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Duong A, Balfour A, Kraus CN. Acquired vulvar lymphangioma: risk factors, disease associations, and management considerations: a systematic review. Int J Womens Dermatol 2023; 9:e087. [PMID: 37234958 PMCID: PMC10208695 DOI: 10.1097/jw9.0000000000000087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Accepted: 04/08/2023] [Indexed: 05/28/2023] Open
Abstract
Acquired vulvar lymphangioma (AVL) is not well-characterized. Diagnosis is delayed and the condition is often refractory to therapy. Objective The objective of this study was to provide a systematic review of AVL including risk factors, disease associations, and management options. Methods A primary literature search was conducted using 3 databases: PubMed, CINAHL, and OVID, from all years to 2022. Results In total, 78 publications with 133 patients (48 ± 17 years) were included. Most studies were case reports/series. The most common disease association was prior malignancy (70 patients, 53% of cases) and inflammatory bowel disease (6 patients, 5% of cases). The most common malignancy was cervical cancer (57 patients, 43% of cases). Most patients had prior radiation or surgery, with 36% (n = 48) treated with radiation, 30% (n = 40) with lymph node dissection, and 27% (n = 36) with surgical resection. Common presenting symptoms included discharge/oozing, pain, and pruritus. Most patients underwent surgical treatment for AVL with 39% treated with excision, 12% with laser therapy (the majority used CO2), and 11% with medical therapies. Most patients had failed prior therapies and there was a diagnostic delay. Limitations Retrospective nature. Most studies were limited to case reports and case series, with interstudy variability and result heterogeneity. Conclusion AVL is an underrecognized entity and should be considered in patients with a history of malignancy or radiation to the urogenital area. Treatment should include multidisciplinary care and address underlying lymphatic changes, manage any existing inflammatory conditions, and utilize skin-directed therapies and barrier agents while addressing symptoms of pruritus and pain. Prospective studies are needed to further characterize AVL and develop treatment guidelines.
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Affiliation(s)
- Amber Duong
- School of Medicine, University of California, Irvine, California
| | - Alex Balfour
- School of Medicine, University of California, Irvine, California
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2
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Luu YT, Kimmis BD, Bodine JS, Gloyeske NC, Dai H. Malignancy-associated acquired vulvar lymphangioma circumscriptum: A clinicopathologic study of 71 cases. J Cutan Pathol 2021; 49:426-433. [PMID: 34877687 DOI: 10.1111/cup.14181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Revised: 11/14/2021] [Accepted: 11/28/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND Acquired lymphangioma circumscriptum of the vulva is rare and can occur subsequent to malignancies of the anogenital and pelvic region. We sought to investigate the clinicopathologic characteristics of malignancy-associated acquired vulvar lymphangioma circumscriptum (AVLC). METHODS We identified all cases of AVLC within our institution with history of prior malignancy between 2005 and 2021. A similar search was performed in the PubMed database to identify published cases to date. The clinical and histopathologic information was recorded. RESULTS A total of 71 cases were identified. The most common preceding malignancy was cervical carcinoma (71.8%, 51/71). Radiation therapy was given to 91.4% (64/70) of the patients and lymph node dissection was made on 70.2% (40/57). Median interval between the diagnosis of malignancy and the AVLC was 10 years (range 0-32 years). AVLC frequently presented as vesicular (31.6%, 18/57) or verrucous (28.1%, 16/57) lesions clinically. Common treatments for AVLC included excision (53.1%, 26/49) and laser therapy (16.3%, 8/49), with an overall recurrence rate of 42.9% (24/56) at a median follow-up interval of 1.8 years (range 0.04-32.3 years). CONCLUSION AVLC is a rare, late complication of anogenital and pelvic malignancies causing debilitating physical symptoms and psychological stress. Further studies are warranted to determine the most effective treatment modalities to mitigate recurrence.
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Affiliation(s)
- Yen T Luu
- School of Medicine, University of Missouri-Kansas City, Kansas City, Missouri, USA
| | - Brooks D Kimmis
- Division of Dermatology, University of Kansas Hospital, Kansas City, Kansas, USA
| | - Jared S Bodine
- Kansas City University of Medicine and Biosciences, Kansas City, Missouri, USA
| | - Nika C Gloyeske
- Department of Pathology and Laboratory Medicine, University of Kansas Hospital, Kansas City, Kansas, USA
| | - Hongyan Dai
- Department of Pathology and Laboratory Medicine, University of Kansas Hospital, Kansas City, Kansas, USA
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3
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Callander JA, Davies BM, Hill G. Acquired lymphangioma circumscriptum of the vulva secondary to severe herpes simplex infection. Sex Transm Infect 2019; 96:233-234. [PMID: 31757874 DOI: 10.1136/sextrans-2019-054224] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2019] [Revised: 10/22/2019] [Accepted: 11/07/2019] [Indexed: 11/04/2022] Open
Affiliation(s)
| | | | - Glenda Hill
- Department of Dermatology, Wrexham Maelor Hospital, Wrexham, UK
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Diani M, Turina M, Cozzi C, Altomare G. Acquired lymphangiomas mimicking multiple hallux warts. An Bras Dermatol 2017; 92:11-13. [PMID: 29267433 PMCID: PMC5726664 DOI: 10.1590/abd1806-4841.20175685] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2016] [Accepted: 05/08/2016] [Indexed: 11/21/2022] Open
Abstract
Lymphangioma is an uncommon benign vascular tumour that involves lymphatic vessels. It can be acquired or, most frequently, congenital. The acquired form presents with dilated lymphatic channels due to an obstruction. These lesions have no risk of malignant transformation, but they have a high rate of recurrence whether removed. We present a case of a 52-year-old woman with acquired lymphangiomas mimicking warts. She came to our observation for some keratotic lesions on her feet. Clinically, we found three warts on the sole of her left foot, but we also noticed the presence of swelling and papillomatous wart-like papules on both halluces. The hallux papules were studied by performing an excisional biopsy and were found to be lymphangiomas.
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Affiliation(s)
- Marco Diani
- Department of Dermatology and Venereology, I.R.C.C.S. Istituto Ortopedico Galeazzi, University of Milan - Milan, Italy
| | - Marco Turina
- Department of Anatomopathology and Cytodiagnostic, I.R.C.C.S. Policlinico San Donato, San Donato Milanese - Milan, Italy
| | - Chiara Cozzi
- Department of Dermatology and Venereology, I.R.C.C.S. Istituto Ortopedico Galeazzi, University of Milan - Milan, Italy
| | - Gianfranco Altomare
- Department of Dermatology and Venereology, I.R.C.C.S. Istituto Ortopedico Galeazzi, University of Milan - Milan, Italy
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5
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Chang MB, Newman CC, Davis MDP, Lehman JS. Acquired lymphangiectasia (lymphangioma circumscriptum) of the vulva: Clinicopathologic study of 11 patients from a single institution and 67 from the literature. Int J Dermatol 2016; 55:e482-7. [DOI: 10.1111/ijd.13264] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2015] [Revised: 10/05/2015] [Accepted: 11/18/2015] [Indexed: 11/27/2022]
Affiliation(s)
| | | | | | - Julia S. Lehman
- Department of Dermatology; Mayo Clinic; Rochester MN USA
- Division of Anatomic Pathology; Mayo Clinic; Rochester MN USA
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6
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Wang S, Krulig E, Hernandez C. Acquired microcystic lymphatic malformation of the distal upper extremity mimicking verrucae vulgaris. Pediatr Dermatol 2013; 30:e78-82. [PMID: 23876174 DOI: 10.1111/pde.12179] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
An 18-year-old African American male with a history of congenital lymphedema of the right upper extremity presented for evaluation of multiple verrucous lesions on his right hand. Clusters of 2 to 4-mm dome-shaped vesicles were intermixed with scattered verrucous papules on the right forearm and the dorsal and palmar aspects of the hand. Histopathology of one the verrucous lesions showed well-circumscribed areas of dilated lymphatic vascular channels with lymph in the lumen. The patient was diagnosed with microcystic lymphatic malformation, verrucous type. This article reviews the literature regarding reports of this variant of microcystic lymphatic malformation in the pediatric population.
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Affiliation(s)
- Stephanie Wang
- Department of Dermatology, University of Illinois at Chicago, Chicago, Illinois
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Savas JA, Ledon J, Franca K, Chacon A, Zaiac M, Nouri K. Carbon Dioxide Laser for the Treatment of Microcystic Lymphatic Malformations (Lymphangioma Circumscriptum): A Systematic Review. Dermatol Surg 2013; 39:1147-57. [DOI: 10.1111/dsu.12220] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Abstract
Vulvar edema is associated with a variety of conditions. The edema can result from inflammatory conditions, infections, infestations, trauma, pregnancy, tumors and iatrogenic causes. At times, it is difficult to determine the cause of the vulvar edema. Treatment consists of determining the origin of the edema and giving the appropriate therapy for that diagnosis as well as the use of compression and, at times, lymphatic massage.
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Affiliation(s)
- Yaa Amankwah
- Department of Obstetrics, Gynecology and Newborn Care, The Ottawa Hospital, University of Ottawa, Ontario, Canada.
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Walsh CA, Allen W, Moore KH. ‘Urinary incontinence’ post-radiotherapy: A diagnostic conundrum. J OBSTET GYNAECOL 2010; 30:424-5. [DOI: 10.3109/01443611003725464] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- C. A. Walsh
- Pelvic Floor Unit, St George Hospital, University of New South Wales, Sydney, Australia
| | - W. Allen
- Pelvic Floor Unit, St George Hospital, University of New South Wales, Sydney, Australia
| | - K. H. Moore
- Pelvic Floor Unit, St George Hospital, University of New South Wales, Sydney, Australia
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11
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Stewart C, Chan T, Platten M. Acquired lymphangiectasia (‘lymphangioma circumscriptum’) of the vulva a report of eight cases. Pathology 2009; 41:448-53. [DOI: 10.1080/00313020902885052] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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12
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[Hyperkeratotic lesion of the nipple revealing cutaneous leiomyoma]. Ann Dermatol Venereol 2008; 135:571-4. [PMID: 18789291 DOI: 10.1016/j.annder.2008.02.020] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2007] [Accepted: 02/14/2008] [Indexed: 11/20/2022]
Abstract
BACKGROUND Leiomyoma of the nipple and areola is a rare benign neoplasm. We report the case of a patient with leiomyoma of the nipple presenting as a hyperkeratotic plaque. OBSERVATION A 23-year-old patient presented with a five year history of a papillomatous, hyperkeratotic, painful plaque originating in her right nipple. Histological examination of a punch biopsy showed hyperkeratosis of the epidermis with dilatation of the lymphatic vessels within the dermis. Surgical excision revealed a proliferation of smooth muscle fibres, leading to diagnosis of leiomyoma. DISCUSSION The clinical and histological features were initially consistent with idiopathic naevoid hyperkeratosis of areola. However, associated pain is uncommon in idiopathic lesions. This unusual feature led us to surgical excision enabling the diagnosis of leiomyoma. A hyperkeratotic lesion of the nipple may be associated with benign or malignant neoplasms, hamartoma or chronic dermatoses, or it may be idiopathic. In the present case, the hyperkeratotic lesion revealed subareolar leiomyoma. This is an uncommon clinical presentation not previously seen in medical observations, since leiomyoma usually presents as a firm, painful lump in the subareolar region.
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Yildiz F, Atahan IL, Ozyar E, Karcaaltincaba M, Cengiz M, Ozyigit G, Aydin A, Usubütün A, Ayhan A. Radiotherapy in congenital vulvar lymphangioma circumscriptum. Int J Gynecol Cancer 2008; 18:556-9. [PMID: 17692089 DOI: 10.1111/j.1525-1438.2007.01040.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Congenital lymphangioma circumscriptum (LC) of the vulva is a rare disorder with unknown etiology. Treatment options include ablative approaches such as laser therapy, sclerotherapy, and surgery. Radiotherapy has been shown to be effective in the management of congenital lymphangioma especially in the thoracic and abdominal lesions. In this report, we describe a patient with persistent vulvar LC despite sclerosing therapy and several surgical excisions. She was treated with a course of external radiotherapy and showed a dramatic objective response with relief of all symptoms
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Affiliation(s)
- F Yildiz
- Department of Radiation Oncology, Faculty of Medicine, Hacettepe University, Ankara, Turkey.
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Kenani N, Ghariani N, Trimèche M, Belajouza C, Denguezli M, Nouira R. [Pseudocondylomatous lymphangiectasia of the vulva secondary to lipoedema]. Ann Dermatol Venereol 2008; 135:341-3. [PMID: 18420091 DOI: 10.1016/j.annder.2007.11.025] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2007] [Accepted: 11/09/2007] [Indexed: 11/30/2022]
Affiliation(s)
- N Kenani
- Service de dermatologie, faculté de médecine, CHU Farhat-Hached, 4002 Sousse, Tunisie
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Motegi SI, Tamura A, Okada E, Nagai Y, Ishikawa O. Successful Treatment with Lymphaticovenular Anastomosis for Secondary Skin Lesions of Chronic Lymphedema. Dermatology 2007; 215:147-51. [PMID: 17684378 DOI: 10.1159/000104267] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2006] [Accepted: 02/03/2007] [Indexed: 11/19/2022] Open
Abstract
The treatment of severe lymphedema is a difficult challenge. We performed lymphaticovenular anastomosis on two patients with secondary skin lesions of chronic lymphedema; one patient exhibited acquired lymphangioma circumscriptum of the vulva and the other presented elephantiasis nostras verrucosa of the lower leg. Both patients obtained a remarkable improvement in skin lesions and also in the reduction of lymphedema of the lower extremity. During a 6-month-follow-up period, constant reduction in the circumference of the lower extremities without exacerbation of skin lesions was achieved in both patients. Lymphaticovenular anastomosis is a useful surgical treatment for secondary lymphedema in the lower extremities. In addition, this surgical treatment is effective for secondary lesions of lymphedema, including acquired lymphangioma circumscriptum and elephantiasis nostras verrucosa.
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Affiliation(s)
- Sei-ichiro Motegi
- Department of Dermatology, Gunma University Graduate School of Medicine, Gunma, Japan.
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