Treatment of lymphangiomas in children: An update of Picibanil (OK-432) sclerotherapy

Picibanil (OK-432) is a sclerosing agent derived from a low-virulence strai n of Streptococcus pyogenes that induces regression of macrocystic lymphang iomas. This report describes a prospective, nonrandomized trial to evaluate the efficacy of Picibanil in the treatment of 13 affected children ranging in age from 1 to 94 months. On average, 4.1 fluoroscopically guided intrac ystic injections were performed per child. with an average total dose of 0. 56 mg of Picibanil. As judged by physical examination and radiographic stud ies, 5 children (42%) showed a complete or substantial response, and 2 chil dren (16%) showed an intermediate response. No response was seen in 5 child ren (42%), 2 of whom had massive craniofacial lymphangioma. Factors that co ntribute to failure with Picibanil sclerotherapy are the presence of a sign ificant microcystic component to the lesion, massive craniofacial involveme nt, and previous surgical resection. Macrocystic lymphangiomas of the infra temporal fossa or cervical area have the best response to therapy.