Well let’s talk for a few moments about
congenital malformations of the lymph system.
They’re very rare. Very, very rare. And
almost always seen in childhood and almost
always taken care of in childhood. So adult
physicians almost never see this except in
a very, very rare circumstance.
You can have obstruction of some of the primitive
lymph vessels during embryonic life. And what
this does is it produces an abnormal lymphatic
system with almost what looks like a cyst
as you can see on this child’s neck: a collection
It’s more commonly seen in the head and
neck and the armpit. And it is almost always
taken care of surgically. These are removed
and they’re benign. They’re not cancerous.
Sometimes you’ll see little small ones inside
the mouth, in the oral cavity. And sometimes
they’ll look a little bit like frogs’
eggs, little tiny translucent bubbles, little
cysts usually less than 2 cm across. They’ve
been called frogs’ eggs or rice pudding.
They can also be seen in the neck and just
below the jaw. And here you see a picture
of an infant with one that’s quite substantial.
And again, these are often taken care of surgically
in early childhood. And they almost never
are seen in adults.
There was a time when people tried various
drugs squirting alcohol or one of the chemotherapeutic
agents bleomycin or doxycycline – one of
the relatives of tetracycline antibiotic – into
them. But usually that doesn’t work. If
you have a very small one, yes it might work
in that. If they become infected, of course,
you’re going to use antibiotics. But usually
surgical excision is the mainstay of therapy
for these. And they’re not neoplastic. They
are not cancer. They do not metastasize and
they’re not life threatening. They’re
usually cosmetic although sometimes, if they’re
large enough, they can interfere with normal
The peripheral lymphatic malformations outside
of the head and neck require some surgical
intervention or they can be dealt with with
laser. If they’re very small, sometimes
just a compressive stocking or an elastic
bandage can control a very localized one.
But, usually, they’re obliterated with laser
or they’re resected surgically.
The ones that are the most trouble – you
saw in the picture of the infant already – are
ones that are in the head and neck.
Well, let’s talk about edema that develops
not because of an abnormality in the lymphatic