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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Circumscribed lymphangioma &#40;LC&#41; is infrequent and usually develops congenitally&#44; being detected up to 90&#37; of the cases in the first decade of life&#59; however&#44; it can also develop in adulthood&#46;<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">1</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">LC in the adult generally appears in areas affected by trauma&#44; infection&#44; or radiation&#44; but it is also reported to appear spontaneously&#46;<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">2</span></a> It is described clinically as lumpy papules&#44; and as verrucose or firm vesicles with a smooth surface&#44; and is classified as a plaque&#44; characterized by its lymphatic content&#46; Histopathological examination describes dilated lymphatic vessels in the papillary dermis that elevate the epidermis above the surrounding skin&#46;<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">2</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">Reports of large-volume lymphangioma are very seldom described in the literature&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Case report</span><p id="par0020" class="elsevierStylePara elsevierViewall">A 51-year-old male from Peru&#44; with a history of liver failure and morbid obesity&#44; was transferred to the emergency department with a time of illness of eight months due to the presence of small tumor lesions at the pubic level&#44; which evolved to become large&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">Upon physical examination&#44; multiple lesions with a cystic appearance&#44; conglomerated&#44; with raised and umbilicated borders were evidenced in the pubis&#59; with a diameter of up to13<span class="elsevierStyleHsp" style=""></span>cm<span class="elsevierStyleHsp" style=""></span>&#215;<span class="elsevierStyleHsp" style=""></span>7<span class="elsevierStyleHsp" style=""></span>cm in which&#44; through their orifices&#44; they presented a purulent and foul exudate&#46; The lesions extended to the scrotal region where they were associated with grouped vesicles that bled during mobilization &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41;&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0030" class="elsevierStylePara elsevierViewall">The lower limbs showed scaly and cracked plaques with hard-consistency hyperkeratosis due to chronic lymphangitis&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">Histopathological studies of the biopsy concluded with the diagnosis of circumscribed lymphangioma &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a>&#41;&#46; The patient was treated with daily cures and antibiotics such as oxacillin and clindamycin during his hospital stay&#46; After two weeks of treatment&#44; the patient progressed with favorable evolution of the lesions&#44; with a decrease in size at the level of the pubis and scrotal region&#59; however&#44; due to the patient&#39;s underlying liver disease&#44; he died a month before he could undergo surgery&#46;</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Discussion</span><p id="par0040" class="elsevierStylePara elsevierViewall">Lymphangioma is an infrequent and benign malformation of the lymphatic system&#44; which can be classified according to the size or depth of the lesion&#46; Although the authors report this entity as having a large volume&#44; it lacks malignant potential&#44; explaining the increase in size due to its ability to branch out and grow in a disorderly manner&#46;<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">3</span></a></p><p id="par0045" class="elsevierStylePara elsevierViewall">The location of this entity is more frequent in the extremities&#44; neck&#44; and trunk&#44; while the appearance in the scrotal region is rare&#46;<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">4</span></a> The lesions described in the patient are not those that are usually mentioned in the literature&#59; the time of illness and the presence of associated infection&#44; and morbid obesity&#44; which probably contributed to the magnitude of the volume and expansion&#44; must be considered&#46; Moreover&#44; a significant reduction of the size and secretion of the lesions was observed due to the use of antibiotics and daily cures&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">The examiner should consider the characteristics of the lesions&#44; which may be confused with condyloma acuminatum&#44; molluscum&#44; contagiosum&#44; or herpes&#46; A thorough inspection and an adequate clinical history can exclude these differential diagnoses&#46;<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">5</span></a></p><p id="par0055" class="elsevierStylePara elsevierViewall">In lymphangiomas&#44; the basic treatment without risk of infection involves the use of surgical resection&#44; CO<span class="elsevierStyleInf">2</span> laser&#44; or sclerotherapy&#59; however there is the possibility of a spontaneous regression after three months that happens only in the macrocystic lymphangioma&#44; while in the rest&#44; the risk of recurrence appears between six months to six years&#46;<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">6</span></a></p><p id="par0060" class="elsevierStylePara elsevierViewall">The biopsy sample was considered to be a limitation because it was not representative&#44; since some histopathological characteristics were not similar to those reported by other studies&#46;<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">5</span></a> When the sampling was to be repeated in the scrotal region&#44; the patient had died&#46;</p><p id="par0065" class="elsevierStylePara elsevierViewall">In summary&#44; lymphangioma is an infrequent pathology in adults and the authors infer that the time of evolution&#44; infection&#44; and morbid obesity of the patient could have contributed to the atypical clinical manifestations described&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Financial support</span><p id="par0070" class="elsevierStylePara elsevierViewall">None declared&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Authors&#8217; contributions</span><p id="par0075" class="elsevierStylePara elsevierViewall">Cristian Mor&#225;n-Mari&#241;os&#58; Statistical analysis&#59; approval of final version of the manuscript&#59; drafting and editing of the manuscript&#59; collection&#44; analysis&#44; and interpretation of data&#59; intellectual participation in the propaedeutic and&#47;or therapeutic conduct of the studied cases&#59; critical review of the literature&#59; critical review of the manuscript&#46;</p><p id="par0080" class="elsevierStylePara elsevierViewall">Wendy Nieto-Gutierrez&#58; Approval of final version of the manuscript&#59; drafting and editing of the manuscript&#59; critical review of the literature&#59; critical review of the manuscript&#46;</p><p id="par0085" class="elsevierStylePara elsevierViewall">Josmel Pacheco-Mendoza&#58; Approval of final version of the manuscript&#59; drafting and editing of the manuscript&#59; critical review of the literature&#59; critical review of the manuscript&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Conflicts of interest</span><p id="par0090" class="elsevierStylePara elsevierViewall">None declared&#46;</p></span></span>"
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Case Report
Atypical lymphangioma and hyperkeratosis in a patient with morbid obesity
Cristian Morán-Mariñosa,
Corresponding author
cp.moran94@gmail.com

Corresponding author.
, Wendy Nieto-Gutierrezb, Josmel Pacheco-Mendozaa
a Bibliometric Investigation Unit, Universidad San Ignacio de Loyola, Lima, Peru
b Institute for the Evaluation of Health Technologies and Investigation, Seguro Social de Salud del Perú, Lima, Peru
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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Circumscribed lymphangioma &#40;LC&#41; is infrequent and usually develops congenitally&#44; being detected up to 90&#37; of the cases in the first decade of life&#59; however&#44; it can also develop in adulthood&#46;<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">1</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">LC in the adult generally appears in areas affected by trauma&#44; infection&#44; or radiation&#44; but it is also reported to appear spontaneously&#46;<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">2</span></a> It is described clinically as lumpy papules&#44; and as verrucose or firm vesicles with a smooth surface&#44; and is classified as a plaque&#44; characterized by its lymphatic content&#46; Histopathological examination describes dilated lymphatic vessels in the papillary dermis that elevate the epidermis above the surrounding skin&#46;<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">2</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">Reports of large-volume lymphangioma are very seldom described in the literature&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Case report</span><p id="par0020" class="elsevierStylePara elsevierViewall">A 51-year-old male from Peru&#44; with a history of liver failure and morbid obesity&#44; was transferred to the emergency department with a time of illness of eight months due to the presence of small tumor lesions at the pubic level&#44; which evolved to become large&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">Upon physical examination&#44; multiple lesions with a cystic appearance&#44; conglomerated&#44; with raised and umbilicated borders were evidenced in the pubis&#59; with a diameter of up to13<span class="elsevierStyleHsp" style=""></span>cm<span class="elsevierStyleHsp" style=""></span>&#215;<span class="elsevierStyleHsp" style=""></span>7<span class="elsevierStyleHsp" style=""></span>cm in which&#44; through their orifices&#44; they presented a purulent and foul exudate&#46; The lesions extended to the scrotal region where they were associated with grouped vesicles that bled during mobilization &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41;&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0030" class="elsevierStylePara elsevierViewall">The lower limbs showed scaly and cracked plaques with hard-consistency hyperkeratosis due to chronic lymphangitis&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">Histopathological studies of the biopsy concluded with the diagnosis of circumscribed lymphangioma &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a>&#41;&#46; The patient was treated with daily cures and antibiotics such as oxacillin and clindamycin during his hospital stay&#46; After two weeks of treatment&#44; the patient progressed with favorable evolution of the lesions&#44; with a decrease in size at the level of the pubis and scrotal region&#59; however&#44; due to the patient&#39;s underlying liver disease&#44; he died a month before he could undergo surgery&#46;</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Discussion</span><p id="par0040" class="elsevierStylePara elsevierViewall">Lymphangioma is an infrequent and benign malformation of the lymphatic system&#44; which can be classified according to the size or depth of the lesion&#46; Although the authors report this entity as having a large volume&#44; it lacks malignant potential&#44; explaining the increase in size due to its ability to branch out and grow in a disorderly manner&#46;<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">3</span></a></p><p id="par0045" class="elsevierStylePara elsevierViewall">The location of this entity is more frequent in the extremities&#44; neck&#44; and trunk&#44; while the appearance in the scrotal region is rare&#46;<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">4</span></a> The lesions described in the patient are not those that are usually mentioned in the literature&#59; the time of illness and the presence of associated infection&#44; and morbid obesity&#44; which probably contributed to the magnitude of the volume and expansion&#44; must be considered&#46; Moreover&#44; a significant reduction of the size and secretion of the lesions was observed due to the use of antibiotics and daily cures&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">The examiner should consider the characteristics of the lesions&#44; which may be confused with condyloma acuminatum&#44; molluscum&#44; contagiosum&#44; or herpes&#46; A thorough inspection and an adequate clinical history can exclude these differential diagnoses&#46;<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">5</span></a></p><p id="par0055" class="elsevierStylePara elsevierViewall">In lymphangiomas&#44; the basic treatment without risk of infection involves the use of surgical resection&#44; CO<span class="elsevierStyleInf">2</span> laser&#44; or sclerotherapy&#59; however there is the possibility of a spontaneous regression after three months that happens only in the macrocystic lymphangioma&#44; while in the rest&#44; the risk of recurrence appears between six months to six years&#46;<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">6</span></a></p><p id="par0060" class="elsevierStylePara elsevierViewall">The biopsy sample was considered to be a limitation because it was not representative&#44; since some histopathological characteristics were not similar to those reported by other studies&#46;<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">5</span></a> When the sampling was to be repeated in the scrotal region&#44; the patient had died&#46;</p><p id="par0065" class="elsevierStylePara elsevierViewall">In summary&#44; lymphangioma is an infrequent pathology in adults and the authors infer that the time of evolution&#44; infection&#44; and morbid obesity of the patient could have contributed to the atypical clinical manifestations described&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Financial support</span><p id="par0070" class="elsevierStylePara elsevierViewall">None declared&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Authors&#8217; contributions</span><p id="par0075" class="elsevierStylePara elsevierViewall">Cristian Mor&#225;n-Mari&#241;os&#58; Statistical analysis&#59; approval of final version of the manuscript&#59; drafting and editing of the manuscript&#59; collection&#44; analysis&#44; and interpretation of data&#59; intellectual participation in the propaedeutic and&#47;or therapeutic conduct of the studied cases&#59; critical review of the literature&#59; critical review of the manuscript&#46;</p><p id="par0080" class="elsevierStylePara elsevierViewall">Wendy Nieto-Gutierrez&#58; Approval of final version of the manuscript&#59; drafting and editing of the manuscript&#59; critical review of the literature&#59; critical review of the manuscript&#46;</p><p id="par0085" class="elsevierStylePara elsevierViewall">Josmel Pacheco-Mendoza&#58; Approval of final version of the manuscript&#59; drafting and editing of the manuscript&#59; critical review of the literature&#59; critical review of the manuscript&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Conflicts of interest</span><p id="par0090" class="elsevierStylePara elsevierViewall">None declared&#46;</p></span></span>"
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Article information
ISSN: 03650596
Original language: English
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