Acquired vulvar lymphangioma: risk factors, disease associations, and management considerations: a systematic review

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.

Extensive tongue lymphangioma followed for eight years: Case report

Lymphangiomas are benign hamartomatous tumours similar to lymphatic vessel neoplasms, originating from lymphatic tissue sequestration and may or may not communicate with the rest of the system. There are several treatment options for lymphangioma, such as surgery, sclerotherapy, cryotherapy, lasers, steroids and bleomycin. Although surgery is the most indicated treatment, it can result in severe sequelae and loss of function in patients. The present case shows a 5-year-old patient diagnosed with extensive tongue lymphangioma and, due to the mutilation that would be caused by its complete excision, the option was for more conservative treatments such as laser therapy and cryotherapy. After follow-up for 8 years, the patient presents with preserved functions and controlled lesion.

Aminolevulinate photodynamic therapy (ALA-PDT) combined with fire needle for vulva lymphangioma circumscriptum

Lymphangioma is a rare benign lymphatic system proliferation, especially in the vulva. The general treatment principle is determined by clinical manifestations, lesion size, anatomic location, and complications. Treatment options include surgical excision, carbon dioxide laser, cryotherapy, electrocoagulation, and sclerosing agent injection. In the absence of evidence to guide the choice of significant treatment modalities, treatment options are often based on the experience of the treatment team and the patient's preferences. This study presents a case of primary vulva lymphangioma circumscriptum treated with fire needle therapy, photodynamic therapy, and cryotherapy. Furthermore, the combination of fire needle and photodynamic therapy demonstrated exceptional comprehensive effects in pain, wound healing and cosmetic.