Case Report
Atypical lymphangioma and hyperkeratosis in a patient with morbid obesity
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Histopathological examination describes dilated lymphatic vessels in the papillary dermis that elevate the epidermis above the surrounding skin.<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.</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, with a history of liver failure and morbid obesity, 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, which evolved to become large.</p><p id="par0025" class="elsevierStylePara elsevierViewall">Upon physical examination, multiple lesions with a cystic appearance, conglomerated, with raised and umbilicated borders were evidenced in the pubis; with a diameter of up to13<span class="elsevierStyleHsp" style=""></span>cm<span class="elsevierStyleHsp" style=""></span>×<span class="elsevierStyleHsp" style=""></span>7<span class="elsevierStyleHsp" style=""></span>cm in which, through their orifices, they presented a purulent and foul exudate. The lesions extended to the scrotal region where they were associated with grouped vesicles that bled during mobilization (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>).</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.</p><p id="par0035" class="elsevierStylePara elsevierViewall">Histopathological studies of the biopsy concluded with the diagnosis of circumscribed lymphangioma (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>). The patient was treated with daily cures and antibiotics such as oxacillin and clindamycin during his hospital stay. After two weeks of treatment, the patient progressed with favorable evolution of the lesions, with a decrease in size at the level of the pubis and scrotal region; however, due to the patient's underlying liver disease, he died a month before he could undergo surgery.</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, which can be classified according to the size or depth of the lesion. Although the authors report this entity as having a large volume, it lacks malignant potential, explaining the increase in size due to its ability to branch out and grow in a disorderly manner.<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, neck, and trunk, while the appearance in the scrotal region is rare.<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; the time of illness and the presence of associated infection, and morbid obesity, which probably contributed to the magnitude of the volume and expansion, must be considered. Moreover, a significant reduction of the size and secretion of the lesions was observed due to the use of antibiotics and daily cures.</p><p id="par0050" class="elsevierStylePara elsevierViewall">The examiner should consider the characteristics of the lesions, which may be confused with condyloma acuminatum, molluscum, contagiosum, or herpes. A thorough inspection and an adequate clinical history can exclude these differential diagnoses.<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">5</span></a></p><p id="par0055" class="elsevierStylePara elsevierViewall">In lymphangiomas, the basic treatment without risk of infection involves the use of surgical resection, CO<span class="elsevierStyleInf">2</span> laser, or sclerotherapy; however there is the possibility of a spontaneous regression after three months that happens only in the macrocystic lymphangioma, while in the rest, the risk of recurrence appears between six months to six years.<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, since some histopathological characteristics were not similar to those reported by other studies.<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">5</span></a> When the sampling was to be repeated in the scrotal region, the patient had died.</p><p id="par0065" class="elsevierStylePara elsevierViewall">In summary, lymphangioma is an infrequent pathology in adults and the authors infer that the time of evolution, infection, and morbid obesity of the patient could have contributed to the atypical clinical manifestations described.</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Financial support</span><p id="par0070" class="elsevierStylePara elsevierViewall">None declared.</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Authors’ contributions</span><p id="par0075" class="elsevierStylePara elsevierViewall">Cristian Morán-Mariños: Statistical analysis; approval of final version of the manuscript; drafting and editing of the manuscript; collection, analysis, and interpretation of data; intellectual participation in the propaedeutic and/or therapeutic conduct of the studied cases; critical review of the literature; critical review of the manuscript.</p><p id="par0080" class="elsevierStylePara elsevierViewall">Wendy Nieto-Gutierrez: Approval of final version of the manuscript; drafting and editing of the manuscript; critical review of the literature; critical review of the manuscript.</p><p id="par0085" class="elsevierStylePara elsevierViewall">Josmel Pacheco-Mendoza: Approval of final version of the manuscript; drafting and editing of the manuscript; critical review of the literature; critical review of the manuscript.</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.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:9 [ 0 => array:3 [ "identificador" => "xres1370006" "titulo" => "Abstract" "secciones" => array:1 [ 0 => array:1 [ "identificador" => "abst0005" ] ] ] 1 => array:2 [ "identificador" => "xpalclavsec1259078" "titulo" => "Keywords" ] 2 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 3 => array:2 [ "identificador" => "sec0010" "titulo" => "Case report" ] 4 => array:2 [ "identificador" => "sec0015" "titulo" => "Discussion" ] 5 => array:2 [ "identificador" => "sec0020" "titulo" => "Financial support" ] 6 => array:2 [ "identificador" => "sec0025" "titulo" => "Authors’ contributions" ] 7 => array:2 [ "identificador" => "sec0030" "titulo" => "Conflicts of interest" ] 8 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2019-06-25" "fechaAceptado" => "2019-11-27" "PalabrasClave" => array:1 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec1259078" "palabras" => array:3 [ 0 => "Ichthyosis" 1 => "Lymphangioma" 2 => "Obesity, morbid" ] ] ] ] "tieneResumen" => true "resumen" => array:1 [ "en" => array:2 [ "titulo" => "Abstract" "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Lymphangioma is a rare and understudied pathology that is usually detected in the first decade of life, and its appearance in adults is rare. This report details a 51-year-old man with morbid obesity who presented, for the last eight months, multiple asymmetric tumor lesions with extension to the scrotal region. The diagnosis of circumscribed lymphangioma with associated infection was confirmed. This case report demonstrates an unusual presentation of the characteristics of the lymphangioma that are seldom described in the literature.</p></span>" ] ] "NotaPie" => array:2 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">How to cite this article: Morán-Mariños C, Nieto-Gutierrez W, Pacheco-Mendoza J. Atypical lymphangioma and hyperkeratosis in a patient with morbid obesity. An Bras Dermatol. 2020;95:477–9.</p>" ] 1 => array:2 [ "etiqueta" => "☆☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0010">Study conducted at the Universidad San Ignacio de Loyola, Lima, Peru.</p>" ] ] "multimedia" => array:2 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 702 "Ancho" => 1007 "Tamanyo" => 148207 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Multiple, grouped lesions of irregular size with purulent discharge.</p>" ] ] 1 => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 804 "Ancho" => 1007 "Tamanyo" => 162794 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Proliferation of dilated lymphatic vessels with thin, irregular walls, lined by soft endothelial cells in the papillary dermis and with non-atypical lymphocytic aggregates; histopathology (Hematoxylin & eosin, x10).</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:6 [ 0 => array:3 [ "identificador" => "bib0035" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Vascular anomalies classification: recommendations from the International Society for the Study of Vascular Anomalies" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "M. 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| Ano/Mês | Html | Total | |
|---|---|---|---|
| 2024 Novembro | 14 | 6 | 20 |
| 2024 Outubro | 88 | 70 | 158 |
| 2024 Setembro | 144 | 81 | 225 |
| 2024 Agosto | 160 | 95 | 255 |
| 2024 Julho | 139 | 123 | 262 |
| 2024 Junho | 95 | 79 | 174 |
| 2024 Maio | 102 | 55 | 157 |
| 2024 Abril | 113 | 86 | 199 |
| 2024 Março | 117 | 71 | 188 |
| 2024 Fevereiro | 177 | 82 | 259 |
| 2024 Janeiro | 119 | 53 | 172 |
| 2023 Dezembro | 109 | 69 | 178 |
| 2023 Novembro | 96 | 69 | 165 |
| 2023 Outubro | 56 | 77 | 133 |
| 2023 Setembro | 106 | 85 | 191 |
| 2023 Agosto | 55 | 36 | 91 |
| 2023 Julho | 69 | 29 | 98 |
| 2023 Junho | 69 | 42 | 111 |
| 2023 Maio | 53 | 24 | 77 |
| 2023 Abril | 45 | 13 | 58 |
| 2023 Março | 64 | 48 | 112 |
| 2023 Fevereiro | 59 | 27 | 86 |
| 2023 Janeiro | 68 | 39 | 107 |
| 2022 Dezembro | 67 | 23 | 90 |
| 2022 Novembro | 81 | 52 | 133 |
| 2022 Outubro | 69 | 56 | 125 |
| 2022 Setembro | 54 | 54 | 108 |
| 2022 Agosto | 105 | 50 | 155 |
| 2022 Julho | 104 | 60 | 164 |
| 2022 Junho | 45 | 52 | 97 |
| 2022 Maio | 44 | 50 | 94 |
| 2022 Abril | 38 | 37 | 75 |
| 2022 Março | 39 | 53 | 92 |
| 2022 Fevereiro | 23 | 34 | 57 |
| 2022 Janeiro | 61 | 74 | 135 |
| 2021 Dezembro | 42 | 50 | 92 |
| 2021 Novembro | 60 | 61 | 121 |
| 2021 Outubro | 55 | 72 | 127 |
| 2021 Setembro | 33 | 48 | 81 |
| 2021 Agosto | 47 | 49 | 96 |
| 2021 Julho | 43 | 44 | 87 |
| 2021 Junho | 27 | 50 | 77 |
| 2021 Maio | 66 | 84 | 150 |
| 2021 Abril | 104 | 282 | 386 |
| 2021 Março | 52 | 53 | 105 |
| 2021 Fevereiro | 17 | 18 | 35 |
| 2021 Janeiro | 19 | 21 | 40 |
| 2020 Dezembro | 14 | 20 | 34 |
| 2020 Novembro | 14 | 20 | 34 |
| 2020 Outubro | 32 | 43 | 75 |
| 2020 Setembro | 21 | 17 | 38 |
| 2020 Agosto | 14 | 10 | 24 |
| 2020 Julho | 21 | 12 | 33 |
| 2020 Junho | 14 | 13 | 27 |
| 2020 Maio | 11 | 17 | 28 |
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