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. Bouassida" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Dermatol Online J" "fecha" => "2007" "volumen" => "13" "paginaInicial" => "10" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18328204" "web" => "Medline" ] ] ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0055" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:3 [ "comentario" => "[Article in Spanish]" "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Acquired progressive lymphangioma (benign lymphangioendothelioma)" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "F. Messeguer" 1 => "O. Sanmartín" 2 => "A. Martorell-Calatayud" 3 => "E. Nagore" 4 => "C. Requena" 5 => "C. 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Cheney" 3 => "M.A. Grassi" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Cutis" "fecha" => "2014" "volumen" => "93" "paginaInicial" => "297" "paginaFinal" => "300" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24999641" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/15782190/0000010900000001/v1_201801020547/S1578219017303669/v1_201801020547/en/main.assets" "Apartado" => array:4 [ "identificador" => "6154" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Case for Diagnosis" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/15782190/0000010900000001/v1_201801020547/S1578219017303669/v1_201801020547/en/main.pdf?idApp=UINPBA000044&text.app=https://actasdermo.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1578219017303669?idApp=UINPBA000044" ]
| año/Mes | Html | Total | |
|---|---|---|---|
| 2024 Noviembre | 9 | 5 | 14 |
| 2024 Octubre | 68 | 30 | 98 |
| 2024 Septiembre | 82 | 32 | 114 |
| 2024 Agosto | 102 | 37 | 139 |
| 2024 Julio | 110 | 42 | 152 |
| 2024 Junio | 101 | 40 | 141 |
| 2024 Mayo | 69 | 36 | 105 |
| 2024 Abril | 91 | 28 | 119 |
| 2024 Marzo | 86 | 23 | 109 |
| 2024 Febrero | 64 | 32 | 96 |
| 2024 Enero | 63 | 27 | 90 |
| 2023 Diciembre | 70 | 16 | 86 |
| 2023 Noviembre | 97 | 23 | 120 |
| 2023 Octubre | 85 | 21 | 106 |
| 2023 Septiembre | 64 | 33 | 97 |
| 2023 Agosto | 55 | 10 | 65 |
| 2023 Julio | 80 | 42 | 122 |
| 2023 Junio | 55 | 23 | 78 |
| 2023 Mayo | 62 | 22 | 84 |
| 2023 Abril | 60 | 24 | 84 |
| 2023 Marzo | 45 | 24 | 69 |
| 2023 Febrero | 52 | 28 | 80 |
| 2023 Enero | 57 | 29 | 86 |
| 2022 Diciembre | 60 | 41 | 101 |
| 2022 Noviembre | 37 | 31 | 68 |
| 2022 Octubre | 40 | 21 | 61 |
| 2022 Septiembre | 26 | 30 | 56 |
| 2022 Agosto | 35 | 38 | 73 |
| 2022 Julio | 19 | 32 | 51 |
| 2022 Junio | 31 | 23 | 54 |
| 2022 Mayo | 32 | 39 | 71 |
| 2022 Abril | 76 | 49 | 125 |
| 2022 Marzo | 69 | 69 | 138 |
| 2022 Febrero | 59 | 37 | 96 |
| 2022 Enero | 77 | 47 | 124 |
| 2021 Diciembre | 50 | 46 | 96 |
| 2021 Noviembre | 63 | 55 | 118 |
| 2021 Octubre | 66 | 62 | 128 |
| 2021 Septiembre | 36 | 60 | 96 |
| 2021 Agosto | 41 | 58 | 99 |
| 2021 Julio | 32 | 49 | 81 |
| 2021 Junio | 24 | 44 | 68 |
| 2021 Mayo | 36 | 55 | 91 |
| 2021 Abril | 76 | 99 | 175 |
| 2021 Marzo | 71 | 51 | 122 |
| 2021 Febrero | 56 | 46 | 102 |
| 2021 Enero | 42 | 43 | 85 |
| 2020 Diciembre | 47 | 34 | 81 |
| 2020 Noviembre | 37 | 44 | 81 |
| 2020 Octubre | 28 | 23 | 51 |
| 2020 Septiembre | 34 | 26 | 60 |
| 2020 Agosto | 39 | 23 | 62 |
| 2020 Julio | 36 | 26 | 62 |
| 2020 Junio | 42 | 39 | 81 |
| 2020 Mayo | 17 | 25 | 42 |
| 2020 Abril | 24 | 18 | 42 |
| 2020 Marzo | 32 | 18 | 50 |
| 2020 Febrero | 5 | 0 | 5 |
| 2020 Enero | 3 | 0 | 3 |
| 2019 Diciembre | 8 | 0 | 8 |
| 2019 Noviembre | 4 | 0 | 4 |
| 2019 Septiembre | 8 | 0 | 8 |
| 2019 Agosto | 4 | 0 | 4 |
| 2019 Julio | 4 | 0 | 4 |
| 2019 Junio | 6 | 0 | 6 |
| 2019 Mayo | 6 | 0 | 6 |
| 2019 Abril | 2 | 0 | 2 |
| 2019 Marzo | 4 | 0 | 4 |
| 2019 Enero | 2 | 0 | 2 |
| 2018 Diciembre | 5 | 0 | 5 |
| 2018 Noviembre | 1 | 0 | 1 |
| 2018 Octubre | 3 | 0 | 3 |
| 2018 Septiembre | 2 | 0 | 2 |
| 2018 Junio | 2 | 1 | 3 |
| 2018 Abril | 1 | 0 | 1 |
| 2018 Febrero | 108 | 21 | 129 |
| 2018 Enero | 128 | 33 | 161 |
| 2017 Diciembre | 10 | 20 | 30 |
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