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Intrauterine Treatment of Large Fetal Neck Lymphangioma with OK-432

Mikovic Z.a · Simic R.b · Egic A.a · Stosic Opincal T.c · Koprivsek K.d · Stanojevic D.a · Bogavac M.e · Popovac M.a · Mandic V.a
aDepartment of High-Risk Pregnancies, University Clinic of Gynaecology and Obstetrics ‘Narodni Front’, bDepartment of Plastic and Reconstructive Surgery, Mother and Child Health Care Institute ‘Dr. Vukan Cupic’, and cMR Centre Clinical Centre of Serbia, Belgrade, and dDiagnostic Imaging Centre, Institute of Oncology, Novi Sad University School of Medicine, Sremska Kamenica, and eClinic of Gynaecology and Obstetrics Clinical Centre, Novi Sad University School of Medicine, Novi Sad, Serbia Fetal Diagn Ther 2009;26:102–106 (DOI:10.1159/000238111)

Abstract

Lymphangiomas are benign vascular malformations of the lymphatic system and most commonly present in the neck area. Large lymphangiomas may compress and/or displace the larynx, trachea and esophagus and cause serious respiratory and feeding problems in neonates. Prenatal therapy could eliminate the risks of the mentioned complications. Prenatal therapy may include the EXIT (ex utero intrapartum treatment) procedure. As this procedure has certain risks for both the neonate and mother, the introduction of a safer method is justified. The use of OK-432, as a sclerosing agent, has shown positive results in several published cases of cystic hygroma, but there is no study about the prenatal use of this agent in the treatment of lymphangioma. The aim of this study was to present our experience with intrauterine intralesional injection of OK-432 in the treatment of neck lymphangiomas. Two cases of large multicystic neck lymphangiomas that were closely situated to the fetal airway were treated by single intralesional injection of OK-432. We noticed a progressive decrease in tumor volume throughout gestation. We did not experience any complications and there were no respiratory or feeding problems in the neonates. The esthetical appearance was satisfactory and both children were normal at the age of 2 years and 6 months, respectively. This report suggests that prenatal intralesional injection of OK-432 might be a safe and effective treatment in selected cases with large fetal neck lymphangiomas.

 

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