Acquired Vulvar Lymphangioma: A Case Series With Emphasis on Expanding Clinical Contexts

Malignancy-associated acquired vulvar lymphangioma circumscriptum: A clinicopathologic study of 71 cases

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.

Genital lymphaticovenous anastomosis (LVA) and leg LVA to prevent the recurrence of genital acquired lymphangiectasia

BACKGROUND

Genital acquired lymphangiectasia (GAL) commonly recurs after simple resection. This study aimed to elucidate the efficacy of lymphaticovenous anastomosis (LVA) in the genital region or legs for preventing GAL recurrence after resection.

METHODS

We retrospectively investigated 25 female patients who underwent GAL resection and LVA, lymphoscintigraphy, and indocyanine green (ICG) lymphography. Isotope or ICG was injected into the leg. Medicine accumulating in the genitals indicates lymphatic flow from the legs to the genitals (type 1). In some cases, we injected ICG into the anus to detect lymphatic flow from the anus to the genitals (type 2). Based on the findings, we selected LVA site (genital or leg).

RESULTS

The mean patient age was 61.4 (range, 42-81) years. Seventeen patients underwent leg LVA only, while eight patients underwent genital LVA. The mean follow-up period was 285 (range, 87-365) days. GAL recurrence was observed in 10 patients (40.0%): three of eight (37.5%) who underwent genital LVA versus seven of 17 (41.2%) who underwent leg LVA. Among patients with type 2 lymphatic vessels, GAL recurrence was observed in two of six (33.3%) who underwent genital LVA versus five of nine (55.6%) who underwent leg LVA.

CONCLUSION

Genital LVA prevented GAL recurrence in patients with type 2 lymphatic flow. Detecting the direction of lymphatic flow around GAL is essential to its successful treatment.

Vulvar Crohn disease: Diagnostic challenges and approach to therapy

Crohn disease (CD) may be complicated by contiguous, metastatic, or associated inflammatory cutaneous lesions. Vulvar CD is a rare phenomenon characterized by granulomatous genital inflammation that occurs independently from fistulizing CD. Left untreated, vulvar CD can result in debilitating lymphedema, disfiguring anatomic changes, secondary abscesses, cellulitis, and squamous cell carcinoma. We present a series of cases to highlight the clinical presentation of vulvar CD, the diagnostic testing required to distinguish complicating conditions, the asynchronous courses of skin and intestinal disease, and the complexities in the management of this disease and associated conditions. We review our multidisciplinary approach to care, aimed at reducing morbidity and improving patient quality of life.

Cutaneous Manifestations of Crohn Disease

Awareness of the extraintestinal manifestations of Crohn disease is increasing in dermatology and gastroenterology, with enhanced identification of entities that range from granulomatous diseases recapitulating the underlying inflammatory bowel disease to reactive conditions and associated dermatoses. In this review, the underlying etiopathology of Crohn disease is discussed, and how this mirrors certain skin manifestations that present in a subset of patients is explored. The array of extraintestinal manifestations that do not share a similar pathology, but which are often seen in association with inflammatory bowel disease, is also discussed. Treatment and pathogenetic mechanisms, where available, are discussed.