HYGROMA COLLI

BY LEE KAHN, M.D.

OF LOUISVILLE, KY.
SURGEON TO JZWISH HOSPITAL, LOUISVILLE CITY HOSPITAL, MASONIC WIDOWS AND ORPHANS HOME AND INFIMARY
AND
STUART GRAVES, M.D.
PATHOLOGIST, MEDICAL DEPARTMENT, UNIVERSITY OF LOUISVILLE AND LOUISVILLE CITY HOSPITAL

HYGROMA colli is relatively rare. The careful collective investigation

of international literature made by Dowd 1 in I9I3 makes a review of the
subject superfluous. To his compilation of 9I cases he has added 3 others.
Since then a like case has been reported by Smith 2 and later another by
Cameron.3 It is the purpose of this report to place on record an additional
case which recently came to Dr. Kahn's care in the Children's Hospital.
The patient, a healthy looking girl of seven years, was brought
because of a disfiguring tumor of the right side of the neck (Fig. i).
There was nothing in her family or personal history that would be
considered noteworthy save that when eleven months old she fell from
a table. When thirteen months of age the growth, the size of a
guinea egg, was first detected by the parents, who, thereafter, closely
observed its gradual enlargement. It was never tender and at no time
showed inflammatory signs. When the child was two years old the
tumor, having attained the size of a chicken egg, was drained by an
incision which, quoting the parents, " spurted blood." Prompt healing
of the wound was followed by reappearance of a steadily growing tumor.
Local Condition.-When admitted to the hospital there presented
over the posterior triangle of the neck a conspicuous ovoidal tumor
about the size of a goose egg, the fundal end extending downward
to the clavicle. It was painless, soft and fluctuant, incompressible,
without impulse and seemingly unilocular. The overlying normal skin
was not adherent and bore no visible evidence of previous operation.
No enlarged lymph-nodes were palpable. Translucency test and
exploratory puncture confirmed the cystic character of the growth.
Operation.-A straight incision over the long axis of the tumor
exposed a thin-walled cyst. Its pressure had so thinned the sterno-
mastoid and trapezius muscles that their contiguous borders were
poorly defined. No special difficulty was encountered in dissecting the
cyst from its bed except at the upper part, where it was intimately
adherent to the triangle floor. Under the posterior border of the
sternomastoid and closely connected with the cyst was a smaller one,
the size of a pecan. It was more deeply embedded in the neck and
its amber hue contrasted with the pale blue color of the larger cyst.
In its excision the thin wall was nicked, but the drainage of its straw-
1 Dowd: ANN. SURG.,I913, Iviii, II3.
'Smith: Jour. Am. Med. Assn., 1914, lxii, 522.
'Cameron: Canad. Med. Assn. Jour., i9i6, vi, 137.
71
 KAHN AND GRAVES
colored, serous contents caused no perceptible reduction in the size or
tension of the adjoined cyst, giving the inference that their cavities
did not communicate. The growth was completely extirpated, the
larger cyst being removed' intact. There was no obvious attachment
to any vessel and haemostatic ligatures were unnecessary. With a
continuous horse-hair suture the skin wound was closed. A small
rubber band for drainage was left in its lower end. Subsequent
healing was without incident.
Pathological Report (Dr. Graves).-Gross description: Specimen consists
of thin-walled cyst, measuring 3x6x8 cm. as it lies on board. It is covered
with tags of fibrous tissue between which wall is pale blue. By transmitted
light contents are translucent and pale pinkish red. Cyst fluctuates and appears
to be unilocular. At one side is an area about 2 cm. in diameter which is
smooth, pink and glistening and around which are remains of wall of cyst,
the smooth area apparently being a part of wall of same emptied- cyst. Sur-
geon states this was opened at operation and thin, straw-colored fluid escaped.
After fixation for museum, cyst is opened and found to be unilocular, with a
smooth, pale lining.
Gross -Diagnosis.-Multilocular hygroma.
Microscopical description: Sections of small punctured cyst show thin wall
of fibrous tissue. Outer surface bears fat and some fragments of muscle.
Inner lining has been rubbed off, making it probable that it was endothelial
rather than epithelial. Sections of larger cyst show an endothelial lining.
Microscopic Diagnosis.-Multiple hygroma colli.
Comments.-These multilocular, serous, cervical cysts in children are
probably due to distention of embryonic sequestrations of lymphatic tissue.
They are usually lined with endothelium. They have the power of per-
sistent, irregular growth. Trauma, in some cases at least, seems to be
a decided factor in stimulating this growth. Their inherent power of
development is sufficient to force themselves into surrounding structures.
In multilocular hygroma the serum in one compartment may be clear,
while in an adjacent one it may be tinged with haemoglobin. After birth
the growth may show a capricious enlargement with no tendency toward
spontaneous recovery. The aggregation of cysts, although presenting super-
ficially, originates beneath the deep cervical fascia and most often appears
in the posterior triangle of the neck. In the submaxillary region its clinical
differentiation from branchial cyst is not always easy.
After partial removal the tumor has, according to Murphy, returned
with enormous increase in size and secretion. This assertion, together
with Bloodgood's observation of late malignant development, indicates that
the proper treatment of cystic hygromata is early, clean and complete removal.
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FIG. 2.-Exterior of larger cyst with inner surface of base of smaller cyst facing.

FIG. 3.-Interior of
opened larger cyst.
FIG. 3.-Interior of opened larger cyst.