Case of the Month

28 year old woman with strange bumps on her stomach that have been present as long as she can remember.

Superficial lymphatic malformation (Iymphangiama circumscriptum)

Formerly and still commonly called ‘lymphangioma circumscriptum’, a better name is ‘superficial lymphatic malformation’ because the lesions are a congenital malformation of the superficial lymphatics, and not tumors.

They appear as grouped vesicles and papules, usually with clear fluid. Sometimes they can have a small amount of blood in the vesicles, from vascular connections, and they can appear pink, red, purple, or dark blue as some of the vesicular-papules do in this case. If punctured, they can often will produce/exude a clear straw colored lymph fluid. Is usually localized to s solitary region. Common sites of superficial lymphatic malformation/lymphangioma circumscriptum are: abdomen, legs, scrotum/vulva, axillae, and tongue.

Textbooks often describe superficial lymphatic malformation/lymphangioma circumscriptum to appear like “frog-spawn”, although very few people have a mind’s image of what frog-spawn is, so I’ve included a picture of frog spawn, below. (By-the-way, frog spawn is a collection eggs which are surrounded by transparent jelly). Sometimes the lesions can appear slightly verrucous and can be mistaken as flat warts, molluscum and even (small) epidermal nevi.

Superficial lymphatic malformation/lymphangioma circumscriptum rarely change over time.

Superficial lymphatic malformation/lymphangioma circumscriptum are often associated with a deep compoment involving the subcutaneous tissue and even muscle. These deeper components may also have small vascular cone connections. This makes treating superficial lymphatic malformation/lymphangioma circumscriptum, superficially, especially challenging when the deeper components are present.

Most patients are not bothered by superficial lymphatic malformation/lymphangioma circumscriptum. In the cases where they are painful, drain, or are cosmetically unacceptable, many experts suggest an imaging study to access if there is a deep component. If there is only a superficial presence, laser ablation has been reported to work well. With deep involvement, reports indicate that surgical excision has had good but not always perfect results.

In this particular case the patient was only curious to what “the group of bumps” were. She wanted no treatment and said that a previous doctor had frozen them multiple times, without effect, calling them molluscum.

Frog Spawn