Case for Diagnosis
Pseudoverrucous Lesions of Recent Appearance on the Vulva
Lesiones seudoverrugosas vulvares de reciente aparición
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Padilla-España, J. Bosco Repiso-Jiménez, C. Abitei" "autores" => array:3 [ 0 => array:4 [ "nombre" => "L." "apellidos" => "Padilla-España" "email" => array:1 [ 0 => "laura.padilla.espana@gmail.com" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "J." "apellidos" => "Bosco Repiso-Jiménez" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 2 => array:3 [ "nombre" => "C." "apellidos" => "Abitei" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] ] "afiliaciones" => array:2 [ 0 => array:3 [ "entidad" => "Servicio de Dermatología, Hospital Costa del Sol, Marbella, Málaga, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Servicio de Anatomía Patológica, Hospital Costa del Sol, Marbella, Málaga, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Lesiones seudoverrugosas vulvares de reciente aparición" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 1000 "Ancho" => 1333 "Tamanyo" => 300745 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Hematoxylin and eosin, original magnification<span class="elsevierStyleHsp" style=""></span>×10.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Medical History</span><p id="par0005" class="elsevierStylePara elsevierViewall">A 47-year-old woman with no past medical history of interest had previously been seen for genital warts that had resolved completely after treatment with imiquimod cream, 5%. Five years later, she was referred back to dermatology for the appearance of similar lesions in the vulvar region.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Physical Examination</span><p id="par0010" class="elsevierStylePara elsevierViewall">Multiple translucent exophytic papular lesions, some of them pedunculated, were observed in the pubic region, with further grouped lesions producing a cobblestone pattern, occupying a large area of the labia majora (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>).</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Histopathology</span><p id="par0015" class="elsevierStylePara elsevierViewall">Biopsy of a lesion showed epidermal hyperplasia with acanthosis and hyperkeratosis with dilated lymph vessels in the papillary dermis (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>). Immunohistochemistry was positive for podoplanin (D2-40) (<a class="elsevierStyleCrossRef" href="#fig0015">Fig. 3</a>).</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><elsevierMultimedia ident="fig0015"></elsevierMultimedia></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Additional Tests</span><p id="par0020" class="elsevierStylePara elsevierViewall">High-resolution skin ultrasound revealed well-defined hypoechoic dermal lesions with no intralesional blood vessels. No significant alterations of the internal genitalia were observed on abdominopelvic magnetic resonance imaging.</p><p id="par0025" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleBold">What is Your Diagnosis?</span></p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Diagnosis</span><p id="par0030" class="elsevierStylePara elsevierViewall">Acquired vulvar lymphangioma circumscriptum.</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Clinical Course</span><p id="par0035" class="elsevierStylePara elsevierViewall">Surgical treatment of the affected area achieved resolution of the lesions and a good functional and cosmetic result.</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Comment</span><p id="par0040" class="elsevierStylePara elsevierViewall">Lymphangioma circumscriptum (LC) is a rare, benign lymph vessel disorder that can arise on any area of the skin, though it is most common on the chest, thighs, and buttocks. Lesions on the vulva are uncommon. The etiology of LC is unknown, but differs between the congenital and acquired forms of the disease.<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">1</span></a> One of the proposed etiologies for acquired LC is obstruction of the normal lymph channels, leading to their sequestration and subsequent dilatation, and the main predisposing factors for acquired vulvar LC are radical surgery and radiation therapy for cervical neoplasms. Other etiological factors include genital tuberculosis, Crohn disease with vulvar and peritoneal fistulas, infection (cellulitis, erysipelas, lymphogranuloma venereum, filariasis), trauma, keloid scars, scleredema, rhabdomyosarcoma, and pregnancy.<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">2</span></a> Two variants have been identified: localized and classic. Classic LC is more common and presents at birth or at an early age (less than 30 years) with lesions larger than 1<span class="elsevierStyleHsp" style=""></span>cm<span class="elsevierStyleSup">2</span>. The localized variety is less common, occurs at any age, and the lesions, which are of less than 1<span class="elsevierStyleHsp" style=""></span>cm<span class="elsevierStyleSup">2</span>, are grouped in a single anatomical area. The 2 variants are distinguished histologically by the presence of grouped lymph vessels in the localized form and isolated dilated lymph vessels in the classic variant.<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">3</span></a></p><p id="par0045" class="elsevierStylePara elsevierViewall">Clinically, LC is characterized by the presence of isolated or grouped vesicular lesions that contain a clear fluid and measure between 1 and 5<span class="elsevierStyleHsp" style=""></span>mm in diameter. The lesions may appear pink, purpuric, or black if they contain blood. Hyperkeratosis, if present, will produce a verrucous appearance, mimicking genital warts. Lesions can arise on normal skin or on preexisting papules. Vulvar LC is usually asymptomatic, although it can cause pruritus, a burning sensation, pain, or dyspareunia.<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">4</span></a></p><p id="par0050" class="elsevierStylePara elsevierViewall">The differential diagnosis of vulvar LC should include in particular genital warts, leiomyoma, cellular angiofibroma, angiomyofibroblastoma, angiomyxoma, verrucous tuberculosis, and lymphogranuloma venereum.<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">5</span></a> The most common complications are vulvar edema, pain, recurrent cellulitis, and sexual dysfunction.</p><p id="par0055" class="elsevierStylePara elsevierViewall">Numerous therapeutic options exist: cryotherapy, electrocoagulation, sclerotherapy, carbon-dioxide laser, 5-fluorouracil, and surgical excision. Although the treatment of choice is surgery, there is a high rate of recurrence, which may even be observed after radical vulvectomy, particularly with lesions measuring over 7<span class="elsevierStyleHsp" style=""></span>cm.<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">6</span></a></p><p id="par0060" class="elsevierStylePara elsevierViewall">We have presented a new case of LC at an unusual site. This is a rare disease that can cause diagnostic error leading to the application of inappropriate treatments. It carries significant social repercussions due to possible confusion with sexually transmitted infections.</p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Conflicts of interest</span><p id="par0065" class="elsevierStylePara elsevierViewall">The authors declare that they have no conflicts of interest.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:9 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Medical History" ] 1 => array:2 [ "identificador" => "sec0010" "titulo" => "Physical Examination" ] 2 => array:2 [ "identificador" => "sec0015" "titulo" => "Histopathology" ] 3 => array:2 [ "identificador" => "sec0020" "titulo" => "Additional Tests" ] 4 => array:2 [ "identificador" => "sec0025" "titulo" => "Diagnosis" ] 5 => array:2 [ "identificador" => "sec0030" "titulo" => "Clinical Course" ] 6 => array:2 [ "identificador" => "sec0035" "titulo" => "Comment" ] 7 => array:2 [ "identificador" => "sec0040" "titulo" => "Conflicts of interest" ] 8 => array:1 [ "titulo" => "Références" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Padilla-España L, Bosco Repiso-Jiménez J, Abitei C. Pseudoverrucous Lesions of Recent Appearance on the Vulva. Actas Dermosifiliogr. 2018;109:65–66.</p>" ] ] "multimedia" => array:3 [ 0 => array:6 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1125 "Ancho" => 1500 "Tamanyo" => 351864 ] ] ] 1 => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 1000 "Ancho" => 1333 "Tamanyo" => 300745 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Hematoxylin and eosin, original magnification<span class="elsevierStyleHsp" style=""></span>×10.</p>" ] ] 2 => array:7 [ "identificador" => "fig0015" "etiqueta" => "Figure 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 1000 "Ancho" => 1333 "Tamanyo" => 220503 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Immunohistochemical stain for D2-40, original magnification<span class="elsevierStyleHsp" style=""></span>×10.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "Références" "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" => "Acquired lymphangiectasia (lymphangioma circumscriptum) of the vulva: Clinicopathologic study of 11 patients from a single institution and 67 from the literature" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "M.B. Chang" 1 => "C.C. Newman" 2 => "M.D. Davis" 3 => "J.S. Lehman" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/ijd.13264" "Revista" => array:6 [ "tituloSerie" => "Int J Dermatol" "fecha" => "2016" "volumen" => "55" "paginaInicial" => "e482" "paginaFinal" => "e487" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26967121" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0040" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Acquired vulvar lymphangioma circumscriptum: A comparison of 12 cases with Crohn's associated lesions or radiation therapy induced tumors" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "J.A. Papalas" 1 => "S.J. Robboy" 2 => "J.L. Burchette" 3 => "W.C. Foo" 4 => "M.A. Selim" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/j.1600-0560.2010.01569.x" "Revista" => array:6 [ "tituloSerie" => "J Cutan Pathol" "fecha" => "2010" "volumen" => "37" "paginaInicial" => "958" "paginaFinal" => "965" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20653826" "web" => "Medline" ] ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0045" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Acquired lymphangioma circumscriptum of the vulva in a twin pregnancy" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "U. Khanna" 1 => "P. D'Souza" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/jdv.12640" "Revista" => array:6 [ "tituloSerie" => "J Eur Acad Dermatol Venereol" "fecha" => "2016" "volumen" => "30" "paginaInicial" => "147" "paginaFinal" => "149" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25099515" "web" => "Medline" ] ] ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0050" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Acquired lymphangioma circumscriptum of the vulva" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "M. Amouri" 1 => "A. Masmoudi" 2 => "S. Boudaya" 3 => "A. Amouri" 4 => "I. Ben Ali" 5 => "S. 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| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 8 | 5 | 13 |
| 2024 October | 68 | 30 | 98 |
| 2024 September | 82 | 32 | 114 |
| 2024 August | 102 | 37 | 139 |
| 2024 July | 110 | 42 | 152 |
| 2024 June | 101 | 40 | 141 |
| 2024 May | 69 | 36 | 105 |
| 2024 April | 91 | 28 | 119 |
| 2024 March | 86 | 23 | 109 |
| 2024 February | 64 | 32 | 96 |
| 2024 January | 63 | 27 | 90 |
| 2023 December | 70 | 16 | 86 |
| 2023 November | 97 | 23 | 120 |
| 2023 October | 85 | 21 | 106 |
| 2023 September | 64 | 33 | 97 |
| 2023 August | 55 | 10 | 65 |
| 2023 July | 80 | 42 | 122 |
| 2023 June | 55 | 23 | 78 |
| 2023 May | 62 | 22 | 84 |
| 2023 April | 60 | 24 | 84 |
| 2023 March | 45 | 24 | 69 |
| 2023 February | 52 | 28 | 80 |
| 2023 January | 57 | 29 | 86 |
| 2022 December | 60 | 41 | 101 |
| 2022 November | 37 | 31 | 68 |
| 2022 October | 40 | 21 | 61 |
| 2022 September | 26 | 30 | 56 |
| 2022 August | 35 | 38 | 73 |
| 2022 July | 19 | 32 | 51 |
| 2022 June | 31 | 23 | 54 |
| 2022 May | 32 | 39 | 71 |
| 2022 April | 76 | 49 | 125 |
| 2022 March | 69 | 69 | 138 |
| 2022 February | 59 | 37 | 96 |
| 2022 January | 77 | 47 | 124 |
| 2021 December | 50 | 46 | 96 |
| 2021 November | 63 | 55 | 118 |
| 2021 October | 66 | 62 | 128 |
| 2021 September | 36 | 60 | 96 |
| 2021 August | 41 | 58 | 99 |
| 2021 July | 32 | 49 | 81 |
| 2021 June | 24 | 44 | 68 |
| 2021 May | 36 | 55 | 91 |
| 2021 April | 76 | 99 | 175 |
| 2021 March | 71 | 51 | 122 |
| 2021 February | 56 | 46 | 102 |
| 2021 January | 42 | 43 | 85 |
| 2020 December | 47 | 34 | 81 |
| 2020 November | 37 | 44 | 81 |
| 2020 October | 28 | 23 | 51 |
| 2020 September | 34 | 26 | 60 |
| 2020 August | 39 | 23 | 62 |
| 2020 July | 36 | 26 | 62 |
| 2020 June | 42 | 39 | 81 |
| 2020 May | 17 | 25 | 42 |
| 2020 April | 24 | 18 | 42 |
| 2020 March | 32 | 18 | 50 |
| 2020 February | 5 | 0 | 5 |
| 2020 January | 3 | 0 | 3 |
| 2019 December | 8 | 0 | 8 |
| 2019 November | 4 | 0 | 4 |
| 2019 September | 8 | 0 | 8 |
| 2019 August | 4 | 0 | 4 |
| 2019 July | 4 | 0 | 4 |
| 2019 June | 6 | 0 | 6 |
| 2019 May | 6 | 0 | 6 |
| 2019 April | 2 | 0 | 2 |
| 2019 March | 4 | 0 | 4 |
| 2019 January | 2 | 0 | 2 |
| 2018 December | 5 | 0 | 5 |
| 2018 November | 1 | 0 | 1 |
| 2018 October | 3 | 0 | 3 |
| 2018 September | 2 | 0 | 2 |
| 2018 June | 2 | 1 | 3 |
| 2018 April | 1 | 0 | 1 |
| 2018 February | 108 | 21 | 129 |
| 2018 January | 128 | 33 | 161 |
| 2017 December | 10 | 20 | 30 |
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