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Scrotal lymphangioma - a rare cause of scrotal swelling.
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MedLine Citation:
PMID:  23277887     Owner:  NLM     Status:  PubMed-not-MEDLINE    
Abstract/OtherAbstract:
Lymphangioma is an extremely rare cause of scrotal swelling. We are reporting such a tumor in a one and half year old child presenting with a painless, progressive scrotal swelling. The mass was evaluated and excised completely. Histopathology confirmed it as Lymphangioma.
Authors:
Pradeep Kajal; Kamal Nain Rattan; Vivek S Malik; Vipin Garsa
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Publication Detail:
Type:  Journal Article     Date:  2013-01-01
Journal Detail:
Title:  APSP journal of case reports     Volume:  4     ISSN:  2218-8185     ISO Abbreviation:  APSP J Case Rep     Publication Date:  2013 Jan 
Date Detail:
Created Date:  2013-01-01     Completed Date:  2013-01-02     Revised Date:  2013-05-30    
Medline Journal Info:
Nlm Unique ID:  101570795     Medline TA:  APSP J Case Rep     Country:  Pakistan    
Other Details:
Languages:  eng     Pagination:  5     Citation Subset:  -    
Affiliation:
Department of Pediatric Surgery, PGIMS Rohtak, Haryana.
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Journal Information
Journal ID (nlm-ta): APSP J Case Rep
Journal ID (iso-abbrev): APSP J Case Rep
Journal ID (publisher-id): AJCR
ISSN: 2218-8185
Publisher: EL-MED-Pub
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Copyright © 2013 Kajal et al
open-access:
Received Day: 21 Month: 9 Year: 2012
Accepted Day: 15 Month: 10 Year: 2012
Electronic publication date: Day: 1 Month: 1 Year: 2013
collection publication date: Season: Jan-Apr Year: 2013
Volume: 4 Issue: 1
First Page: 5 Last Page: 5
PubMed Id: 23277887
ID: 3525287
Publisher Id: ajcr-4-1

Scrotal Lymphangioma – A Rare Cause of Scrotal Swelling
Pradeep Kajal Affiliation: Department of Pediatric Surgery, PGIMS Rohtak, Haryana.
Kamal Nain Rattan Affiliation: Department of Pediatric Surgery, PGIMS Rohtak, Haryana.
Vivek S Malik Affiliation: Department of Anatomy, PGIMS Rohtak, Haryana.
Vipin Garsa Affiliation: Department of Anatomy, PGIMS Rohtak, Haryana.
Correspondence: Address for Correspondence: Dr. Pradeep Kajal, 33/11J, Medical Campus PGIMS Rohtak, Haryana 124001. drpradeepkajal@gmail.com.

INTRODUCTION

Lymphangioma are congenital lymphatic hamartomas, 95% of which occur in neck and axilla [1]. The scrotum and retroperitoneum are unusual sites [2]. The scrotum is one of the rarest sites for lymphangioma. It can involve scrotal wall, tunics, testis, epididymis, spermatic cord or Colle’s fascia [3]. This is a report of scrotal lymphangioma with special emphasis on clinical, ultrasonographic, and histopathological findings.


CASE REPORT

An 18-month-old male child presented with painless, progressive enlargement of left hemiscrotum for last one year. Examination revealed a non-tender and soft mass in left hemi scrotum which was compressible with positive transillumination test. The left testis could be felt separately from the mass (Fig. 1). Patient underwent surgery after routine investigations. At operation a multilocular cystic mass measuring 5cmx5cm adherent to the tunics found. The left testis and spermatic cord were not involved (Fig. 2). Complete excision of the mass along with overlying skin was done. Suction drain kept at surgery was removed on 2nd postoperative day. Child was discharged on 3rd postoperative in good health. On histopathological examination, it was reported as cystic lymphangioma. No recurrence was noted at one year follow up.


DISCUSSION

Lymphangioma results from inadequate drainage of lymph from sequestrated lymphatic vessels and are considered to be lymphatic hamartomas. Most of these are congenital due to paucity or atresia of the efferent lymphatics or lack of communication between lymphatics and venous channels [1]. These lesions can also be acquired because of obstruction of lymphatics after inflammation, trauma or degeneration [3].

Histologically, three types – capillary, cavernous and cystic are described. The cystic form is the most common variety. Half of these are recognized at birth, 90% are evident by the age of 2 years and 95% occur in the neck or axilla. Unusual sites are scrotum, retroperitoneum, intraperitoneum, gluteal region, mediastinum, groin, pelvis, mesentery, omentum and spleen [1, 4, 5]. Scrotum is a rare site for lymphangioma. Singh et al reported thirty two cases of cystic lymphangiomas in children, and only one was located in the scrotum [1]. Loberant et al estimated that less than fifty cases of scrotal cystic lymphangioma have been reported in literature till 2002 [6]. When scrotum is involved, it is usually misdiagnosed as hernia, hydrocele, varicocele, large epididymal cyst or acute scrotal conditions which may lead to inadequate treatment with a risk of recurrence [2, 5, 7]. Hurwitz et al reported seven cases of scrotal cystic lymphangioma over a period of ten years, all of which were misdiagnosed preoperatively [7]. Ultrasound scan usually shows a multicystic extra testicular mass with internal septae; internal echoes in the cysts due to debris and/or hemorrhage may be noted as a result of complication [6, 8]. The treatment consists of surgical excision of the entire mass along with the overlying skin. Incomplete excision can result in recurrence [7]. Scrotal lymphangioma though rare must be kept in mind while exploring any scrotal swelling.


Footnotes

Source of Support: Nil

Conflict of Interest: None declared


References
1. Singh S,Baboo M L,Pathak I C. Cystic lymphangioma in children: Report of 32 cases including lesions at rare sitesSurgYear: 19716994751
2. Ratan S K,Rattan K N,Sehgal T,Maggu S. Spermatic cord lymphangioma in a 7 year old child masquerading as a hydroceleBr J Urol IntYear: 2003104046
3. Koshy A,Tandon R K,Kapur B M,Rao K V,Joshi K. Retroperitoneal lymphangioma. A case report with review of the literature.Am J GastroenterolYear: 1978469485490685957
4. Singla SL, Rattan KN, Singh S. Cystic hygroma of the gluteal region. Indian J Pediatr.Year: 200067 77911105431
5. Parakh A, Dubey AP, Garg A, Khurana N, Aggarwal SK. Cystic lymphangiomatous hamartoma masquerading as massive ascites.Indian J PediatrDay: 27 Month: 5 Year: 200977675375410.1007/s12098-009-0141-yhttp://geneticalliance.org/ws_display.asp?filter=infosearch_results&info_keyword=Lymphangioma19475359
6. Loberant N,Chernihovski A,Goldfeld M. Role of doppler sonography in the diagnosis of cystic lymphangioma of the scrotumJ Clin UltrasoundYear: 2002630384710.1002/jcu.1008012116101
7. Hurwitz R S,Shapiro E,Hulbert W C,Diamond D A,Casale A J,Rink R C. Scrotal cystic lymphangioma: the misdiagnosed scrotal mass.J UrolYear: 199715811821185http://www.scholaruniverse.com/ncbi-linkout?id=92581679258167
8. Rattan K N,Kajal P. Kadian YS, Gupta R. Hemorrhage in a scrotal lymphangioma in a child: a rarityAfr J Pediatr SurgYear: 2009611011

Figures

[Figure ID: F1]

Figure 1: Clinical photograph showing left scrotal swelling (arrow) separate from left testis.



[Figure ID: F2]

Figure 2: Cystic lymphangioma (arrow) arising from scrotal wall and adherent to the tunics.



Article Categories:
  • Case Report

Keywords: Lymphangioma, Scrotum, Child.

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