Giacomini P G, De Angelis E, Russo S
Clinica ORL, Università Tor Vergata di Roma.
Acta Otorhinolaryngol Ital. 1998 Feb;18(1):34-7.
Lymphangioma in the adult is quite rare: the most common localization in the head and neck region is at the posterior triangle of the cervical lateral region (75%). Moreover, it favors the right latero-cervical area (72%) thus supporting a disembryogenetic pathogenesis. Indeed, according to Dowd and Goetsch, the lymphatic tissues are rearranged in this area, creating the principle head and neck drainage. The presence of disembryogenetic alterations in the lymphatic architecture could go on unnoticed until the lymphatic circulation equilibrium is altered by some anatomo-functional event compromising the involved area.
G.P., a 41-year-old male, presented a swelling in the right submandibular region since approximately 4 months and which had increased in size over the last 30 days. The case history revealed that, at the age of 18 he had been admitted to the hospital for surgical removal of an angiomatose phlegmonous neoformation while, at the age of 18 38, he had undergone surgery for a lipoma in the right temporo-zigomatic area. Head and neck CT using a contrast medium revealed a formation of mixed density, predominantly liquid, apparently multiloculated. The patient underwent surgery, via a right submandibular cervicotomy approach, to remove the cystic neoformation and attached submandibular gland. In addition, the plurilobate mass showed submentonier, parapharyngeal, subdigastric and subhyoid extensions. Histology led to a diagnosis of "cystic lymphangioma". The clinical case reported is quite unusual in that:--the submandibular (anterior triangle) location is rare, accounting for only 6.25% of the cervical manifestations;--the previous case history of this patient underlines the importance of an embryogenic alteration in the regional lymph network;--this condition, clinically manifest in infancy as a submandibular (angiomatose) phlegmon became latent in adulthood after surgery for right temporo-zigomatic lipoma. In light of the above data, it can be hypothesized that a disembryogenetic origin of the adult lymphangioma, associated with a predisposition (scarred areas further compromising the lymph vessel architecture) and some precipitating event (surgical trauma in adulthood), have lead to delayed development of the amartoma.
成人淋巴管瘤相当罕见：头颈部最常见的部位是颈外侧区的后三角（75%）。此外，它更倾向于右侧颈外侧区（72%），从而支持发育异常的发病机制。事实上，根据多德和戈奇的说法，淋巴组织在该区域重新排列，形成了主要的头颈部引流。淋巴结构中发育异常改变的存在可能一直未被注意到，直到淋巴循环平衡因某些影响受累区域的解剖功能事件而改变。
G.P.，一名41岁男性，大约4个月以来右侧下颌下区出现肿胀，且在过去30天内肿大。病史显示，他18岁时因手术切除一个血管性脓性新生物而入院，38岁时因右侧颞颧部脂肪瘤接受手术。使用造影剂的头颈部CT显示一个混合密度的肿物，主要为液性，明显呈多房性。患者通过右侧下颌下颈部切开术进行手术，以切除囊性新生物及附着的下颌下腺。此外，多叶状肿物显示颏下、咽旁、二腹肌下和舌骨下延伸。组织学诊断为“囊性淋巴管瘤”。所报告的临床病例相当不寻常，原因如下：——下颌下（前三角）部位罕见，仅占颈部表现的6.25%；——该患者之前的病史强调了区域淋巴网络中胚胎发育改变的重要性；——这种情况在婴儿期表现为下颌下（血管性）蜂窝织炎，在右侧颞颧部脂肪瘤手术后成年期潜伏。根据上述数据，可以推测成人淋巴管瘤的发育异常起源，与易感性（瘢痕区域进一步损害淋巴管结构）和一些促发事件（成年期手术创伤）相关，导致错构瘤延迟发展。
