Congenital lymphangioma circumscriptum of vulva presenting as multiple giant mass lesions: a case report and literature review

Surgical extraction of an unusual macrocystic lymphatic malformation in the buttock: case report

Background

Macrocystic lymphatic malformation is a rare benign skin disorder, especially the anogenital area, which covers less than .5% of the reported cases. It can cause vesicular and papular lesions on the face, trunk, extremities, and, less frequently, anogenital areas. Although there are currently several therapeutic options, surgical excision is the most widely used, considering the lowest recurrence rate.

Case presentation

In this article, we describe the case of a 15-year-old male patient who presented with herpetiform skin lesions, corresponding to the diagnosis of macrocystic lymphatic malformation, in the lower region of the right buttock. After confirmation of the diagnosis by histopathology, surgical excision was performed with a tensor fascia lata graft, with successful aesthetic and functional results.

Conclusions

Considering the diagnosis of macrocystic lymphatic malformation is of utmost importance, although its presence is unusual, to differentiate it from other herpetiform lesions. Despite the existence of multiple approaches today, definitive treatment with surgical extraction is necessary, both to improve the cosmetic aspect and to prevent associated complications. It is suggested that histopathological and imaging diagnostic tools be used as a routine element, in order to increase therapeutic success, as well as decrease the risk of recurrences.

Evidence-based medicine ranking

Level IV

Peri-Umbilical Lymphangioma Circumscriptum Associated with Intra-Abdominal Lymphatic Malformations

A 12-year-old African female presented with a 6-year history of relatively asymptomatic umbilical lesions. On clinical examination, the lesions were papillomatous, violaceous nodules and translucent papules with a serosanguineous discharge. The lesions emanated from the umbilicus and extended peri-umbilically. Histopathology confirmed a lymphangioma and MRI and CT imaging revealed multiple intra-abdominal lymphatic malformations. The patient was referred to plastic surgery for further management. Due to the extent of involvement, surgical resection was an option but currently the therapeutic approach is sclerotherapy with bleomycin.

Exposure to air pollution during pregnancy and newborn liver function

Exposure to air pollution has been associated with a wide range of adverse health outcomes. However, the available evidence on the impact of air pollution exposures on liver enzymes is still scarce. The aim of the present study was to assess the relationship between exposure to ambient PM₁, PM_2.5 and PM₁₀ during pregnancy and serum level of aspartate aminotransferase (AST), alanine aminotransferase (ALT), alkaline phosphatase (ALP) and gamma-glutamyl transferase (GGT) in cord blood samples of newborns. Moreover, the association between total street length in different buffers and distance to major roads at the maternal residential address and liver enzymes were investigated. This cross-sectional study was based on data from a sample of 150 newborns, from Sabzevar, Iran. Land use regression models were used to estimate concentrations of air pollutants at home during pregnancy. Multiple linear regression was developed to estimate association of AST, ALT, ALP and GGT with air pollution controlled for relevant covariates. In fully adjusted models, increase in PM₁ and PM_2.5 as well as PM₁₀ were associated with higher levels of AST, ALT and GGT. Moreover, there was a significant association between total street length in a 100 m buffer at residential address with AST, ALT and GGT. Each meter increase in distance to major roads was associated with -0.017 (95% confidence interval (CI): -0.028, -0.006) decrease in AST. Overall, our findings were supportive for association between PMs exposure during pregnancy and increase in liver enzymes in newborns. Further studies are needed to confirm these findings in other settings and populations.