Cystic hygroma

Phenotypic and Genomic Analysis of Cystic Hygroma in Pigs

Cystic hygroma is a malformation of the lymphatic and vascular system and is recognized as a benign congenital tumor that affects humans and animals in the perinatal period. This congeni-tal disorder is rarely described in animals, and until today, cystic hygroma in pigs has not been described in the literature. In a purebred Piètrain litter with twelve live-born piglets, cystic hy-groma was noticed on the rump of two male pigs within the first week of life. In addition, a third case of a crossbred weaner (Large White × Landrace) was detected during a herd examina-tion. To rule out common differential diagnoses, e.g., abscess or hematoma, further clinical and pathological investigations were conducted. During clinical examination, a painless and soft mass, which was compressible, was detected on the rump of all affected animals. The ultra-sonographic examination revealed a fluid-filled and cavernous subcutaneous structure. In addi-tion, a puncture of the cyst was conducted, revealing a serosanguinous fluid with negative bacte-riological culture. In all cases, a necropsy was performed, showing that the animals had fluid-filled cysts lined by well-differentiated lymphatic endothelium. Based on the clinicopathological examination, cystic hygroma was diagnosed. Furthermore, SNP array genotyping and whole-genome sequencing was performed and provided no evidence for a chromosomal disorder. In the Piètrain family, several genome regions were homozygous in both affected piglets. None-theless, a dominant acting de novo germline variant could not be ruled out, and therefore differ-ent filtering strategies were used to find pathogenic variants. The herein presented lists of pri-vate variants after filtering against hundreds of control genomes provide no plausible candidate and no shared variants among the two sequenced cases. Therefore, further studies are needed to evaluate possible genetic etiology. In general, systematic surveillance is needed to identify ge-netic defects as early as possible and to avoid the occurrence of losses in the pig population.

Cysts and Pseudocysts of the Oral Cavity: Revision of the Literature and a New Proposed Classification

This article includes a comprehensive and up-to-date review on the cysts of the oral cavity. Several classifications of odontogenic (OC) and non-odontogenic (non-OC) oral cysts and the surrounding regions have been proposed. We suggest a new critical classification based on an established relationship between anatomical area, histological origin and clinical behavior (frequency, rate of recurrence, malignant potential). Moreover, the differential cytokeratin (CKs) expression of the various cysts is reported as epithelium-specific markers of differential diagnosis. Finally, issues related to differential diagnosis and therapeutic approaches of the cysts included in the two groups are described.

Adult Cystic Lymphangioma of the Parotid Gland: An Unwonted Presentation

Cystic lymphangioma of the parotid gland is an uncommon congenital lymphatic malformation. Its occurrence in patients of advanced age is infrequent. Patients usually present with painless soft swelling, often having experienced a long duration of symptoms. Lymphangioma among the salivary glands frequently involves the parotid gland. When evaluating cystic lesions of the parotid gland, cystic lymphangioma should be included in the differential diagnosis in addition to Warthin's tumor, branchial cyst, cystic pleomorphic adenoma, and cystic mucoepidermoid tumor. Ultrasonography (USG) and magnetic resonance imaging (MRI) are useful in diagnosing cystic lymphangioma and help to identify the lesion. Fine needle aspiration cytology (FNAC) may show lymphocytes, salivary epithelial cells, and rarely, endothelial cells. FNAC is often inconclusive; this was the case in our investigation of the cystic lesion presented here of a 50-year-old woman who presented with a slowly growing swelling and a dull aching pain over the right parotid region for the past two years. On examination, there was a non-tender, cystic swelling of 5×5 cm in the right parotid region causing lifting the earlobe. There was no cervical lymphadenopathy or any facial nerve palsy associated with the swelling. USG of the parotid gland revealed a cystic lesion in the superficial lobe of the parotid. Results of FNAC performed on the lesion were inconclusive. The patient was posted for surgery and the cyst was excised. Final histopathology of the lesion gave the diagnosis of cystic lymphangioma of the parotid gland. The patient was kept under follow up for six months to watch for any local recurrence, but none occurred.

Excellent Result With the Use of Single-Dose OK-432 in Cervical Macrocystic Lymphangioma

Though the lymphangioma is a benign neoplasm, it may make an invasion to vital structures by progressively growing. For lymphangioma, which progressed in such a way, surgical treatment has high morbidity and recurrence risk. On these cases, OK-432 is a frequently used sclerotherapy agent. The authors report the result they obtained by the use of single-dose OK-432 on an inoperable pediatric cervical macrocystic lymphangioma case and also their experiences.

Caution is recommended prior to sildenafil use in vascular anomalies

Since publication of a single case report of lymphatic malformation improvement during sildenafil therapy for pulmonary hypertension, sildenafil use has propagated across multiple vascular anomalies diagnoses. Vascular anomalies are rare conditions, often with poor long-term outcomes from available therapies, making these patients vulnerable to novel therapy use. We have retrospectively reviewed 14 children with vascular anomalies treated with sildenafil. None of these patients reported improvement of disease while on treatment and some reported side effects including infections and bleeding. Pending more convincing prospective data, we recommend caution prior to sildenafil use for vascular anomalies.

Case report: cystic hygroma

BACKGROUND

Cystic hygroma (CH) is a congenital malformation of the lymphatic system. It most commonly presents in the neck, and aetiological factors include environmental and genetic factors.

CASE REPORT

A 13-year-old female presented with spontaneous dental pain affecting the maxillary left first and second permanent molar teeth. Medical history revealed a history of left sided cervico-facial-thoracic CH. She was diagnosed with periapical peridontitis and required extraction of both teeth. Clinical management was compromised by the CH involving the left face, neck, ear, tongue, larynx, oropharynx and mediastinum and circling the trachea and great vessels.

TREATMENT

Initial management included the placement of obtundant dressings for teeth number 26 and 27 with resolution of dental pain. Intensive prevention was instigated, and teeth number 16 and 17 were restored with composite resin under local analgesia (LA) without incident. Extraction of teeth number 26 and 27 was complicated by significant trismus and the unacceptably high risk associated with general anaesthesia, due to intubation difficulties. It proved impossible to achieve satisfactory local analgesia. Due to her difficult airway, it was decided to treat the patient with inhalational sedation, but administered in an operating theatre by a consultant anaesthetist, and teeth were extracted using articaine LA.

FOLLOW-UP

The patient coped well with this treatment, and was discharged home on the same day. Two year follow-up with intensive prevention showed improved oral health, with no new carious lesions detected.

CONCLUSION

This is the first report to our knowledge describing dental extractions in the immediate vicinity of a cystic hygroma. A potential management strategy and the difficulties of conventional methods in such patients are discussed.