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CORRESPONDENCE
Year : 2010  |  Volume : 55  |  Issue : 1  |  Page : 121-122
Extensive congenital vulvar lymphangioma mimicking genital warts


Department of Skin and STD, Kasturba Medical College, Manipal, Karnataka, India

Date of Web Publication4-Mar-2010

Correspondence Address:
Vandana Mehta
Department of Skin and STD, Kasturba Medical College, Manipal - 576 104, Karnataka
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0019-5154.60372

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How to cite this article:
Mehta V, Nayak S, Balachandran C, Monga P, Rao R. Extensive congenital vulvar lymphangioma mimicking genital warts. Indian J Dermatol 2010;55:121-2

How to cite this URL:
Mehta V, Nayak S, Balachandran C, Monga P, Rao R. Extensive congenital vulvar lymphangioma mimicking genital warts. Indian J Dermatol [serial online] 2010 [cited 2019 Aug 20];55:121-2. Available from: http://www.e-ijd.org/text.asp?2010/55/1/121/60372


Sir,

Lymphatic malformation (LM) or lymphangioma is a benign proliferation of the lymphatics accounting for four per cent of all vascular malformations and 26% of all benign vascular tumors. [1],[2]

A 26-year-old female presented with vulvar hypertrophy since 10 years of age, which gradually increased in size after puberty. It was associated with episodic pain on and off interfering with walking. There was no history of oozing. Cutaneous examination of the external genitalia revealed gross vulvar hypertrophy extending upto the fourchette. The overlying skin was hyper- pigmented, indurated, rugose and studded with multiple skin colored papules. [Figure 1] and [Figure 2] Based on the clinical appearance, a differential diagnosis of vulvar lymphangioma and genital warts was entertained. Biopsy for histopathology revealed dilated lymphatics lined with flattened endothelial cells and luminal macrophages, neutrophils and lymphocytes consistent with our diagnosis of lymphangioma.

LMs are broadly classified into superficial lymphangioma circumscriptum and deeper cavernous lymphangioma. [3] There is no clear distinction between both, the difference being solely on the extent of the malformation. [4] Differentiation between congenital vs. acquired lymphangiomas with respect to localization within the skin have been made. The former result from a hamartomatous malformation of lymphatic vessels, the latter from acquired obstruction of lymph vessels, e.g. after surgical or radiation treatment of malignancies of the breast or uterus. [5] Acquired lymphangioma of the vulva, arising without obvious causes, seems to be unusual. [6]

Lymphangiomas of the vulva are rare. Thirteen cases of the congenital and 24 cases of acquired form have been reported in the literature presently. [7] Diffuse lymphangiomas, though present from birth, may go unnoticed for many years. They present as asymptomatic, erythematous flat indurated or atrophic plaques. Swelling may or may not be apparent. Diffuse lymphangiomas, unlike the superficial type, may not have any surface changes. The diagnosis is usually made by biopsy. [7]

Various modalities of treatment have been suggested viz., observation, surgical excision of skin and subcutaneous tissues, surface ablation with Laser (CO 2 , Er:YAG), sclerotherapy, superficial radiotherapy. [8],[9],[10] Our patient was advised vulvectomy but she was lost for follow-up.

 
   References Top

1.Kim JK, Yoo KS, Moon JH, Park KH, Chung YW, Kim KO, et al. Gallbladder lymphangioma: a0 case report and review of the literature. World J Gastroenterol 2007;13:320-3.  Back to cited text no. 1      
2.Colange E, Wilson JE. Vascular tumors, tumors and tumour like conditions of blood vessels and lymphatics. In: Elder DE, Elenitsas, Johnson Jr. BL, Murphy GF, editors. Lever's histopathology of skin. 9 th ed. Philadelphia: Lippincott Williams and Wilkins; 2005. p. 1046-7.  Back to cited text no. 2      
3.Flanagan BP, Helwig EB. Cutaneous lymphangioma. Arch Dermatol 1977;113:24-30.  Back to cited text no. 3  [PUBMED]  [FULLTEXT]  
4.Rao R, Shenoi SD. Diseases of Arteries, Veins and Lymphatics. Valia RG, Valia A. IADVL textbook of dermatology 3 rd ed. Bhalani publishing house Mumbai. 2008. p. 729-31.  Back to cited text no. 4      
5.Mehta V, Gupta S, Shenoi D. Acquired lymphangioma of vulva secondary to radiotherapy for carcinoma cervix. Indian J Dermatol 2003;48:221-2.  Back to cited text no. 5    Medknow Journal  
6.Akimoto K, Nogita T, Kawashima M. A case of acquired lymphangioma of the vulva. J Dermatol 1993;20:449-51.  Back to cited text no. 6  [PUBMED]  [FULLTEXT]  
7.Ghaemmaghami F, Karimi Zarchi M, Mousavi A. Surgical management of primary vulvar lymphangioma circumscriptum and postradiation: c0 ase series and review of literature. J Minim Invasive Gynecol 2008;15:205-8.  Back to cited text no. 7  [PUBMED]  [FULLTEXT]  
8.Ochsendorf FR, Kaufmann R, Runne U. Erbium:YAG laser ablation of acquired vulval lymphangioma. Br J Dermatol 2003;144:442-4.  Back to cited text no. 8      
9.Ghaemmaghami F, Karimi Zarchi M, Mousavi A. Major labiaectomy as surgical management of vulvar lymphangioma circumscriptum: t0 hree cases and a review of the literature. Arch Gynecol Obstet 2008;278:57-60.  Back to cited text no. 9  [PUBMED]  [FULLTEXT]  
10.Huilgol SC, Neill S, Barlow RJ. CO 2 laser therapy of vulval lymphangiectasia and lymphangioma circumscriptum. Dermatol Surg 2002;28:575-7.  Back to cited text no. 10  [PUBMED]  [FULLTEXT]  


    Figures

  [Figure 1], [Figure 2]

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2 Giant congenital cavernous lymphangioma: A case report and literature review
Li, M.-M., Guo, Z.-P., Chen, T., Zhang, Y.-H., Jiao, X.-Y.
Journal of Clinical Dermatology. 2012; 41(4): 218-220
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3 Acquired lymphangioma circumscriptum of the vulva
Shetty, V., Venkatesh, S.
International Journal of Gynecology and Obstetrics. 2012; 117(2): 190
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