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LETTER TO EDITOR
Year : 1995  |  Volume : 61  |  Issue : 4  |  Page : 237-238

Lymphangioma circumscriptum masquerading as larva migrans




Correspondence Address:
M Devinder Thappa


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Source of Support: None, Conflict of Interest: None


PMID: 20952969

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How to cite this article:
Thappa M D, Garg B R, Ratnakar C. Lymphangioma circumscriptum masquerading as larva migrans. Indian J Dermatol Venereol Leprol 1995;61:237-8

How to cite this URL:
Thappa M D, Garg B R, Ratnakar C. Lymphangioma circumscriptum masquerading as larva migrans. Indian J Dermatol Venereol Leprol [serial online] 1995 [cited 2019 Sep 16];61:237-8. Available from: http://www.ijdvl.com/text.asp?1995/61/4/237/4222



  To the Editor, Top


A 30-year-old man presented with mildly itchy eruptions on right upper limb that had been present for last 3 months. The lesions had commenced on right forearm and gradually spread to the upper arm. There was no history of any operative procedure performed on the arm or local radiation therapy for any tumour. No family history of similar disorder was forthcoming.

Cutaneous examination revealed serpiginous raised shiny skin lesions of irregular shape over the right forearm (flexor aspect), elbow and upper arm (medial and flexor aspects). Some of these lesions were forming arcuate pattern. The width of these lesions was varying from 1 mm to 3 mm and were easily compressible. On puncturing the lesions exuded clear watery fluid. Rest of the cutaneous and systemic examination was unremarkable.

A clinical diagnosis of larva migrans was initially made, as this disease is endemic here and patient was put on oral albendazole 400 mg twice daily for 3 days, without any relief. Hence, skin biopsy was performed. Microscopic examination of section from skin lesions showed dilated lymphatic vessels lined by single layer of endothelium, containing lymph. The overlying epidermis was thinned out at places. In other areas, the epidermis showed hyperkeratosis and papillomatosis. There was also mild lymphocytic infiltrate in the dermis. A final diagnosis of lymphangioma circumscriptum was made on the basis of histopathologic findings.

The cutaneous lymphangioma, benign lesions of the lymphatic vessels, though uncommon, occurs in several forms that differ in histologic characteristics and prognosis.[1] They may be broadly classified into superficial lymphangioma circumscriptum and deep lymphangioma cavernosum.[2] The former, usually manifest as irregular clusters of vesicles forming no particular pattern, but in occasional cases forms linear or band like lesions.[3] It has been further subdivided into classical and localised forms on the basis of size of the lesion. The lesions of the classical type may occur over any part of the body, but are mostly concentrated over the proximal parts of limbs and the adjacent parts of limb girdles.[2] Usually, it manifests at birth or soon afterwards,[2] may become clinically apparent at any age.[1] The atypical serpiginous skin lesions mimicking cutaneous larva migrans in our case were observed for the first time at the age of 30 years.

Many authors distinguish between the lymphangioma circumscriptum that arise de novo and lymphangiectasia that occur subsequent to surgical operation or irradiation. Clinically and histologically, the lesions are usually indistinguishable and differentiation is often made on the basis of clinical history. [1,2] The histopathological diagnosis of lymphangioma is established by the presence of thin walled vascular channels that are empty or contain eosinophilic homogeneous material (lymph) and few or no erythrocytes. Characteristically, these channels show widely spaced endothelial nuclei lining, irregular lumen and absence of muscular layer surrounding the endothelial lining. The changes in the tissue around these vessels vary with different types of lymphangioma.[1][3]

 
  References Top

1.Flanagan BP, Helwig EB. Cutaneous lymphangioma. Arch Dermatol 1977;113:24-30,  Back to cited text no. 1  [PUBMED]  
2.Peachey RDG, Lim CC, Whimster LW. Lymphangioma of skin. A review of 65 cases. Br J Dermatol 1970;83:519-27.  Back to cited text no. 2    
3.Francis AG. Lymphangioma circumscriptum cutis. Br J Dermatol 1893;5:33 and 65.  Back to cited text no. 3    




 

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