Kolkata: What began as a slowly growing swelling on the right side of a
66-year-old man's neck eventually developed into a rare, giant tumour that
threatened to compress his airway and some of the neck's most critical blood
vessels and nerves. In a highly complex surgery, doctors at Manipal Hospital
Broadway successfully removed the massive 10 × 10 × 10 cm lymphangioma—a
rare benign malformation of the lymphatic system, while carefully preserving
the carotid artery, internal jugular vein and vagus nerve. The intricate
procedure not only eliminated the tumour completely but also helped the patient
recover without any post-operative complications.
The patient was admitted on 2
July with a swelling on the right side of his neck that had been gradually
increasing in size for nearly one and a half years. Over the previous few
months, the swelling had grown rapidly. A contrast-enhanced CT scan, conducted
on 23 May, revealed a large 10 × 10 × 10 cm fluid-filled mass in
the neck. The tumour was located very close to the right common carotid artery
and the thyroid gland, while also pressing against the internal jugular vein
and pushing the windpipe and voice box slightly to the left. These findings raised
concerns that the swelling could affect the patient's breathing if left
untreated. Based on the scan, doctors suspected it to be a lymphangioma,
a rare benign malformation of the lymphatic system.
Following a comprehensive
pre-anaesthetic evaluation, the patient underwent complete surgical excision of
the tumour under the leadership of Dr. Kaushik Das, Senior Consultant – ENT,
Head & Neck Surgeon, Manipal Hospital Broaway, along with Dr. Ushirin Bose,Consultant -ENT ,Head &Neck Surgeon ,Manipal Hospitals .The
anaesthesia team was led by Dr. Tushar Kanti Ghosh, Senior Anaesthesiologist.
During the surgery, doctors found
a large, multi-chambered fluid-filled mass wrapped around some of the neck's
most important structures, including the carotid artery (the main artery
supplying blood to the brain), the internal jugular vein and the vagus nerve.
The surgery was particularly challenging because these vital structures had to
be carefully separated from the tumour without causing any damage. The surgical
team successfully removed the entire mass while preserving these critical blood
vessels and nerves. Blood loss during the procedure was minimal, and a sample
of the fluid from the cyst was sent for laboratory testing to confirm the
diagnosis. Histopathological examination later confirmed the diagnosis,
validating the team's initial clinical assessment.
Speaking about the case, Dr.
Kaushik Das, said, "Lymphangiomas are uncommon benign malformations of
the lymphatic system and are usually detected during childhood. While smaller
lesions may simply be monitored, larger lesions like this one require complete
surgical removal, particularly when they compress vital structures. In this
case, the tumour had grown to a significant size and was closely related to the
carotid artery, internal jugular vein and vagus nerve, making the surgery
highly challenging. The key objective was to achieve complete excision while
preserving these critical structures, as incomplete removal can lead to
recurrence. We are pleased that the surgery was successful and the patient has
made an excellent recovery."
Dr. Ushrin Bose, said, "One of the most
challenging aspects of this surgery was the distorted anatomy caused by the
giant lymphangioma. The tumour had displaced the carotid artery medially in the neck, leaving very little
margin for error during dissection. Also ,
dissection was challenging in order to resect the lymphangioma en bloc without
leaving any walls behind. Every step required meticulous planning and
precise surgical technique to safely separate the mass while preserving the
patient's nerves and major blood vessels. Careful post-operative monitoring was
equally important to ensure there were no breathing difficulties, nerve-related
complications or wound issues. The patient's smooth recovery and excellent
functional outcome reflect the value of a coordinated multidisciplinary
approach and timely intervention."
The patient's post-operative
recovery was uneventful. He remained haemodynamically stable with satisfactory
pain control and experienced no complications. Daily assessments documented
stable vital signs, minimal drain output, good oral intake and steady recovery.
The drain was removed on the second post-operative day, following which the
patient was discharged. During a follow-up visit seven days later, the surgical
stitches were removed, and the patient was found to be recovering well without
any complications.
Doctors noted that if left
untreated, giant lymphangiomas can progressively enlarge and exert pressure on
surrounding structures, leading to difficulty swallowing, breathing problems
and significant discomfort. Early diagnosis and timely surgical intervention
are essential to prevent these complications and ensure complete recovery.