Acquired microcystic lymphatic malformation of the distal upper extremity mimicking verrucae vulgaris

Ultrasonography findings of pediatric head and neck lymphatic malformations: A 10-year experience of 140 surgical cases

OBJECTIVE

To discuss the usefulness of ultrasonography (US) in the diagnosis and management of pediatric head and neck lymphatic malformations (HNLMs).

METHODS

We conducted a retrospective analysis of 140 children who were referred to our hospital for the treatment of HNLMs.

RESULTS

The median age at presentation was 12 months (1 day-171 months; 66.4% under 2 years old; 35.7% neonatus). The majority clinical presentations were asymptomatic mass (65.7%, 92/140) and cosmetic deformity (25.7%, 36/140). HNLMs involved the neck accounting for 65.7% (92/140), especially posterior cervical trigone (22.1%, 31/140), and submandibular (20.0%, 28/140). The US diagnostic accuracy was 91.4% (128/140). Their boundary with the surrounding tissues was usually clear (87.9%, 123/140), whereas the shape was mostly irregular (97.1%, 136/140). Based on surgical findings, there were 67 pure HNLMs and 73 intracystic hemorrhage. Between the two groups, there were statistical differences in capsule contents (χ2 = 7.8299, p = 0.0051), flocculent echo floating (χ2 = 21.2964, p < 0.0001), overlying skin (χ2 = 9.0498, p = 0.0026), and palpation (χ2 = 13.4058, p = 0.0003).

CONCLUSIONS

US typically reveals the lesion with clear boundary, irregular morphology, anechoic contents, no blood flow signal, and echoic intracapsular septum with blood flow signal. In contrast, bluish appearance, tensional palpation, and capsule contents with low/mixed echo or flocculent echo floating may indicate intracystic hemorrhage.

Microcystic lymphatic malformation presenting as firm, skin-colored papules of the lips

Microcystic lymphatic malformation (MiLM), also known as lymphangioma circumscriptum, is a superficial collection of lymphatic vessels measuring <1 cm in the largest diameter, often with a more extensive deeper malformation. It commonly presents as discrete or grouped plaques of clear or hemorrhagic vesicles classically described as "frogspawn"; however, here we describe a case of its unique presentation as firm papules on the lips of a healthy six-year-old child. These skin-colored papules in the absence of vesicles with lymphatic and/or hemorrhagic fluid may not be clinically indicative of MiLM. This case represents a diagnostic challenge due to the unique morphology of pink, fleshy papules as opposed to the clear or hemorrhagic vesicles typically observed in MiLM.