LYMPHANGIOMA (IIYGROMA), COLL1 CYSTICUM CONGENITUM Pathological Anatomy.—Among the congenital tumors of the neck lymphangioma cystiennt occupies a position of its own (Figs.:21/a and 20b).
It is a multilo•ular tumor, laterally situated in the vicinity of the large vessels which it encircles, has a downward course toward the clavicle, penetrates underneath it into the sternal muscles, and may finally grow around all the vessels of the neck, larynx, and (esophagus, and lead to death by suffocation. Section through t he growth shows a meshwork of connective tissue, the cavities being lined with endothe lium and filled with clear lymph.
(As to etiology, etc., sec Tumors.) The size of the cysts varies; they lie close together, resembling a bunch of grapes and are usually firmly adherent to the surrounding parts, skin, periosteum, and muscles. Their adhesion to the blood-vessels is particularly intimate, so that occasionally there is a transition into a vascular tumor (Bayer).
The prognosis is decidedly unfavorable owing to the rapid growth of these tumors. Their peculiarity of penetrating into all loose tissues and to surround all organs, which they slowly stifle, renders expectant treat ment particularly dangerous.
The treatment can only consist in radical operation. The peculiarity of the tumor to firmly adhere to its environment and its often widely extending ramifications into the intercellular cavities, considerably complicates their extirpation, which even becomes impossible in cases where the tumor has already encircled the median cervical organs and involved the opposite side of the neck (Fig. 20b).
Difficulty in deglutition and respiration, as well as digital examina tion both inside and outside the pharynx, will furnish information on the extent of the growth.
Relapses may easily occur emanating from inaccessible or overlooked tissue gaps, even after complete extirpation of the tumor. As a rule, the operation is followed by prolonged lymphorrhiea which, however, is self-limited and only becomes dangerous from the great infectiousness of the wound, which is continually wet.
Aspirations and injections are of little value owing to the multi locular consistency of the growth, while its rapid and dangerous devel opment will not admit of losing any time by punctures, cautery, or electrolysis.