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Cervicofacial Lymphatic Malformations: A Retrospective Review of 40 Cases

Identifieur interne : 007E50 ( Ncbi/Merge ); précédent : 007E49; suivant : 007E51

Cervicofacial Lymphatic Malformations: A Retrospective Review of 40 Cases

Auteurs : Byung Chae Cho [Corée du Sud] ; Jae Bong Kim [Corée du Sud] ; Jeong Woo Lee [Corée du Sud] ; Kang Young Choi [Corée du Sud] ; Jung Dug Yang [Corée du Sud] ; Seok-Jong Lee [Corée du Sud] ; Yong-Sun Kim [Corée du Sud] ; Jong Min Lee [Corée du Sud] ; Seung Huh [Corée du Sud] ; Ho Yun Chung [Corée du Sud]

Source :

RBID : PMC:4738111

Abstract

Background

Lymphatic malformation (LM) is a form of congenital vascular malformation with a low incidence. Although LM has been studied, no consensus has emerged regarding its cause or treatment.

Methods

In this study, we retrospectively evaluated 40 patients who visited our vascular anomalies center for the treatment of cervicofacial LM, which is a common manifestation of LM. The medical records of patients over a period of 12 years were reviewed and analyzed for commonalities regarding the diagnosis and the results of treatment.

Results

Suspected cervicofacial LM was confirmed through imaging studies. No difference in incidence was observed according to sex, and 73% of patients first presented with symptoms before the age of two years. The left side and the V2–V3 area were most commonly affected. No significant differences in incidence were observed among the macrocystic, microcystic, and combined types of LM. A total of 28 out of 36 patients received sclerotherapy as the first choice of treatment, regardless of the type of lesion. Complete resolution was achieved in only 25% of patients.

Conclusions

LM is important to confirm the diagnosis early and to choose an appropriate treatment strategy according to the stage of the disease and each individual patient's symptoms. When treatment is delayed or an incorrect treatment is administered, patient discomfort increases as the lesion gradually spreads. Therefore, more so than is the case for most other diseases, a team approach on a case-by-case basis is important for the accurate and appropriate treatment of LM.


Url:
DOI: 10.5999/aps.2016.43.1.10
PubMed: 26848440
PubMed Central: 4738111

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PMC:4738111

Le document en format XML

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<title level="j">Archives of Plastic Surgery</title>
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<title>Background</title>
<p>Lymphatic malformation (LM) is a form of congenital vascular malformation with a low incidence. Although LM has been studied, no consensus has emerged regarding its cause or treatment.</p>
</sec>
<sec>
<title>Methods</title>
<p>In this study, we retrospectively evaluated 40 patients who visited our vascular anomalies center for the treatment of cervicofacial LM, which is a common manifestation of LM. The medical records of patients over a period of 12 years were reviewed and analyzed for commonalities regarding the diagnosis and the results of treatment.</p>
</sec>
<sec>
<title>Results</title>
<p>Suspected cervicofacial LM was confirmed through imaging studies. No difference in incidence was observed according to sex, and 73% of patients first presented with symptoms before the age of two years. The left side and the V2–V3 area were most commonly affected. No significant differences in incidence were observed among the macrocystic, microcystic, and combined types of LM. A total of 28 out of 36 patients received sclerotherapy as the first choice of treatment, regardless of the type of lesion. Complete resolution was achieved in only 25% of patients.</p>
</sec>
<sec>
<title>Conclusions</title>
<p>LM is important to confirm the diagnosis early and to choose an appropriate treatment strategy according to the stage of the disease and each individual patient's symptoms. When treatment is delayed or an incorrect treatment is administered, patient discomfort increases as the lesion gradually spreads. Therefore, more so than is the case for most other diseases, a team approach on a case-by-case basis is important for the accurate and appropriate treatment of LM.</p>
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</TEI>
<pmc article-type="research-article">
<pmc-dir>properties open_access</pmc-dir>
<front>
<journal-meta>
<journal-id journal-id-type="nlm-ta">Arch Plast Surg</journal-id>
<journal-id journal-id-type="iso-abbrev">Arch Plast Surg</journal-id>
<journal-id journal-id-type="publisher-id">APS</journal-id>
<journal-title-group>
<journal-title>Archives of Plastic Surgery</journal-title>
</journal-title-group>
<issn pub-type="ppub">2234-6163</issn>
<issn pub-type="epub">2234-6171</issn>
<publisher>
<publisher-name>The Korean Society of Plastic and Reconstructive Surgeons</publisher-name>
</publisher>
</journal-meta>
<article-meta>
<article-id pub-id-type="pmid">26848440</article-id>
<article-id pub-id-type="pmc">4738111</article-id>
<article-id pub-id-type="doi">10.5999/aps.2016.43.1.10</article-id>
<article-categories>
<subj-group subj-group-type="heading">
<subject>Original Article</subject>
</subj-group>
</article-categories>
<title-group>
<article-title>Cervicofacial Lymphatic Malformations: A Retrospective Review of 40 Cases</article-title>
</title-group>
<contrib-group>
<contrib contrib-type="author">
<name>
<surname>Cho</surname>
<given-names>Byung Chae</given-names>
</name>
<xref ref-type="aff" rid="A1">1</xref>
</contrib>
<contrib contrib-type="author">
<name>
<surname>Kim</surname>
<given-names>Jae Bong</given-names>
</name>
<xref ref-type="aff" rid="A1">1</xref>
</contrib>
<contrib contrib-type="author">
<name>
<surname>Lee</surname>
<given-names>Jeong Woo</given-names>
</name>
<xref ref-type="aff" rid="A1">1</xref>
</contrib>
<contrib contrib-type="author">
<name>
<surname>Choi</surname>
<given-names>Kang Young</given-names>
</name>
<xref ref-type="aff" rid="A1">1</xref>
</contrib>
<contrib contrib-type="author">
<name>
<surname>Yang</surname>
<given-names>Jung Dug</given-names>
</name>
<xref ref-type="aff" rid="A1">1</xref>
</contrib>
<contrib contrib-type="author">
<name>
<surname>Lee</surname>
<given-names>Seok-Jong</given-names>
</name>
<xref ref-type="aff" rid="A2">2</xref>
</contrib>
<contrib contrib-type="author">
<name>
<surname>Kim</surname>
<given-names>Yong-Sun</given-names>
</name>
<xref ref-type="aff" rid="A3">3</xref>
</contrib>
<contrib contrib-type="author">
<name>
<surname>Lee</surname>
<given-names>Jong Min</given-names>
</name>
<xref ref-type="aff" rid="A3">3</xref>
</contrib>
<contrib contrib-type="author">
<name>
<surname>Huh</surname>
<given-names>Seung</given-names>
</name>
<xref ref-type="aff" rid="A4">4</xref>
</contrib>
<contrib contrib-type="author" corresp="yes">
<name>
<surname>Chung</surname>
<given-names>Ho Yun</given-names>
</name>
<xref ref-type="aff" rid="A1">1</xref>
</contrib>
</contrib-group>
<aff id="A1">
<label>1</label>
Department of Plastic and Reconstructive Surgery, Kyungpook National University School of Medicine, Daegu, Korea.</aff>
<aff id="A2">
<label>2</label>
Department of Dermatology, Kyungpook National University School of Medicine, Daegu, Korea.</aff>
<aff id="A3">
<label>3</label>
Department of Radiology, Kyungpook National University School of Medicine, Daegu, Korea.</aff>
<aff id="A4">
<label>4</label>
Department of Vascular Surgery, Kyungpook National University School of Medicine, Daegu, Korea.</aff>
<author-notes>
<corresp>Correspondence: Ho Yun Chung. Department of Plastic and Reconstructive Surgery, Kyungpook National University School of Medicine, 130 Dongdeok-ro, Jung-gu, Daegu 41944, Korea. Tel: +82-53-420-5692, Fax: +82-53-425-3879,
<email>hy-chung@knu.ac.kr</email>
</corresp>
</author-notes>
<pub-date pub-type="ppub">
<month>1</month>
<year>2016</year>
</pub-date>
<pub-date pub-type="epub">
<day>15</day>
<month>1</month>
<year>2016</year>
</pub-date>
<volume>43</volume>
<issue>1</issue>
<fpage>10</fpage>
<lpage>18</lpage>
<history>
<date date-type="received">
<day>12</day>
<month>8</month>
<year>2015</year>
</date>
<date date-type="rev-recd">
<day>15</day>
<month>12</month>
<year>2015</year>
</date>
<date date-type="accepted">
<day>15</day>
<month>12</month>
<year>2015</year>
</date>
</history>
<permissions>
<copyright-statement>Copyright © 2016 The Korean Society of Plastic and Reconstructive Surgeons</copyright-statement>
<copyright-year>2016</copyright-year>
<license license-type="open-access" xlink:href="http://creativecommons.org/licenses/by-nc/3.0/">
<license-p>This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (
<ext-link ext-link-type="uri" xlink:href="http://creativecommons.org/licenses/by-nc/3.0/">http://creativecommons.org/licenses/by-nc/3.0/</ext-link>
), which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.</license-p>
</license>
</permissions>
<abstract>
<sec>
<title>Background</title>
<p>Lymphatic malformation (LM) is a form of congenital vascular malformation with a low incidence. Although LM has been studied, no consensus has emerged regarding its cause or treatment.</p>
</sec>
<sec>
<title>Methods</title>
<p>In this study, we retrospectively evaluated 40 patients who visited our vascular anomalies center for the treatment of cervicofacial LM, which is a common manifestation of LM. The medical records of patients over a period of 12 years were reviewed and analyzed for commonalities regarding the diagnosis and the results of treatment.</p>
</sec>
<sec>
<title>Results</title>
<p>Suspected cervicofacial LM was confirmed through imaging studies. No difference in incidence was observed according to sex, and 73% of patients first presented with symptoms before the age of two years. The left side and the V2–V3 area were most commonly affected. No significant differences in incidence were observed among the macrocystic, microcystic, and combined types of LM. A total of 28 out of 36 patients received sclerotherapy as the first choice of treatment, regardless of the type of lesion. Complete resolution was achieved in only 25% of patients.</p>
</sec>
<sec>
<title>Conclusions</title>
<p>LM is important to confirm the diagnosis early and to choose an appropriate treatment strategy according to the stage of the disease and each individual patient's symptoms. When treatment is delayed or an incorrect treatment is administered, patient discomfort increases as the lesion gradually spreads. Therefore, more so than is the case for most other diseases, a team approach on a case-by-case basis is important for the accurate and appropriate treatment of LM.</p>
</sec>
</abstract>
<kwd-group>
<kwd>Lymphatic abnormalities</kwd>
<kwd>Lymphangioma</kwd>
<kwd>Sclerotherapy</kwd>
</kwd-group>
<funding-group>
<award-group>
<funding-source country="KR">
<institution-wrap>
<institution>National Research Foundation of Korea</institution>
<institution-id institution-id-type="CrossRef">http://dx.doi.org/10.13039/501100003725</institution-id>
</institution-wrap>
</funding-source>
<award-id>NRF-2014R1A1A4A01009584</award-id>
</award-group>
<award-group>
<funding-source country="KR">
<institution-wrap>
<institution>Kyungpook National University</institution>
<institution-id institution-id-type="CrossRef">http://dx.doi.org/10.13039/501100002531</institution-id>
</institution-wrap>
</funding-source>
</award-group>
</funding-group>
</article-meta>
</front>
<floats-group>
<fig id="F1" orientation="portrait" position="float">
<label>Fig. 1</label>
<caption>
<title>Type of cervicofacial lymphatic malformation</title>
<p>Types of cervicofacial lymphatic malformations, with no significant differences observed according to type.</p>
</caption>
<graphic xlink:href="aps-43-10-g001"></graphic>
</fig>
<fig id="F2" orientation="portrait" position="float">
<label>Fig. 2</label>
<caption>
<title>Distribution of cervicofacial lymphatic malformations</title>
<p>The left side and the V2–V3 areas were the predominant regions.</p>
</caption>
<graphic xlink:href="aps-43-10-g002"></graphic>
</fig>
<fig id="F3" orientation="portrait" position="float">
<label>Fig. 3</label>
<caption>
<title>Location of cervicofacial lymphatic malformations</title>
<p>The areas with the most lesions were the cheek (19 patients), mandible (13 patients), and neck (10 patients).</p>
</caption>
<graphic xlink:href="aps-43-10-g003"></graphic>
</fig>
<fig id="F4" orientation="portrait" position="float">
<label>Fig. 4</label>
<caption>
<title>A case of cervicofacial lymphatic malformation</title>
<p>(A) A pre-treatment photo of a child with LM, showing swelling in the upper lip and eyelid area. (B) Pre-treatment MRI, T2 phase, with the orange arrows indicating the high signal intensity of the LM lesion. (C) Pre-treatment D-USG image, where the red circle indicates a combined-type LM lesion. (D) Photo of the patient at four years of age, showing aggravated swelling, pain, and symptoms. (E) Post-sclerotherapy D-USG image, where the red circle indicates a sprouting LM channel. (F) Sclerotherapy procedure using bleomycin. LM, lymphatic formation; MRI, magnetic resonance imaging; D-USG, Doppler ultrasonography.</p>
</caption>
<graphic xlink:href="aps-43-10-g004"></graphic>
</fig>
<fig id="F5" orientation="portrait" position="float">
<label>Fig. 5</label>
<caption>
<title>A case of cervicofacial lymphatic malformation</title>
<p>(A) A pre-treatment photo of a child with LM who presented with swelling on the left cheek. (B) Pre-treatment MRI, T2 phase, with the orange arrow indicating the high signal intensity of the combined-type LM lesion. (C) Pre-treatment D-USG image, where the red circle indicates the combined-type LM lesion. (D) Postoperation MRI, T2 phase, where the orange arrow indicates the high signal intensity of the microcystic LM lesion. (E) Postoperation D-USG image, where the red circle indicates the remnant microcystic LM lesion. (F) Photo of the patient at seven years of age; after resection, the macrocystic LM improved, but the microcystic LM remained present. LM, lymphatic formation; MRI, magnetic resonance imaging; D-USG, Doppler ultrasonography.</p>
</caption>
<graphic xlink:href="aps-43-10-g005"></graphic>
</fig>
<fig id="F6" orientation="portrait" position="float">
<label>Fig. 6</label>
<caption>
<title>A case of cervicofacial lymphatic malformation</title>
<p>(A) A pre-treatment photo of a woman with LM who experienced swelling on the right cheek. (B) Pre-treatment MRI, T2 phase, with the orange arrow indicating the high signal intensity of the microcystic LM lesion. (C) Pre-treatment D-USG image, where the green box indicates the microcystic LM lesion. (D) A post-sclerotherapy photo showing that the LM had completely improved. (E) A post-sclerotherapy D-USG image, where the green box shows that almost the entire LM lesion had been removed. LM, lymphatic formation; MRI, magnetic resonance imaging; D-USG, Doppler ultrasonography.</p>
</caption>
<graphic xlink:href="aps-43-10-g006"></graphic>
</fig>
<table-wrap id="T1" orientation="portrait" position="float">
<label>Table 1</label>
<caption>
<title>Treatment methods and outcomes of cervicofacial lymphatic malformations according to type (n=40)</title>
</caption>
<alternatives>
<graphic xlink:href="aps-43-10-i001"></graphic>
<table frame="hsides" rules="rows">
<thead>
<tr>
<th valign="middle" align="left" rowspan="1" colspan="1">Type</th>
<th valign="middle" align="center" rowspan="1" colspan="2">Treatment</th>
<th valign="middle" align="center" rowspan="1" colspan="1">Partially improved</th>
<th valign="middle" align="center" rowspan="1" colspan="1">Improved</th>
<th valign="middle" align="center" rowspan="1" colspan="1">Completely improved</th>
<th valign="middle" align="center" rowspan="1" colspan="1">Aggravated</th>
<th valign="middle" align="center" rowspan="1" colspan="1"></th>
<th valign="middle" align="center" rowspan="1" colspan="1">Total</th>
</tr>
</thead>
<tbody>
<tr>
<td valign="top" align="left" rowspan="9" colspan="1">Macrocystic</td>
<td valign="top" align="left" rowspan="1" colspan="1">Passive observation</td>
<td valign="top" align="left" rowspan="1" colspan="1"></td>
<td valign="top" align="center" rowspan="1" colspan="1">0</td>
<td valign="top" align="center" rowspan="1" colspan="1">0</td>
<td valign="top" align="center" rowspan="1" colspan="1">1</td>
<td valign="top" align="center" rowspan="1" colspan="1">0</td>
<td valign="top" align="left" rowspan="1" colspan="1">1</td>
<td valign="top" align="center" rowspan="9" colspan="1">12+1 loss to follow-up</td>
</tr>
<tr>
<td valign="top" align="left" rowspan="1" colspan="1">Sclerotherapy</td>
<td valign="top" align="left" rowspan="1" colspan="1"></td>
<td valign="top" align="center" rowspan="1" colspan="1">0</td>
<td valign="top" align="center" rowspan="1" colspan="1">1</td>
<td valign="top" align="center" rowspan="1" colspan="1">1</td>
<td valign="top" align="center" rowspan="1" colspan="1">0</td>
<td valign="top" align="left" rowspan="1" colspan="1">2</td>
</tr>
<tr>
<td valign="top" align="left" rowspan="1" colspan="1">Sclerotherapy</td>
<td valign="top" align="left" rowspan="1" colspan="1">Sclerotherapy</td>
<td valign="top" align="center" rowspan="1" colspan="1">0</td>
<td valign="top" align="center" rowspan="1" colspan="1">2</td>
<td valign="top" align="center" rowspan="1" colspan="1">1</td>
<td valign="top" align="center" rowspan="1" colspan="1">1</td>
<td valign="top" align="left" rowspan="1" colspan="1">4</td>
</tr>
<tr>
<td valign="top" align="left" rowspan="1" colspan="1"></td>
<td valign="top" align="left" rowspan="1" colspan="1">OP</td>
<td valign="top" align="center" rowspan="1" colspan="1">0</td>
<td valign="top" align="center" rowspan="1" colspan="1">0</td>
<td valign="top" align="center" rowspan="1" colspan="1">0</td>
<td valign="top" align="center" rowspan="1" colspan="1">0</td>
<td valign="top" align="left" rowspan="1" colspan="1">0</td>
</tr>
<tr>
<td valign="top" align="left" rowspan="1" colspan="1">OP</td>
<td valign="top" align="left" rowspan="1" colspan="1"></td>
<td valign="top" align="center" rowspan="1" colspan="1">0</td>
<td valign="top" align="center" rowspan="1" colspan="1">0</td>
<td valign="top" align="center" rowspan="1" colspan="1">1</td>
<td valign="top" align="center" rowspan="1" colspan="1">0</td>
<td valign="top" align="left" rowspan="1" colspan="1">1</td>
</tr>
<tr>
<td valign="top" align="left" rowspan="1" colspan="1">OP</td>
<td valign="top" align="left" rowspan="1" colspan="1">OP</td>
<td valign="top" align="center" rowspan="1" colspan="1">1</td>
<td valign="top" align="center" rowspan="1" colspan="1">0</td>
<td valign="top" align="center" rowspan="1" colspan="1">0</td>
<td valign="top" align="center" rowspan="1" colspan="1">0</td>
<td valign="top" align="left" rowspan="1" colspan="1">1</td>
</tr>
<tr>
<td valign="top" align="left" rowspan="1" colspan="1"></td>
<td valign="top" align="left" rowspan="1" colspan="1">Sclerotherapy</td>
<td valign="top" align="center" rowspan="1" colspan="1">1</td>
<td valign="top" align="center" rowspan="1" colspan="1">1</td>
<td valign="top" align="center" rowspan="1" colspan="1">0</td>
<td valign="top" align="center" rowspan="1" colspan="1">0</td>
<td valign="top" align="left" rowspan="1" colspan="1">2</td>
</tr>
<tr>
<td valign="top" align="left" rowspan="1" colspan="1">CO
<sub>2</sub>
laser ablation</td>
<td valign="top" align="left" rowspan="1" colspan="1"></td>
<td valign="top" align="center" rowspan="1" colspan="1">1</td>
<td valign="top" align="center" rowspan="1" colspan="1">0</td>
<td valign="top" align="center" rowspan="1" colspan="1">0</td>
<td valign="top" align="center" rowspan="1" colspan="1">0</td>
<td valign="top" align="left" rowspan="1" colspan="1">1</td>
</tr>
<tr>
<td valign="top" align="left" rowspan="1" colspan="1">CO
<sub>2</sub>
laser ablation</td>
<td valign="top" align="left" rowspan="1" colspan="1">Sclerotherapy</td>
<td valign="top" align="center" rowspan="1" colspan="1">0</td>
<td valign="top" align="center" rowspan="1" colspan="1">0</td>
<td valign="top" align="center" rowspan="1" colspan="1">0</td>
<td valign="top" align="center" rowspan="1" colspan="1">0</td>
<td valign="top" align="left" rowspan="1" colspan="1">0</td>
</tr>
<tr>
<td valign="top" align="left" rowspan="8" colspan="1">Microcystic</td>
<td valign="top" align="left" rowspan="1" colspan="1">Sclerotherapy</td>
<td valign="top" align="left" rowspan="1" colspan="1"></td>
<td valign="top" align="center" rowspan="1" colspan="1">0</td>
<td valign="top" align="center" rowspan="1" colspan="1">2</td>
<td valign="top" align="center" rowspan="1" colspan="1">0</td>
<td valign="top" align="center" rowspan="1" colspan="1">0</td>
<td valign="top" align="left" rowspan="1" colspan="1">2</td>
<td valign="top" align="center" rowspan="8" colspan="1">13+1 loss to follow-up</td>
</tr>
<tr>
<td valign="top" align="left" rowspan="1" colspan="1">Sclerotherapy</td>
<td valign="top" align="left" rowspan="1" colspan="1">Sclerotherapy</td>
<td valign="top" align="center" rowspan="1" colspan="1">0</td>
<td valign="top" align="center" rowspan="1" colspan="1">3</td>
<td valign="top" align="center" rowspan="1" colspan="1">0</td>
<td valign="top" align="center" rowspan="1" colspan="1">0</td>
<td valign="top" align="left" rowspan="1" colspan="1">3</td>
</tr>
<tr>
<td valign="top" align="left" rowspan="1" colspan="1"></td>
<td valign="top" align="left" rowspan="1" colspan="1">OP</td>
<td valign="top" align="center" rowspan="1" colspan="1">1</td>
<td valign="top" align="center" rowspan="1" colspan="1">0</td>
<td valign="top" align="center" rowspan="1" colspan="1">0</td>
<td valign="top" align="center" rowspan="1" colspan="1">0</td>
<td valign="top" align="left" rowspan="1" colspan="1">1</td>
</tr>
<tr>
<td valign="top" align="left" rowspan="1" colspan="1">OP</td>
<td valign="top" align="left" rowspan="1" colspan="1"></td>
<td valign="top" align="center" rowspan="1" colspan="1">0</td>
<td valign="top" align="center" rowspan="1" colspan="1">0</td>
<td valign="top" align="center" rowspan="1" colspan="1">2</td>
<td valign="top" align="center" rowspan="1" colspan="1">0</td>
<td valign="top" align="left" rowspan="1" colspan="1">2</td>
</tr>
<tr>
<td valign="top" align="left" rowspan="1" colspan="1">OP</td>
<td valign="top" align="left" rowspan="1" colspan="1">OP</td>
<td valign="top" align="center" rowspan="1" colspan="1">1</td>
<td valign="top" align="center" rowspan="1" colspan="1">1</td>
<td valign="top" align="center" rowspan="1" colspan="1">0</td>
<td valign="top" align="center" rowspan="1" colspan="1">1</td>
<td valign="top" align="left" rowspan="1" colspan="1">3</td>
</tr>
<tr>
<td valign="top" align="left" rowspan="1" colspan="1"></td>
<td valign="top" align="left" rowspan="1" colspan="1">Sclerotherapy</td>
<td valign="top" align="center" rowspan="1" colspan="1">0</td>
<td valign="top" align="center" rowspan="1" colspan="1">0</td>
<td valign="top" align="center" rowspan="1" colspan="1">0</td>
<td valign="top" align="center" rowspan="1" colspan="1">0</td>
<td valign="top" align="left" rowspan="1" colspan="1">0</td>
</tr>
<tr>
<td valign="top" align="left" rowspan="1" colspan="1">CO
<sub>2</sub>
laser ablation</td>
<td valign="top" align="left" rowspan="1" colspan="1"></td>
<td valign="top" align="center" rowspan="1" colspan="1">0</td>
<td valign="top" align="center" rowspan="1" colspan="1">0</td>
<td valign="top" align="center" rowspan="1" colspan="1">1</td>
<td valign="top" align="center" rowspan="1" colspan="1">0</td>
<td valign="top" align="left" rowspan="1" colspan="1">1</td>
</tr>
<tr>
<td valign="top" align="left" rowspan="1" colspan="1">CO
<sub>2</sub>
laser ablation</td>
<td valign="top" align="left" rowspan="1" colspan="1">Sclerotherapy</td>
<td valign="top" align="center" rowspan="1" colspan="1">1</td>
<td valign="top" align="center" rowspan="1" colspan="1">0</td>
<td valign="top" align="center" rowspan="1" colspan="1">0</td>
<td valign="top" align="center" rowspan="1" colspan="1">0</td>
<td valign="top" align="left" rowspan="1" colspan="1">1</td>
</tr>
<tr>
<td valign="top" align="left" rowspan="9" colspan="1">Combined</td>
<td valign="top" align="left" rowspan="1" colspan="1">Passive observation</td>
<td valign="top" align="left" rowspan="1" colspan="1"></td>
<td valign="top" align="center" rowspan="1" colspan="1">0</td>
<td valign="top" align="center" rowspan="1" colspan="1">0</td>
<td valign="top" align="center" rowspan="1" colspan="1">1</td>
<td valign="top" align="center" rowspan="1" colspan="1">0</td>
<td valign="top" align="left" rowspan="1" colspan="1">1</td>
<td valign="top" align="center" rowspan="9" colspan="1">11+2 lost to follow-up</td>
</tr>
<tr>
<td valign="top" align="left" rowspan="1" colspan="1">Sclerotherapy</td>
<td valign="top" align="left" rowspan="1" colspan="1"></td>
<td valign="top" align="center" rowspan="1" colspan="1">0</td>
<td valign="top" align="center" rowspan="1" colspan="1">2</td>
<td valign="top" align="center" rowspan="1" colspan="1">0</td>
<td valign="top" align="center" rowspan="1" colspan="1">1</td>
<td valign="top" align="left" rowspan="1" colspan="1">3</td>
</tr>
<tr>
<td valign="top" align="left" rowspan="1" colspan="1">Sclerotherapy</td>
<td valign="top" align="left" rowspan="1" colspan="1">Sclerotherapy</td>
<td valign="top" align="center" rowspan="1" colspan="1">0</td>
<td valign="top" align="center" rowspan="1" colspan="1">1</td>
<td valign="top" align="center" rowspan="1" colspan="1">1</td>
<td valign="top" align="center" rowspan="1" colspan="1">2</td>
<td valign="top" align="left" rowspan="1" colspan="1">4</td>
</tr>
<tr>
<td valign="top" align="left" rowspan="1" colspan="1"></td>
<td valign="top" align="left" rowspan="1" colspan="1">OP</td>
<td valign="top" align="center" rowspan="1" colspan="1">0</td>
<td valign="top" align="center" rowspan="1" colspan="1">0</td>
<td valign="top" align="center" rowspan="1" colspan="1">0</td>
<td valign="top" align="center" rowspan="1" colspan="1">0</td>
<td valign="top" align="left" rowspan="1" colspan="1">0</td>
</tr>
<tr>
<td valign="top" align="left" rowspan="1" colspan="1">OP</td>
<td valign="top" align="left" rowspan="1" colspan="1"></td>
<td valign="top" align="center" rowspan="1" colspan="1">0</td>
<td valign="top" align="center" rowspan="1" colspan="1">0</td>
<td valign="top" align="center" rowspan="1" colspan="1">0</td>
<td valign="top" align="center" rowspan="1" colspan="1">0</td>
<td valign="top" align="left" rowspan="1" colspan="1">0</td>
</tr>
<tr>
<td valign="top" align="left" rowspan="1" colspan="1">OP</td>
<td valign="top" align="left" rowspan="1" colspan="1">OP</td>
<td valign="top" align="center" rowspan="1" colspan="1">0</td>
<td valign="top" align="center" rowspan="1" colspan="1">1</td>
<td valign="top" align="center" rowspan="1" colspan="1">0</td>
<td valign="top" align="center" rowspan="1" colspan="1">0</td>
<td valign="top" align="left" rowspan="1" colspan="1">1</td>
</tr>
<tr>
<td valign="top" align="left" rowspan="1" colspan="1"></td>
<td valign="top" align="left" rowspan="1" colspan="1">Sclerotherapy</td>
<td valign="top" align="center" rowspan="1" colspan="1">0</td>
<td valign="top" align="center" rowspan="1" colspan="1">1</td>
<td valign="top" align="center" rowspan="1" colspan="1">0</td>
<td valign="top" align="center" rowspan="1" colspan="1">1</td>
<td valign="top" align="left" rowspan="1" colspan="1">2</td>
</tr>
<tr>
<td valign="top" align="left" rowspan="1" colspan="1">CO
<sub>2</sub>
laser ablation</td>
<td valign="top" align="left" rowspan="1" colspan="1"></td>
<td valign="top" align="center" rowspan="1" colspan="1">0</td>
<td valign="top" align="center" rowspan="1" colspan="1">0</td>
<td valign="top" align="center" rowspan="1" colspan="1">0</td>
<td valign="top" align="center" rowspan="1" colspan="1">0</td>
<td valign="top" align="left" rowspan="1" colspan="1">0</td>
</tr>
<tr>
<td valign="top" align="left" rowspan="1" colspan="1">CO
<sub>2</sub>
laser ablation</td>
<td valign="top" align="left" rowspan="1" colspan="1">Sclerotherapy</td>
<td valign="top" align="center" rowspan="1" colspan="1">0</td>
<td valign="top" align="center" rowspan="1" colspan="1">0</td>
<td valign="top" align="center" rowspan="1" colspan="1">0</td>
<td valign="top" align="center" rowspan="1" colspan="1">0</td>
<td valign="top" align="left" rowspan="1" colspan="1">0</td>
</tr>
<tr>
<td valign="top" align="left" rowspan="1" colspan="1">Total</td>
<td valign="top" align="left" rowspan="1" colspan="1"></td>
<td valign="top" align="left" rowspan="1" colspan="1"></td>
<td valign="top" align="center" rowspan="1" colspan="1">6</td>
<td valign="top" align="center" rowspan="1" colspan="1">15</td>
<td valign="top" align="center" rowspan="1" colspan="1">9</td>
<td valign="top" align="center" rowspan="1" colspan="1">6</td>
<td valign="top" align="left" rowspan="1" colspan="1">36</td>
<td valign="top" align="left" rowspan="1" colspan="1">40 (including those lost to follow-up)</td>
</tr>
</tbody>
</table>
</alternatives>
<table-wrap-foot>
<fn>
<p>OP, operation (surgical resection).</p>
</fn>
</table-wrap-foot>
</table-wrap>
</floats-group>
</pmc>
<affiliations>
<list>
<country>
<li>Corée du Sud</li>
</country>
</list>
<tree>
<country name="Corée du Sud">
<noRegion>
<name sortKey="Cho, Byung Chae" sort="Cho, Byung Chae" uniqKey="Cho B" first="Byung Chae" last="Cho">Byung Chae Cho</name>
</noRegion>
<name sortKey="Choi, Kang Young" sort="Choi, Kang Young" uniqKey="Choi K" first="Kang Young" last="Choi">Kang Young Choi</name>
<name sortKey="Chung, Ho Yun" sort="Chung, Ho Yun" uniqKey="Chung H" first="Ho Yun" last="Chung">Ho Yun Chung</name>
<name sortKey="Huh, Seung" sort="Huh, Seung" uniqKey="Huh S" first="Seung" last="Huh">Seung Huh</name>
<name sortKey="Kim, Jae Bong" sort="Kim, Jae Bong" uniqKey="Kim J" first="Jae Bong" last="Kim">Jae Bong Kim</name>
<name sortKey="Kim, Yong Sun" sort="Kim, Yong Sun" uniqKey="Kim Y" first="Yong-Sun" last="Kim">Yong-Sun Kim</name>
<name sortKey="Lee, Jeong Woo" sort="Lee, Jeong Woo" uniqKey="Lee J" first="Jeong Woo" last="Lee">Jeong Woo Lee</name>
<name sortKey="Lee, Jong Min" sort="Lee, Jong Min" uniqKey="Lee J" first="Jong Min" last="Lee">Jong Min Lee</name>
<name sortKey="Lee, Seok Jong" sort="Lee, Seok Jong" uniqKey="Lee S" first="Seok-Jong" last="Lee">Seok-Jong Lee</name>
<name sortKey="Yang, Jung Dug" sort="Yang, Jung Dug" uniqKey="Yang J" first="Jung Dug" last="Yang">Jung Dug Yang</name>
</country>
</tree>
</affiliations>
</record>

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