Microcystic lymphangioma of the vulva

Abstract

Cystic cutaneous lymphatic malformations are developmental anomalies of the lymphatic system characterized by lymphatic vessel dilatation. Microcystic forms, also known as circumscribed lymphangiomas, present as clusters of translucent or hemorrhagic vesicles, papules, or infiltrated plaques, often appearing in early childhood and primarily affecting the proximal extremities. Although generally asymptomatic, they may cause inflammatory, infectious, or hemorrhagic episodes. We report a 39-year-old woman with a 2-year history of vesicular lesions on the medial surface of both labia majora associated with intermittent pruritus and fluid leakage. Clinical examination revealed bilateral painless swellings, each approximately 6 cm, with translucent and hemorrhagic vesicles. Histology confirmed bilateral subcutaneous microcystic lymphangiomas. Given their benign nature, no treatment was recommended aside from surveillance. Microcystic lymphangiomas have an unpredictable course, with some remaining stable and others developing complications requiring treatment. Management depends on lesion location, symptoms, and esthetic impact, with options including sclerotherapy, CO₂ laser, or surgical excision, if necessary. This case highlights the importance of accurate diagnosis and individualized treatment of microcystic lymphangiomas.