OK432 (picibanil) efficacy in an adult cervical lymphangioma

Objective:Establish the efficacy of OK432 (picibanil) in an adult cervical lymphangioma clinical case. A lymphangioma is a rare congenital malformation. It is believed to be due to a congenital blockage of the primary lymphatic channels. 90% are located in the cervical region. Although surgical treatment is the most widely accepted, possible injury to vital neck structures, means only 33% can be surgically treated. Relapses have been reported in up to 75% of cases. Methods:Male aged 22 with no history of illness presented a soft asymptomatic depressible mass 7cm x 7 cm, which had grown progressively over the last 4 months. An echography reported a multicystic mass of 9.1x7 cm and a CAT scan reported a polylobulated cystic mass of 9.5x6.8x5 cm. The FNAB determined a serous liquid with mature lymphocytes but without malignant cells. The findings led to a diagnosis of cervical lymphangioma. The patient was informed as to the different therapeutical alternatives available likewise their complications and informed consent was obtained to treat with OK423 according to the Oguita procedure. OK432 (picibanil; Chugay Pharmaceutical Co., Tokyo Japan) is a sclerosant obtained from a lyophilized mixture of Group A haemolytic streptococcus, which after incubation with penicillin G loses its antigenicity and behaves like a sclerosant due to its immunomodulator activity. Although its efficacy in children has been reported little is known in relation to adults. Results: Using local anaesthesia 20 cc of the lymphangioma contents were aspirated and 20 cc of OK432 injected. During immediate post-operation the patient suffered a general syndrome of pain and fever in the cervical area remitting several hours later after iv administration of metamizol. One month after treatment the lymphangioma had totally remitted. Thirteen months later the patient continues free of illness. Conclusion: OK432 (picibanil) was efficient in the regression of an adult cervical lymphangioma.