Diagnostyka naczyniaka limfatycznego oczodołu u dzieci i jego leczenie
Orbital Lymphangioma Diagnostics and Treatment in Children
Barbara Chipczyńska, Mirosława Grałek, Wojciech Hautz, Beata Kocyła-Karczmarewicz
Klinika Okulistyki, Instytut ?Pomnik ? Centrum Zdrowia Dziecka? w Warszawie Kierownik: prof. dr hab. n. med. Mirosława Grałek
Summary: Orbital lymphangioma is a vascular malformation described as hamartoma, combined of venous-lymphatic malformation. It is usually diagnosed in early childhood. In contrast with the benign histology, these lesions have a locally aggressive nature. They are slightly more common in females than in males, with a gender ratio of 1.35:1. The purpose of the study is to present the diagnostics difficulties, clinical course and management of orbital lymphangioma in children. Material and Methods: Ten patients with orbital lymphangioma were observed in The Department of Ophthalmology of the Children?s Memorial Health Institute in the period of time from 1995 to 2008. The clinical findings, imaging diagnostics, biopsy with histopathological examination and treatment were described in this study. The case of a 6.5-years-old girl was described in detail because she demonstrated the most invasive course of the disease. The child was hospitalized due to acute onset of painful proptosis, diplopia, decreased vision, optic disc oedema, and concomitant nausea. Results: Six children were diagnosed with benign form of lymphangioma. Lymphangiomas were localized due to clinical examination and CT/ or MRI in upper -nasal quadrant of anterior part of the orbit. Despite of intermittent disease intensification the children?s health remained stable during the observation period. Children were treated with conservative therapy. Four children with lymphangioma in the middle and posterior part of the orbit underwent open biopsy and histopathological examinations on account of the proliferative disease suspicion. Three of these children required surgical treatment (one of them was operated twice). Conclusions: Lymphangioma diagnosis demands not only clinical examination but also imaging diagnostics and occasionally histopathological verification. The management should be as conservative as possible (bed rest, systemic corticosteroids). Surgery is controversial and decision about surgical treatment requires accurate qualification and adequate surgical methods. There is a risk of serious complications after surgery.
Keywords: lymphangioma, children, clinical findings, proptosis, imaging diagnostics, treatment.