Cystic hygroma of the neck: association with a growing venous aneurysm.

Venous anomalies are rarely seen with cystic hygromas. We describe an unusual case of cystic hygroma of the neck associated with a saccular venous aneurysm that was increasing in size. A multi-modality examination of the neck-including CT, Doppler sonography, and MR imaging-revealed multiloculated cystic lesions bilaterally with predominance on the left side. A saccular venous aneurysm was noted within one of the sacs. Comparison with previous CT images showed that the aneurysm enlarged from 0.8 x 0.5 x 1.5 cm to 3.0 x 1.3 x 2.1 cm over 2 years. Identification of these malformations before surgery is critical.

High angiogenic activity in cells isolated from cystic hygroma: role of bFGF.

BACKGROUND: Cystic hygromas are characterized by a proliferation of small vessels and lymphatics with intervening fibrous tissue. Studies have shown malignant tumors and some benign neoplasms are dependent on angiogenesis, the induction of new capillaries from preexisting vessels. Growth and progression of these tumors are associated with a disturbance in the balance of angiogenic inducers and inhibitors. We have postulated that cells derived from cystic hygromas are angiogenic due to secretion of higher levels of angiogenic inducers that promote vascular proliferation. DESIGN: A large cystic mass was surgically removed and a portion of the sterile tumor was immediately placed in the medium. The tissue was minced, washed in phosphate-buffered saline, and grown to near confluence. Conditioned medium was collected under serum-free conditions after 48 hours. Secreted proteins were concentrated, quantitated, and analyzed in an in vitro endothelial cell migration assay and by Western blot. Antibody to factor VIII-related antigen was performed to confirm endothelial cell origin of the cultured cells. MAIN OUTCOME MEASURES: In vitro angiogenic activity of secreted proteins in a capillary endothelial migration assay was tested by using blocking antibodies to angiogenic inducer, basic fibroblast growth factor, and angiogenic inhibitor, thrombospondin-1. Total protein levels of thrombospondin-1 were determined by Western blot. RESULTS: Cells isolated from cystic hygroma are angiogenic in vitro and this angiogenic activity is due to secretion of high levels of angiogenic inducer, basic fibroblast growth factor, and lower levels of naturally occurring angiogenic inhibitor, thrombospondin-1. CONCLUSIONS: Cystic hygromas may represent another neoplasm dependent on angiogenesis. The angiogenic activity is due in part to elevated levels of potent angiogenic inducer, basic fibroblast growth factor. Antiangiogenic therapy directed at the endothelial cell may help suppress the growth of cystic hygromas.

Colour-flow Doppler artifacts in anechoic soft-tissue masses of infants.

Colour-flow Doppler imaging is a noninvasive, readily accessible method of assessing the vascularity of soft-tissue masses. To produce acceptable images of flowing blood, various types of signal processing are needed to suppress the colour in moving but nonvascular masses. The author describes two infants with anechoic soft-tissue masses; both masses demonstrated colour flow. One patient had a vascular hemangioma, in which the colour was due to blood flow; the other had a nonvascular lymphangioma, in which the colour was caused by persistent movement between the transducer and the leg being scanned. Artifacts such as that observed in the lymphangioma may be misinterpreted as flow, unless Doppler spectral analysis is employed. Differentiation between vascular and nonvascular soft-tissue masses before surgical excision is important.