Generic selectors
Exact matches only
Search in title
Search in content
Search in posts
Search in pages
Filter by Categories
15th National Conference of the IAOMFP, Chennai, 2006
Abstract
Abstracts from current literature
Acne in India: Guidelines for management - IAA Consensus Document
Addendum
Announcement
Art & Psychiatry
Article
Articles
Association Activities
Association Notes
Award Article
Book Review
Brief Report
Case Analysis
Case Letter
Case Letters
Case Notes
Case Report
Case Reports
Clinical and Laboratory Investigations
Clinical Article
Clinical Studies
Clinical Study
Commentary
Conference Oration
Conference Summary
Continuing Medical Education
Correspondence
Corrigendum
Cosmetic Dermatology
Cosmetology
Current Best Evidence
Current View
Derma Quest
Dermato Surgery
Dermatopathology
Dermatosurgery Specials
Dispensing Pearl
Do you know?
Drug Dialogues
e-IJDVL
Editor Speaks
Editorial
Editorial Remarks
Editorial Report
Editorial Report - 2007
Editorial report for 2004-2005
Errata
Erratum
Focus
Fourth All India Conference Programme
From Our Book Shelf
From the Desk of Chief Editor
General
Get Set for Net
Get set for the net
Guest Article
Guest Editorial
History
How I Manage?
IADVL Announcement
IADVL Announcements
IJDVL Awards
IJDVL AWARDS 2015
IJDVL Awards 2018
IJDVL Awards 2019
IJDVL Awards 2020
IJDVL International Awards 2018
Images in Clinical Practice
In Memorium
Inaugural Address
Index
Knowledge From World Contemporaries
Leprosy Section
Letter in Response to Previous Publication
Letter to Editor
Letter to the Editor
Letter to the Editor - Case Letter
Letter to the Editor - Letter in Response to Published Article
LETTER TO THE EDITOR - LETTERS IN RESPONSE TO PUBLISHED ARTICLES
Letter to the Editor - Observation Letter
Letter to the Editor - Study Letter
Letter to the Editor - Therapy Letter
Letter to the Editor: Articles in Response to Previously Published Articles
Letters to the Editor
Letters to the Editor - Letter in Response to Previously Published Articles
Letters to the Editor: Case Letters
Letters to the Editor: Letters in Response to Previously Published Articles
Medicolegal Window
Messages
Miscellaneous Letter
Musings
Net Case
Net case report
Net Image
Net Letter
Net Quiz
Net Study
New Preparations
News
News & Views
Obervation Letter
Obituary
Observation Letter
Observation Letters
Oration
Original Article
ORIGINAL CONTRIBUTION
Original Contributions
Pattern of Skin Diseases
Pearls
Pediatric Dermatology
Pediatric Rounds
Perspective
Presedential Address
Presidential Address
Presidents Remarks
Quiz
Recommendations
Regret
Report
Report of chief editor
Report of Hon : Treasurer IADVL
Report of Hon. General Secretary IADVL
Research Methdology
Research Methodology
Resident page
Resident's Page
Resident’s Page
Residents' Corner
Residents' Corner
Residents' Page
Retraction
Review
Review Article
Review Articles
Revision Corner
Self Assessment Programme
SEMINAR
Seminar: Chronic Arsenicosis in India
Seminar: HIV Infection
Short Communication
Short Communications
Short Report
Special Article
Specialty Interface
Studies
Study Letter
Supplement-Photoprotection
Supplement-Psoriasis
Symposium - Contact Dermatitis
Symposium - Lasers
Symposium - Pediatric Dermatoses
Symposium - Psoriasis
Symposium - Vesicobullous Disorders
SYMPOSIUM - VITILIGO
Symposium Aesthetic Surgery
Symposium Dermatopathology
Symposium-Hair Disorders
Symposium-Nails Part I
Symposium-Nails-Part II
Tables
Technology
Therapeutic Guidelines
Therapeutic Guidelines - IADVL
Therapeutics
Therapy
Therapy Letter
View Point
Viewpoint
What’s new in Dermatology
Case Report
2002:68:3;166-167
PMID: 17656926

Acquired vulval lymphangiectases mimicking genital warts

Rajeev Sharma, Sudarshan Tomar, Mithilesh Chandra
 Bishen Skin Centre and Krishna Memorial Clinic, India

Correspondence Address:
Rajeev Sharma
M-69, Morris Road, Aligarh-202 001
India
How to cite this article:
Sharma R, Tomar S, Chandra M. Acquired vulval lymphangiectases mimicking genital warts. Indian J Dermatol Venereol Leprol 2002;68:166-167
Copyright: (C)2002 Indian Journal of Dermatology, Venereology, and Leprology

Abstract

Acquired lymphangiectasia can sometimes occur on the vulva and cause diagnostic difficulties especially if they have a warty appearance. We report a case of acquired vulva I lymphangiectasia which mimicked genital warts.
Keywords: Vulval, Lymphangiectasia

Introduction

Acquired cutaneous lymphangiectasia (ACL) sometimes arises following damage to the deeper lymphatic vessels. The known causes for ACL include scarring after some surgical procedures, keloid formation, chronic infections or radiotherapy which cause alterations in the connective tissue and obstruction of the lymphatic vessels. Clinically ACL resembles lymphangioma circumscriptum, which is a developmental defect of the deep dermal and subcutaneous lymphatics. The lesions may start oozing after trivial trauma, and not only be a cause for concern, but also provide a route for entry to the pathogenic organisms.

We describe a case of acquired cutaneous lymphangiectasis of the vulva mimicking genital warts that followed removal of the inguinal nodes for probable tubercular lymphadenitis.

Case Report

A 48-year- old woman developed papulo-nodules on the vulva for the last 5 years. She had difficulty during intercourse but was otherwise healthy. Oozing used to occur during and / or soon after intercourse and the vulva would often become swollen and tender. This would subside after a course of antibiotics. Twelve years ago, she had undergone an operation in the inguinal region for the removal of some nodules, the details of which were not known. Examination revealed multiple, firm translucent to milky white, warty papules solitary at places but mostly grouped [Figure - 1] on the vulva and the mons pubis along with mild vulvar edema. On puncturing a lesion with a fine needle, straw-colored fluid came out. Scars were present in both the inguinal regions. Complete analysis on blood, liver and renal function tests, urinalysis, and stool examinations were normal or negative. Gynaecological workup and untrasonography of the pelvic organs revealed no abnormality. A skin biopsy revealed multiple dilated channels in the dermis lined by a single layer of edothelial cells [Figure - 2]. A few channels had deposition of an eosinophilic material and a few polymorphs. Thrombosis of a few vessels with deposition of fibrinod material was also present.

A wide excision of the lesions (vulvectomy) led to complete recovery and there was no recurrence during a follow up of 1 year.

Discussion

Congenital lymphangioma and acquired lymphangiectasias are clinically indistinguishable. The differentiation however is possible on the basis of history because lymphangiomas are present since birth or early childhood, while acquired cutaneous lymphangiectasia develop later and probably result from injury and damage to the deep collecting channels in the conection tissue leading to build up of the lymph in the superficial vessels and subsequent formation of the lesions. The literature has reports of 23 case of vulval lymphangiectases.[1] Most of them followed surgery/radiotherapy for carcinoma of the cervix or vulva, tubercular inguinal lymphadenitis, or Crohn′s disease of the vulva. In 6 cases the cause could not be ascertained. The most common presentation was thin-walled vesicles filled with a clear fluid. Rarely, they may develop a hyperkeratotic appearance,[2] and often misdiagnosed and treated as viral warts before the correct diagnosis is established. This variation in the morphology is explained on the basis of a gradual tissue organization, probably enhanced by the presence of lymphoedema.[3],[4] Lymphoedema as in our case, has been observed in only a few cases. Recurrent cellulitis has also been reported earlier. The interval between the surgery and the lymphangiomatous lesions may be several years. Our patient underwent a wide vulvectomy and had no recurrence during a follow up period of 1 year.

References
1.
Vingili A, Corazza M. Lymphangioma and lymphangiectasis of the vulva. J Eur Acad Dermatol Venereal 1997;88:229-232.
[Google Scholar]
2.
Harwood CA, Mortimer PS. Acquired vulval lymphangiomata mimicking gential warts. Br J Dermatol 1993;129:334-336.
[Google Scholar]
3.
Hanfieldjones SE, Prendiville WJ, Norman S. Vulval lymphangiectasia. Genitourin Med 1989;65:335-337.
[Google Scholar]
4.
Whimster IW. The pathology of lymphangioma circumscriptum. Br J Dermatol 1976;94:473-486.
[Google Scholar]
Show Sections