OK-432 therapy for a cervical thoracic duct cyst

Mediastinal Thoracic Duct Cyst Infection after Endoscopic Submucosal Dissection for Early Esophageal Cancer: A Case Report

A mediastinal thoracic duct cyst that originates from the thoracic duct is a very rare disease in the mediastinum. There have been no reports of mediastinal thoracic duct cyst infection caused by endoscopic treatment. This is the first case of mediastinal thoracic duct cyst infection after endoscopic submucosal dissection for early esophageal cancer. We herein report a 75-year-old man with mediastinal thoracic duct cyst infection caused by esophageal endoscopic submucosal dissection. In cases where a mediastinal thoracic duct cyst is found before performing endoscopic esophageal treatment, we should carefully consider the potential risk of post-treatment cyst infection.

Sclerotherapy for Benign Cystic Lesions of the Head and Neck: Systematic Review of 474 Cases

OBJECTIVE

The role of sclerotherapy for vascular lesions of the head and neck is well established. However, the efficacy of sclerotherapy for benign cystic lesions of the head and neck is less clear. The objective of this review is to determine the efficacy and safety of sclerotherapy for benign cystic lesions of the head and neck.

DATA SOURCES

PubMed/MEDLINE, Cochrane Library, and Embase.

REVIEW METHODS

The PRISMA guidelines (Preferred Reporting Systems for Systematic Reviews and Meta-analyses) were followed for this systematic review. Studies of patients with benign head and neck cystic masses treated primarily with sclerotherapy were included. Thirty-two studies met criteria for inclusion.

RESULTS

A total of 474 cases of sclerotherapy were reviewed. Agents comprised OK-432, ethanol, doxycycline, tetracycline, and bleomycin. Lesions in the analysis were ranula, thyroglossal duct cyst, branchial cleft cyst, benign lymphoepithelial cyst, parotid cyst, thoracic duct cyst, and unspecified lateral neck cyst. A total of 287 patients (60.5%) had a complete response; 132 (27.9%) had a partial response; and 55 (11.6%) had no response. OK-432 was the most widely utilized agent, with a higher rate of complete response than that of ethanol (62.0% vs 39.4%, P = .015). Fifty-three cases (11.2%) required further surgical management. One case of laryngeal edema was reported and managed nonoperatively.

CONCLUSION

Sclerotherapy appears to be a safe and efficacious option for benign cystic lesions if malignancy is reliably excluded. Efficacy rates are comparable to those of sclerotherapy for vascular malformations. The rate of serious complications is low, with 1 incident of airway edema reported in the literature.

Variations in the Management of Cervical Thoracic Duct Cyst

We present an uncomplicated case report of a cervical thoracic duct cyst (CTDC) in a 61-year-old woman treated with surgical excision. We reviewed 47 similar cases since it was first described in 1964 and evaluated the different diagnostic and management approaches. Previously believed to be the gold standard tool for evaluation, lymphangiography is now less popular due to advent of high-resolution imaging combined with aspiration techniques. CTDC treatment includes observation, low-fat diet, repeated aspirations, external pressure, sclerotherapy, embolisation, and surgical intervention. The preferred management of choice to date is surgical excision.

Spontaneous retropharyngeal and mediastinal thoracic duct cyst in an infant with respiratory distress

Thoracic duct cysts (TDC) within the retropharyngeal space and mediastinum are exceedingly rare lesions, with the majority related to trauma or neoplasm. We describe a case of an otherwise healthy 8-month-old boy who presented with severe respiratory distress, which was found to be caused by a large, spontaneous TDC occupying most the retropharyngeal and mediastinal space. To our knowledge, this is the youngest patient to date presenting with TDC. Ultimately, his TDC was completely resolved with sclerotherapy, however the patient's age and size presented unique challenges to his medical management, which we describe below.

OK-432 (Sapylin) Reduces Seroma Formation After Axillary Lymphadenectomy in Breast Cancer

Purpose/aim: Modified radical mastectomy is the standard surgery for breast cancer in developing countries. However, seroma formation regarded as the most frequent postoperative complication limits the therapeutic benefit of mastectomy and axillary surgery. The purpose of this study was to evaluate the efficacy of OK-432 in reducing seroma formation after axillary dissection.

METHODS

This prospective cohort study included 80 patients with advanced breast cancer who underwent modified radical mastectomy. Patients were randomized into two groups, which differed with the OK-432 administration. N = 40 patients per group were treated with either OK-432 plus closed suction drainage or drainage-only.

RESULT

In comparison with the drainage-only group, we found that patients in the OK-432 group had a lower drainage volume (p = .030) and a shorter duration of axillary drainage (p < .01). Besides, the use of OK-432 could reduce the incidence of seroma formation (p < .01) and the volume of seroma (p = .040). There were also significant differences in reducing the chance of evacuative punctures (p = .036) and the healing time (p < .01) between control and OK-432 group.

CONCLUSION

OK-432 not only shortened the suction drainage duration, but also significantly reduced seroma formation as well as the needs for aspiration punctures after modified radical mastectomy.

A Giant Thoracic Duct Cyst as the Cause of Abdomen Pain: A Case Report and Review of the Literature

Thoracic duct cysts, which may be of congenital or degenerative origin, are very rare lesions. Most patients are asymptomatic, but when symptoms are present they include cough, dyspnea, dysphagia and chest pain. However, in this case report a 35-year-old male patient presented to us with intermittent abdomen pain. Clinical symptoms and radiographic findings helped to identify a giant thoracic duct cyst in this patient. Surgical resection of the cyst resolved the abdominal symptoms. This was the first case reported in the literature of a thoracic duct cyst with the symptoms of abdominal pain.

Cervical thoracic duct cyst: Importance of preoperative suspicion for appropriate management of left-sided neck mass

Cervical thoracic duct cysts occur infrequently but are an important consideration when evaluating cystic supraclavicular masses. Only 22 cases have been reported to date. We review the clinical presentation, evaluation, and treatment of 2 cases of large thoracic duct cysts treated with surgical resection. A high suspicion of thoracic duct cyst based on location, radiographic findings, and fine-needle aspiration results is sufficient evidence for recommendation of surgical excision. However, enlarged cysts, as noted in our cases, can obliterate or attenuate the thoracic duct, making it difficult to identify intraoperatively. A high suspicion of thoracic duct cyst is important for identifying and ligating the duct to prevent complications such as chyle leak or chylothorax.

Direct puncture sclerotherapy of a thoracic duct cyst presenting as an enlarging left supraclavicular mass

A 58-year-old woman presented with a palpable mass at the base of the left neck which she had first noticed 12 years previously, shortly after abdominal surgery. The mass had progressively enlarged, resulting in dysphagia, dyspnea and occasional pain. Imaging showed a septated but otherwise simple cystic mass extending into the mediastinum and containing lymphocytic fluid on aspiration. A diagnosis of the rare entity of a thoracic duct cyst with supraclavicular extension was made. The patient opted for percutaneous sclerotherapy of the lesion, which was performed using glacial acetic acid. This resulted in complete resolution of the mass with one treatment. After exclusion of other causes of cystic left supraclavicular masses including cystic neoplasms and pseudoaneurysms of the carotid or subclavian arteries, direct puncture sclerotherapy can be safe and effective.

[Sclerotherapy for cystic lesions of the head and neck region]

Cystic lesions are frequently occurring diseases of the head and neck region. Complete surgical resection near to neurovascular structures can be accompanied by various complications. In selected cases intralesional injection of OK-432 could constitute an alternative. The average success rate of sclerotherapy of lymphatic malformations is 60%. Side effects are rare. Sclerotherapy is a minimally invasive, simple and cost-effective procedure performed without general anaesthesia at the outpatient clinic. Nerve lesions or troublesome scarring do not occur. In residual cases surgical excision is realisable without any difficulty. Repeated injections of sclerotherapy agents represent a disadvantage. Abscess formation has been observed as a rare complication. A malignant disease has to be excluded by cytological examination before commencing sclerotherapy. The intracystic injection of OK-432 is an effective treatment modality for cystic cervical lesions.