Lymphatic malformations (LMs) are one of the more commonly encountered cystic head-and-neck tumors. Surgical excision is the traditional treatment with inherent perioperative risks. Alternative treatment of these tumors using percutaneous sclerotherapy agents has been proposed with no major consensus on the treatment approaches and sclerotherapy agent choices. This paper presents a systematic review of percutaneous ethanol sclerotherapy for neck lymphangioma and a case report of ethanol ablation in a patient with neck lymphangioma with good cosmesis results. Systematic review was conducted on PubMed using key words: “Ethanol” OR “Alcohol” AND “Ablation” OR “Sclerotherapy” OR “Sclerosing” AND “Lymphangioma” OR “Lymphatic Malformation” as per Preferred Reporting Items for Systematic Reviews and Meta-Analyses guideline. Three hundred fifteen articles from initial PubMed search results were screened by titles and abstracts. Full text was retrieved. 3 studies were included in our systematic review. Overall evidence quality is modest with marked heterogeneity. All 12 patients treated with percutaneous ethanol sclerotherapy for head-and-neck LMs reported favorable response. Only 1 patient (8.3%) encountered a peri-procedural complication. Percutaneous ethanol sclerotherapy of neck lymphangioma in our patient also reported favorable response with no complications. Invasive treatment for LMs should be personalized and dependent on the availability of experienced operators/ centers with appropriate volume in either primary excisional surgery or percutaneous sclerotherapy. Percutaneous ethanol sclerotherapy is an acceptable option with benefits of widespread availability and cost-effectiveness in our South-East Asia region. Limitations of our review are largely due to significant study heterogeneity.

INTRODUCTIONIn a patient with hyperthyroidism, the detection of elevated thyroid hormone concentration with measurable thyroid-stimulating hormone (TSH) value poses considerable diagnostic difficulties.

CLINICAL PICTUREThis 38-year-old lady presented with clinical features of thyrotoxicosis. Her serum free thyroxine concentrations were unequivocally elevated [45 to 82 pmol/L (reference interval, 10 to 20 pmol/L)] but the serum TSH values were persistently within the reference interval [0.49 to 2.48 mIU/L (reference interval, 0.45 to 4.5 mIU/L)].

TREATMENTInvestigations excluded a TSH-secreting pituitary adenoma and a thyroid hormone resistance state and confirmed false elevation in serum TSH concentration due to assay interference from heterophile antibodies. The patient was treated with carbimazole for 18 months.

OUTCOMEThe heterophile antibody-mediated assay interference disappeared 10 months following the initiation of treatment with carbimazole, but returned when the patient relapsed. It disappeared again 2 months after the initiation of treatment.

CONCLUSIONSClinicians should be aware of the potential for interference in immunoassays, and suspect it whenever the test results seem inappropriate to the patient's clinical state. Misinterpretation of test values, arising as a result of assay interference, may lead to misdiagnosis, unnecessary and at times expensive investigations, delay in initiation of treatment and worst of all, the initiation of inappropriate treatment.

Adenoma ; diagnosis ; Adult ; Antibodies, Heterophile ; analysis ; immunology ; Diagnostic Errors ; Female ; Graves Disease ; diagnosis ; Humans ; Immunoassay ; Pituitary Neoplasms ; diagnosis ; Thyrotoxicosis ; blood ; diagnosis ; immunology ; Thyrotropin ; blood ; Thyroxine ; blood