ARTICLE
A 12-year-old, healthy, black girl of Ethiopian origin, was referred
to us because of the presence of several lesions on the vulva, which had
developed gradually over the previous few years. On examination, several
dark colored lesions with a vesicular appearance were present on the vulva
(Fig. 1). A biopsy of
a skin lesion revealed dilated tortuous blood vessels in the mid- and
upper dermis (Fig. 2).
Diagnosis:
lymphangioma circumscriptum on the vulva mimicking condyloma acuminata
Lymphangioma circumscriptum (LC) is a rare dermatosis that can be located
anywhere on the skin or mucous membranes [1]. We report here a case which
presented LC in an unusual area, the vulva. The histology of the lesion
was consistent with the diagnosis of LC (Fig.
2). Gynecological ultrasonographic examination was normal and
no vascular malformation was found. The patient was treated initially
with liquid nitrogen applications, but no improvement was achieved. Treatment
with CO2 laser induced an almost completely disappearance of
the lesions.
Discussion
LC is a rare disorder of the lymphatic channels and it is characterized
by a local distribution of grouped, thin-walled, translucent verrucous
vesicles. LC can appear at any site, but most commonly on the axilla,
shoulders, neck, proximal part of the limbs, perineum, tongue and buccal
mucous membranes [1]. Only a few reports describe LC on the vulva [2-9].
In older patients (ages 51-75 years), LC may appear after irradiation
or surgery for carcinoma [3-5, 9]. In younger patients (ages 20-35 years),
the lesions appear spontaneously [2, 6, 7].
Harwood and Mortimer [9] reported two patients,
49 and 50 years old, in whom vulvar lymphangiomata resulting from treatment
for cervical neoplasia were mistaken for viral warts. Our patient had
dark-colored skin, the lesions appeared spontaneously and were diagnosed
initially as condylomata acuminata. After the correct diagnosis was made,
the patient was treated with carbon dioxide laser and most lesions were
resolved.
Treatment is indicated because the lesions may
act as portals of entry for infection and for cosmetic or psychosexual
reasons. LC has been treated in the past with multiple agents, including
liquid nitrogen, electrocautery, radiotherapy and surgery. Recent literature
reports suggests that the best treatments are laser vaporization and excisional
surgery [6].
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