Lymphangioma is a rare developmental anomaly of the lymphatic system, commonly arising at birth, in infancy, or early childhood. Treatment is rarely curative. We report a case of macrocystic lymphangioma treated with sildenafil in a 16-year-old Filipino child diagnosed clinically, radiologically and histologically. The patient presented with grouped papulovesicles on the left lower extremity, associated with limb length discrepancy, unilateral leg pain and difficulty in ambulation. Given the recurrent course of this condition, even with surgical management, the use of a non-invasive approach such as sildenafil as a potential treatment option for lymphangioma is an important emerging area of study.

Mass of the vulva include both benign and malignant lesions. Benign mass lesions of the vulva include tumors, hamartomas, cysts, infectious disorders, and non-neoplastic epithelial disorders. Some are rare mass lesions. Here, we presented three rare mass lesions of the vulva. The first case presented with the complaint of vulvar lesion since childhood, while the two cases presented in reproductive age and perimenopausal age. All three cases presented as mass lesions in the vulva with pain or uneasiness during work. In all these cases, excision was done. On histopathological examination, the lesions have different diagnoses which are common in other parts of the body, but rarely present at the vulva. A definitive diagnosis of a vulvar mass lesion is difficult to make, especially in the case of rare mass lesion. Histopathology is the principal tool of diagnosis.
Lymphangioma ; Fibroadenoma

Lymphangioma circumscriptum (LC) is a rare congenital proliferation of the lymphatic vessels characterized by clusters of thin-walled translucent vesicles, often called “frog spawn,” within a specific area. The exact cause of LC is unknown, but it can be present at birth or develop due to damage to lymphatic vessels from various causes. Symptoms may include intermittent swelling, hemorrhage, and lymph leakage, and early evaluation is essential to prevent potential complications such as infection. Fractional CO2 ablation laser therapy offers excellent functional and cosmetic results.

This is a case of a 32-year-old Filipino female patient with a 30-year history of multiple grouped translucent to hemorrhagic vesicles forming warty-like growths on the right axillary area, gradually extending to the arm and scapular area. Histopathological findings of dilated lymphatic channels in the papillary dermis lined by endothelial cells confirmed the diagnosis of Lymphangioma circumscriptum. The patient underwent a series of fractional carbon dioxide laser ablation for treatment. Clinical and subjective improvement of lesions were noted and the patient was satisfied with the outcome.

Lymphangioma circumscriptum remains challenging to treat, given its rarity and significant tendency for recurrence regardless of the treatment modality. In this case, fractional carbon dioxide laser ablation was utilized to manage Lymphangioma circumscriptum (LC), which resulted in satisfactory cosmetic improvement and lasting symptom relief.

Lymphangioma is a rare vascular malformation, comprising about 4% of such anomalies. Its most common symptom is swelling, which often leads to cosmetic deformity. The most prevalent subtype, lymphangioma circumscriptum, seldom presents on the vulvar area, making treatment especially challenging due to potential complications and recurrence risks.

This is a case of a 10-year-old Filipino female, otherwise healthy, who presented with progressively enlarging, tender, “frog spawn”-like papules on the left vulva since birth. These papules showed partial improvement following surgical excision. Histopathological examination confirmed the diagnosis of lymphangioma. Over the past year, the patient experienced recurrence of papules, resulting in vulvar asymmetry and labial swelling. Pelvic magnetic resonance imaging (MRI), ultrasound, and fine needle aspiration biopsy, revealed multiple superficial and deep cystic masses consistent with lymphangioma. Long-pulsed Nd:YAG laser was administered to the external lesions, yielding partial improvement. Subsequently, she underwent ultrasound-guided sclerotherapy with bleomycin under local anesthesia.

This procedure, performed by interventional radiology, successfully resolved the deep cysts and swelling after two sessions, with no reported complications.

In cases of cutaneous lymphangioma, especially in anatomically sensitive regions like the vulva, imaging plays a crucial role in determining lesion depth and guiding treatment to minimize recurrences. Although no local literature is available, this case highlights the effectiveness and safety of ultrasound-guided sclerotherapy with bleomycin as a novel treatment option for lymphangioma.

Tuberous sclerosis complex (TSC) is a rare, autosomal dominant multisystem disorder affecting the brain, heart, kidneys, lungs, and skin leading to significant morbidity and mortality. We report a case of TSC and highlight the need for prompt diagnosis and proper surveillance to minimize life‑threatening complications. A 20‑year‑old female presented with facial and ungual papulonodular lesions 4 years after being diagnosed with epilepsy at the age of eight. No family history of genetic diseases was reported. Eight years later, the patient developed recurrent cough, shortness of breath, and blurring of vision. Biopsy of facial and digital nodule showed angiofibroma and ungual fibroma (Koenen tumor), respectively. Chest computed tomography scan revealed extensive cystic lesions diffusely scattered throughout the entire lung parenchyma suggestive of lymphangioleiomyomatosis. Cranial MRI revealed cortical and subependymal tubers, compatible with TSC. The patient had multidisciplinary management. However, her symptoms progressed, and she eventually succumbed to death. Cutaneous lesions such as facial angiofibromas and ungual fibromas along with multisystemic manifestations should alarm the clinician to TSC. Given its highly variable expressivity, awareness of different TSC‑associated signs and symptoms is essential for prompt diagnosis, proper treatment, disease monitoring, and early recognition of TSC complications.
Angiofibroma ; Lymphangioleiomyomatosis ; Tuberous Sclerosis

Airway management of a pediatric patient with cervical cystic hygroma can be challenging as the large neck mass may extend in the oral cavity, result in tracheal deviation, and cause possible upper airway obstruction. This is a case of a 4-year-old female admitted due to sudden enlargement of neck mass associated with dysphagia and sialorrhea. Patient was intubated under sedation while maintaining spontaneous ventilation with a pediatric flexible fiberoptic scope through a nasopharyngeal airway serving as a passage guide for ease of scoping and a protective device against trauma.
Lymphangioma, Cystic ; Airway Management ; Intubation

Humans ; Lymphangioma/surgery* ; Female ; Breast Neoplasms

Child ; Humans ; Circulating Tumor DNA ; Lymphangioma ; Family ; Hemangioendothelioma ; Sarcoma, Kaposi

A fetal neck mass such as cystic hygroma imposes a challenge in the continuing prenatal care and birth strategy for a 26-year-old gravida 2 para 1 (1001) with a scarred uterus from previous low transverse cesarean section (CS). An intricate delivery for the fetus with a potential airway obstruction necessitates an ex utero intrapartum treatment (EXIT) delivery. The patient was initially scheduled to undergo the procedure at 38 weeks of gestation, but preterm labor ensued. Close antenatal monitoring was done which carried the pregnancy to term. The multidisciplinary approach and planning requires consensus among varied specialties as this maternal–fetal surgery differs immensely from a regular CS. This aims to document and discuss the preoperative, operative and postoperative management done for this patient. The EXIT procedure was performed at 38 weeks' age of gestation with good maternal outcomes. The fetus was delivered safely.
Lymphangioma, Cystic

Diagnostic Errors ; Humans ; Intervertebral Disc Degeneration ; Intervertebral Disc Displacement/diagnostic imaging* ; Lumbar Vertebrae/diagnostic imaging* ; Lymphangioma/diagnostic imaging* ; Magnetic Resonance Imaging