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Eur. J. Pediat. Dermatol.
25, 20-23, 2015
Acquired lymphangiectasis
associated with a surgery scar from a congenital hemangioma.
Ting Tian, Ru-zhi Zhang
Department of Dermatology
The Third Affiliated Hospital of Soochow University
Changzhou, P.R. China
Summary Acquired lymphangiectasis (AL) occurs due to the blockage of deep lymphatic vessels.
The latter is responsible for dilated dermal lymphatic channels that can induce superficial
vesicle formation. We report an 11-year-old girl presented to us with a 10-year history of
translucent thick-walled vesicles, which was diagnosed as AL according to the typical clinical lesions.
Key words Acquired lymphangiectasis; surgery scar; congenital hemangioma.
A
1-5 mm in diameter, on her left upper extremity
(Fig. 1). She had undergone surgery for a congenital hemangioma on her left axilla and left upper extremity when she was one year old. After
the surgery, she had surgery-related scars in both
axilla and upper limb .
About a few months after the surgery, the parents noticed that a few vesicles had appeared on
their daughter’s left upper extremity near the surgery scar. It was inferred that these lesions had
appeared progressively over the previous year.
Two months before the examination, the lesions
sometimes drained a clear fluid but were otherwise asymptomatic. No significant lymphadenopathy had developed on the axilla or upper extremity.
On dermatological examination, the patient
had multiple, 1 to 5 mm, clear to yellowish, thickwalled, grouped vesicles located on her left upper
extremity in an area of approximately 5 cm. Moreover, there were also some scattered vesicles,
2-3 mm in diameter, on the left extremity. The
content inside the vesicles was a clear fluid. She
also had long congenital hemangioma surgery-
cquired lymphangiectasis (AL) occurs
due to the blockage of deep lymphatic
vessels. The latter is responsible for dilated dermal lymphatic channels that can induce
superficial vesicle formation. The development
of AL occurs secondarily in the areas of the skin
affected by the destruction and/or obstruction
of lymphatic drainage. No specific histological
criteria can be used to differentiate primary lymphangioma circumscriptum from AL, the only
difference being the early onset and the lack of
external acquired causes in lympangioma circuscriptum. We report an 11-year-old girl with a 10year history of translucent thick-walled vesicles,
which were clinically diagnosed as AL.
To our knowledge, there are no previous reports of AL associated with a surgery scar from a
congenital hemangioma.
Case report
An 11-year-old girl presented to us with a 10year history of translucent thick-walled vesicles,
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Acquired lymphangiectasis
Fig. 1: Acquired lymphangectasias of the left upper limb in an 11-year-old girl, secondary to surgery performed at the age of
1 year to remove a congenital hemangioma.
be used to differentiate primary lymphangioma
circumscriptum from AL. The pathogenesis of
these conditions involves the obstruction and/or
damage of deep lymphatic vessels that leads to
increased lymphatic pressure and dilatation of
the vessels. The diagnosis does not present a significant problem, and it is based mainly on the
clinical presentation.
AL have been reported in association with repeated trauma (16), surgery, hysterectomy and
radiation therapy for carcinoma (5), resection
of regional lymph nodes alone (17), pregnancy,
scarring from scrofuloderma (7), scleroderma
and keloids, Crohn’s disease treated with marsupialization of perianal fistulae (3), malignancies, tuberculosis (4, 15), topical corticosteroid
application (2) and recurrent cutaneous infections (12). Lymphangiectasias can also develop
a hyperkeratotic surface that mimics warts (8).
Pain and oozing may occur after infection.
related scars on her left axilla and medial aspect
of the left upper limb.
Although the patient and her parents refused a
skin biopsy, a diagnosis of AL was made according to her medical history and the characteristic
clinical lesions.
Discussion
Lymphangiomas may be divided, according to
Flanagan and Helwig (9), into two forms: superficial lymphangioma circumscriptum and deep
lymphangioma cavernosum. These primary lymphangiomas usually present at birth or soon afterwards.
Acquired dilatation of lymphatic vessels are
called AL, which represent an acquired dilatation of lymphatic channels secondary to an external cause. No specific histological criteria can
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Tian, Zhang
grafting, sclerotherapy (1), cryotherapy, electrodesiccation and/or carbon dioxide laser vaporization (6).
Although the preferred treatment of AL is
complete surgical excision, recurrence may occur because of the persistence of deep lymphatic
vessels after treatment (10).
Carbon dioxide lasers can not treat deep vessels, but the surface lymphatic vessels are vaporized and communicating channels to the deeper
vessels are sealed (13). Moreover, carbon dioxide laser therapy can be used easily under local
anesthesia, so the carbon dioxide laser may be a
better choice. However, our patient refused any
treatment.
Minor trauma and solar elastosis from chronic
ultraviolet radiation exposure may be etiologic
factors in the development of AL; the latter is associated with decreased immune cell trafficking
and cell-mediated immunity (14).
We think that the lesions in our patient are acquired and are due to impaired lymph flow, considering in particular their late onset (11) and the
fact that in our patient the lymphangiectasia appeared to be associated with a congenital hemangioma surgery scar that may have altered lymph
flow and damaged lymphatic vessels, that resulted in the acquired lymphatic obstruction.
Treatment of AL often includes surgical resection of the involved tissue and closure with skin
Address to:
Ru-zhi Zhang, M.D.
Department of Dermatology
The 3rd Affiliated Hospital of Soochow University
195 Juqian Road, Changzhou
P.R. China 213000
e-mail: [email protected]
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Acquired lymphangiectasis
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