Author(s): HAMICH Soumaya
We report the case of a 49-year-old female patient with a medical history of breast cancer treated by mastectomy with axillary lymph node dissection, radiotherapy and hormonotherapy currently in remission. She presented to our department with an asymptomatic growing lesion located on the right inframammary area of one year duration. Physical examination revealed a 9mm lobulated, flesh-colored nodule surmounted by a yellowish crust, and surrounded by a hyperpigmented patch (figure 1). An orange cystic formation measuring 4mm was also observed (figure 1). It became blackish and scaly 2 weeks later (figure 2). The remainder of the examination was without abnormalities.
We report the case of a 49-year-old female patient with a medical history of breast cancer treated by mastectomy with axillary lymph node dissection, radiotherapy and hormonotherapy currently in remission. She presented to our department with an asymptomatic growing lesion located on the right inframammary area of one year duration. Physical examination revealed a 9mm lobulated, flesh-colored nodule surmounted by a yellowish crust, and surrounded by a hyperpigmented patch (figure 1). An orange cystic formation measuring 4mm was also observed (figure 1). It became blackish and scaly 2 weeks later (figure 2). The remainder of the examination was without abnormalities
Dermoscopy of the nodule revealed multiple red lacunae circled by white lines, an unstructured white area and a peripheral delicate pigment network. Dermoscopy of the cystic lesion showed vascular structures, scales and a yellowish background.
Complete excision was performed. Anatomopathological examination objected cystic formations lined with regular endothelial cells suggesting the diagnosis of lymphangioma circumscriptum.
Cutaneous lymphangioma circumscriptum is an uncommon congenital malformation of the superficial cutaneous lymphatic vessels. These malformations are either isolated or are part of complex malformations. They appear as more or less extensive vesicles, with clear or hematic content as well as plaques with a smooth or hyperkeratosic surface The lesions are often present in early childhood but they may spread later or even appear later in life. The most common locations are the head, neck, armpits, buttocks and proximal limbs. The trunk may be affected. On dermoscopy, lacunae and vascular structures are the most frequently associated dermoscopic pattern [1,2] .
Several cases have been described on the breast and inframammary region, with a trauma history or antecedent of radiotherapy as we reported on our case. However, these cases presented as papulovesicular lesions. Only one case was described as skincoloured nodule located on the milk line in the inframammary area and thus mimicking a supernumerary nipple [3-5].
Figure 1: Right inframammary area with a 9mm lobulated, fleshcolored nodule surmounted by a yellowish crust, and surrounded by a hyperpigmented patch. On its left, an orange cystic formation measuring 4mm was noted
Figure 2: Blackish and scaly cystic lesion 2 weeks after the initial examination
Figure 3: Dermoscopy of the nodule showing multiple red lacunae circled by white lines, an unstructured white area and a peripheral delicate pigment network
Figure 4: Dermoscopy of the cystic formation with vascular structures, scales and a yellowish background
Herein, we reported an atypical case of lymphangioma circumsriptum by its unusual clinical presentation including two components: a vesicular yellowish lesion and a flesh-coloured firm and exophytic nodule. Histology remains the gold standard for any uncertain diagnosis.
Conflicts of interest: none
