Modern Approaches in Treatment of Lymphatic Malformations in Children

Lymphatic malformations (LMs) represent a prevalent subtype of vascular anomalies associated with significant morbidity in pediatric patients. Clinical manifestations, disease progression, and prognosis correlate with cyst size and anatomical location. However, optimal therapeutic strategies remain incompletely defined. The aim of this study was to analyze the clinical presentation, complications, and treatment outcomes of LMs in children. Methods. This retrospective, non-randomized case series included 259 patients with LMs who underwent hospital treatment at a single center between 2014 and 2024. Results. The majority of patients presented with LMs during the first two years of life (81,5%), and a significant number were diagnosed prenatally (15,83%). Cervicofacial LMs were the most common type (52,51%), with mediastinal involvement observed in 11.9% of cases. Airway obstruction necessitated tracheostomy in 4.2% of patients. Abdominal and retroperitoneal LMs were diagnosed in 43 (19,1%) while external genitalia involvement was noted in 17 (6,56%) patients. Sclerotherapy was the primary treatment for head and neck LMs (117/136 (86,03%)), whereas surgical resection was more frequently employed for abdominal LMs (32/43 (74,42%)) and external genitalia LMs (10/26 (38,46%)). Extremity, axillary, and truncal LMs were predominantly managed with sclerotherapy. Systemic sirolimus therapy was administered in 3.1% of cases (n=8) with complicated LMs, resulting in symptomatic improvement in 78.5% of these patients, though no complete resolutions were achieved. Conclusion. Common LM complications included inflammation and intralesional bleeding with mass effect. Surgical resection proved effective for abdominal and external genitalia LMs but carried potential risks for cervicofacial and limb LMs. mTOR inhibitor therapy demonstrated efficacy in complex cases. A multidisciplinary approach remains essential for LM management, with further refinement of treatment strategies required to optimize outcomes.