7] [17] [19] [21]. Postoperative recurrence rates are high [1] [3] [4] [7] [17] [19] [21]. Sclerotherapy with a variety of agents has also been reported in the literature as a primary treatment or as an adjunct to surgical excision [2] [5] [14] [15] [16] [18] [19] [20]. Each method of sclerotherapy is associated with potential complications and a significant chance of failure. Although spontaneous resolution or regression has been randomly documented in the literature [1] [4] [7], the option to observe an asymptomatic LM is not entertained by most pediatric surgeons.

Like LM, VM can also occur in any region of the body, including the head and neck [8] [6] [11] [20] [22]. The risk of hemorrhage is high with surgical resection. Sclerotherapy of VM has been described, but requires significant expertise that may not be available in many pediatric surgical centers [9] [10] [13]. To our knowledge, no reports exist of spontaneous resolution of VM.

In this report, we present two patients whose vascular malformations spontaneously resolved. The literature will also be reviewed to highlight the indications for observation of asymptomatic lesions.

References

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