Taylor Dustin, Kash Natalie, Silapunt Sirunya
University of Texas McGovern Medical School, Houston, TX, USA.
Department of Dermatology, University of Texas McGovern Medical School, Houston, TX, USA.
Case Rep Dermatol Med. 2018 Feb 11;2018:6925105. doi: 10.1155/2018/6925105. eCollection 2018.
Lymphangioma circumscriptum is a superficially localized variant of lymphangioma. The characteristic clinical presentation is a "frogspawn" grouping of vesicles or papulovesicles on the proximal limb or limb girdle areas. Though most lymphangiomas develop congenitally, the lymphangioma circumscriptum subtype is known to present in adults. We report a case of lymphangioma circumscriptum on the left inframammary area of an African American female with an unusual supernumerary nipple-like clinical presentation. Our patient presented with a firm, smooth, hypopigmented papule, and the clinical diagnosis of keloid was made initially. However, she returned reporting growth of the lesion and was noted to have a firm, exophytic, lobulated, pink to skin-colored nodule. Histopathological examination demonstrated dilated lymphatic vessels, consistent with the diagnosis of lymphangioma. The presentation as a firm, hypopigmented papule and later exophytic, lobulated, skin-colored nodule in our case represents a clinical presentation of lymphangioma circumscriptum not previously described in the literature. Correct diagnosis in lymphangioma circumscriptum is vital, as recurrence following surgical resection and secondary development of lymphangiosarcoma and squamous cell carcinoma following treatment with radiation have been reported. Thus, it is important to consider lymphangioma circumscriptum in the differential of similar lesions in the future to allow appropriate diagnosis, treatment, and monitoring.
局限性淋巴管瘤是淋巴管瘤的一种浅表局限性变体。其特征性临床表现为近端肢体或肢体带区出现呈“蛙卵”样聚集的水疱或丘疹水疱。虽然大多数淋巴管瘤为先天性发育而来，但已知局限性淋巴管瘤亚型可在成人中出现。我们报告一例非裔美国女性左乳房下区域的局限性淋巴管瘤，其临床表现为罕见的多余乳头样表现。我们的患者最初表现为一个质地硬、表面光滑、色素减退的丘疹，初步临床诊断为瘢痕疙瘩。然而，她复诊时报告病变增大，发现有一个质地硬、外生性、分叶状、粉红色至肤色的结节。组织病理学检查显示淋巴管扩张，符合淋巴管瘤的诊断。在我们的病例中，最初表现为质地硬、色素减退的丘疹，随后发展为外生性、分叶状、肤色结节，这是文献中未曾描述过的局限性淋巴管瘤的临床表现。局限性淋巴管瘤的正确诊断至关重要，因为据报道手术切除后会复发，放疗后会继发淋巴管肉瘤和鳞状细胞癌。因此，今后在鉴别类似病变时考虑局限性淋巴管瘤很重要，以便进行适当的诊断、治疗和监测。
