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Year : 2017  |  Volume : 32  |  Issue : 1  |  Page : 73-74  

Tc-99m sulfur colloid lymphoscintigraphy with single-photon emission computed tomography/computed tomography in a case of acquired vulval lymphangiomas


Department of Nuclear Medicine and PET/CT, All Institute of Medical Sciences, New Delhi, India

Date of Web Publication17-Jan-2017

Correspondence Address:
Madhavi Tripathi
Department of Nuclear Medicine and PET, All India Institute of Medical Sciences, New Delhi - 110 029
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0972-3919.198495

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   Abstract 

We describe the lymphoscintigraphy findings of a 25-year-old female patient who was undergoing presurgical workup for lymphangiomas of the vulva. She had a history of treatment for disseminated tuberculosis 6 years back and presented with herpetiform oozing vesicles in the external genitalia. Single-photon emission computed tomography/computed tomography (SPECT/CT) confirmed cutaneous tracer accumulation in the vulval lesions and demonstrated the presence of densely calcified inguinal nodes secondary to healed tuberculosis as the etiology of secondary lymphangioma.

Keywords: Lymphangioma, lymphoscintigraphy, single-photon emission computed tomography/computed tomography


How to cite this article:
Tulsyan S, Tripathi M, Das K, Yadav D, Shamim SA, Damle N, Bal C. Tc-99m sulfur colloid lymphoscintigraphy with single-photon emission computed tomography/computed tomography in a case of acquired vulval lymphangiomas. Indian J Nucl Med 2017;32:73-4

How to cite this URL:
Tulsyan S, Tripathi M, Das K, Yadav D, Shamim SA, Damle N, Bal C. Tc-99m sulfur colloid lymphoscintigraphy with single-photon emission computed tomography/computed tomography in a case of acquired vulval lymphangiomas. Indian J Nucl Med [serial online] 2017 [cited 2019 Dec 9];32:73-4. Available from: http://www.ijnm.in/text.asp?2017/32/1/73/198495

A 25-year-old female patient was referred to our department for Tc-99m sulfur colloid lymphoscintigraphy (SCLS). She was undergoing presurgical workup for lymphangioma of the vulva. She had a history of treatment for disseminated tuberculosis. At present, she had a gradually increasing swelling of the left lower limb and oozing vesicles in the vulva. Serial anterior static SCLS images [Figure 1]a - 30 min, b - 1 h, and c - 3 h] revealed dermal backflow (black arrow) in the left lower limb and in the right thigh, with visualization of a few inguinal and iliac lymph nodes. Tracer accumulation was also noted in the vulvar region (white block arrow). Single-photon emission computed tomography/computed tomography (SPECT/CT) images [Figure 1]d showed skin thickening and tracer uptake in the mons pubis and labia majora region corresponding to multiple vesicles over labia and suprapubic area on inspection. Densely calcified right inguinal nodes (white arrow) and pelvic nodes were noted on CT.
Figure 1: Tc-99m sulfur colloid planar anterior and posterior images showing the dermal backflow and tracer accumulation in vulvar region (a) at 30 min, (b) at 60 min and (c) at 3 hours and single-photon emission computed tomography/computed tomography, (d) at the level of vulva showing tracer accumulation on the skin surface. Also noted was a calcified right inguinal node (arrow)

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Lymphangiomas are malformations of lymphatic channels consisting of dilated lymphatic channels due to congenital or acquired causes. Acquired or secondary lymphangiomas are rare and occur following radiotherapy in carcinoma cervix, tuberculous inguinal adenitis,[1],[2] pelvic and intra-abdominal surgeries,[3] scrofuloderma,[4] Crohn's disease,[5] scarring after keloids, recurrent cellulitis, and filariasis.[6] The lymphatic vessels of the superficial dermal plexus drain a fixed area of skin to the deep plexus. Damage to the deep lymphatic vessels leads to back pressure and dermal backflow, with subsequent dilatation of the superficial lymphatics as seen in this case. Densely calcified healed inguinal lymphadenitis was the underlying cause lymphatic obstruction leading to lower limb lymphedema and vulvar lymphangiomas which was well elucidated on SPECT/CT, thus aiding in understanding of the physiopathology of edema. Thus, SPECT/CT is a promising additional to lymphoscintigraphy in investigation of lymphangioma.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
   References Top

1.
Serpier H, Frecourt C, Cambie MP, Salmon-Ehr V, Estève E, Kalis B. Vulvar lymphangiectasis 14 years after treatment for epidermoid carcinoma of the cervix. Treatment with cryosurgery. Ann Dermatol Venereol 1996;123:96-9.  Back to cited text no. 1
    
2.
Singh N, Kumari R, Thappa DM. Vulval lymphangiectasia secondary to tubercular lymphadenitis. Indian J Sex Transm Dis 2007;28:38-9.  Back to cited text no. 2
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3.
Heuvel NV, Stolz E, Notowicz A. Lymphangiectases of the vulva in a patient with lymph node tuberculosis. Int J Dermatol 1979;18:65-6.  Back to cited text no. 3
    
4.
Sharmil H, Ghaemmaghami F, Yarandi F, Milani F, Alizadeh N. Vulvar lymphangioma circumscriptum: A case report. Acta Med Iran 2004;42:458-60.  Back to cited text no. 4
    
5.
Sharma R, Tomar S, Chandra M. Acquired vulval lymphangiectases mimicking genital warts. Indian J Dermatol Venereol Leprol 2002;68:166-7.  Back to cited text no. 5
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Gnanaraj P, Revathy V, Venugopal V, Tamilchelvan D, Rajagopalan V. Secondary lymphangioma of vulva: A report of two cases. Indian J Dermatol 2012;57:149-51.  Back to cited text no. 6
[PUBMED]  Medknow Journal  


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