Uncommon presentation of lymphangioma circumscriptum: case series

Introduction: Lymphangioma circumscriptum (superficial lymphatic malformation) is a congenital malformation of the superficial lymphatics presenting as a group of deep seated vesicles like papules. Method: a 12 yr old male presented with multiple non scaly slowly progressive asymptomatic plaques of variable size and shape over the right forearm and a single plaque on left arm and right leg since 8 years in skin OPD, SMS hospital and clinically was thought to be 1) Cutaneous Leishmaniasis 2) Borderline tuberculoid leprosy. A biopsy from the lesion was taken and submitted for histological examination. Result: on performing histopathology, these lesions came out to be of lymphangioma circumscriptum. Discussion: this case presents with different presentation as verrucous lesions, wherein usually it presents with clear vesicles. On microscopy it is composed of numerous dilated lymphatics in the superficial and papillary dermis with the presence of clear fluid. Overlying dermis shows acanthosis and hyperkeratosis. The surrounding stroma shows scattered lymphocytes. This entity is the most common subtype of lymphangioma. Conclusion: this interesting case of lymphangioma presenting with uncommon clinical features exemplifies a case where utmost vigilance is required for correct diagnosis. This case is taken for better understanding of lymphangioma.