A giant fetal lymphangioma of the axilla and the anterolateral thorax: pre- and postnatal aspects

Objective:

A septated fetal lymphangioma takes its origin from the failure of drainage of the lymphatic ducts into the final venous vessels. Its prevalence has been reported to be about 1.1 – 5.3 per 10000 births. The evidence for treatment modalities is low. That is why we report our perinatal Management.

Material and methods:

A 38-year-old woman was presented to our clinic at 28+3 weeks' gestation with a fetal right-sided mass. The mass measuring 10 × 10 cm, filling the right fetal axilla, was subsepted without colour Doppler flow and well-circumscribed borders. A multidisciplinary approach was undertaken. To protect the uterus and prolong the pregnancy we minimized the increasing mass by performing three intrauterine punctions. Directly after the third punction a healthy baby was delivered via cesarean section at 35 weeks' gestation. Five days after the MRI showed a mass of 12 × 7,5 × 17 cm. Day 31 an operative resection of the lymphangioma (20 × 20 × 15 cm) was performed. The histological examinations confirmed the diagnosis of a lymphangioma. The neonate was discharged 5 days later in healthy condition.

Conclusion:

A giant fetal lymphangioma is treatable but requires perioperative planning, multidisciplinary coordination, and careful operative decision-making to ensure optimal safety of mother and fetus. Intrauterine punctions could help to prolong the pregancy.

Abb. 1: Giant fetal lymphangioma of the axilla and the antelateral thorax pre- and postnatal