Acquired Vulvar Lymphangioma Circumscriptum

Lymphangioma circumscriptum (LC) is a benign dilation of lymph channels localized to the skin and subcutaneous tissues. It is generally localized in mouth mucosa, tongue, proximal regions of arms and legs, groin, axilla, and trunk. Primary vulvar involvement is very rare. Vulvar involvement occurs in various clinical settings. Here, two uncommon cases with giant lymphangioma circumscriptum mimicking genital warts will be presented: a 55-year-old female patient with extensive lymphangiectasic lesions and genital wart-like papular lesions in the vulva secondary to diffuse scrofuloderma scars and a 60-year-old female patient with verruca-like lesions secondary to chronic inflammation. 1. Case 1 A 55-year-old female patient was admitted to our outpatient clinic for her complaints of oozy and itchy raised lesions. Dermatologic examination revealed multiple scars of scrofuloderma, typically in the form of a cord travelling over the neck, axilla, inguinal region, trunk, and the extremities (Figure 1). There was lymphedema of the vulva and labia majora associated with multiple bilateral pseudovesicular lesions which were a few mm in size. Some of the lesions were full of serous fluid and formed groups in the pubis, labia majora, vulva, and the inguinal region (Figure 2). There was obvious nonpitting edema in the right foot and leg (Figure 3). Figure 1: Scar tissue forming constrictions on the neck. Figure 2: Widespread papules and vesicles on the pubis, labia majora, and inguinal region. Figure 3: Nonpitting edema of the right leg and foot. History of the patient revealed exudative wounds which started in right side of the neck almost 35 years ago and spread over the axilla and to the bottom of the thorax and left scars as they healed. Similar lesions also occurred in the inguinal and genital regions almost 25 years ago. Doppler ultrasonography yielded normal results for this patient. All the other routine examinations including VDRL test produced normal or negative results. Histopathology of the lesions suggested lymphangioma. The patient whose complaints got very significant occasionally was recommended short term anti-inflammatory treatment for her exudative lesions in the vulvar region. In addition, the patient was referred to the plastic surgery outpatient clinic for a possible vulvectomy operation due to the severity of her symptoms. However, the patient rejected the operation and has been regularly followedup since then. 2. Case 2 A 60-year-old female patient presented to the gynecology and obstetrics outpatient clinic with complaints of abdominal