Massive unilateral fetal axillary lymphangioma: A case repor

• There is a paucity of literature describing large prenatal axillary lymphangioma.

• Nonnuchal lymphangiomas may be etiologically distinct.

• Septate and nonseptate axillary lymphangiomas are potentially different entities.

• Compared with nuchal lesions, axillary lymphangioma is less strongly associated with hydrops.

• Detailed fetal anatomic survey is imperative to screen for additional anomalies.

• Close surveillance should be undertaken to optimize neonatal outcomes.

A 21-year-old woman (gravida 2, para 1) was referred at 15 weeks of gestation for a maternal-fetal consultation for post-surgical hypothyroidism. Her medical history was significant for papillary thyroid cancer during her first, otherwise uneventful, pregnancy and subsequent total thyroidectomy with adjuvant radioactive iodine postpartum. The patient denied prior neck radiation and her family history was unremarkable. Detailed fetal survey at 20 weeks revealed a 5.45 × 3.72 cm nonvascular cystic axillary structure without other malformations; amniocentesis was negative. Serial surveillance was performed throughout the pregnancy. A male infant weighing 3000 g with a 16 × 12 × 9 cm septated cystic mass arising from the left axilla was delivered via cesarean section. The newborn period was complicated by cellulitis overlying the mass and interval cystic hemorrhage requiring sclerotherapy and subsequent excision. Nonnuchal lymphangiomas may be etiologically distinct entities. The prognostic factors include anatomic location, presence of septa, and association with other congenital abnormalities. A thorough evaluation, multidisciplinary approach, and close surveillance should be undertaken to optimize neonatal outcomes.