Sunday, March 05, 2017

Vascular Lesion in a Six Year-Old

The patient is a 6-year-old boy who was seen for evaluation of a lesion on his right knee that has been present since infancy.  When he is active it swells up a bit and is uncomfortable, if not painful. He is in otherwise good health and his identical twin has no such lesion.  The child has seen by his family practitioner and two or three pediatricians.  He has had ultrasounds and x-rays, but none were diagnostic.  

O/E:  The examination shows a subtle dusky area on the right knee.  There are some vascular lesions within the area that are a millimeter in diameter or less.   Dermatoscopy more clearly defines them.

Clinical Photos:

PLAN:  A 4 mm punch biopsy was taken for diagnostic purposes. He may need to be referred to a center where they deal with vascular anomalies.   

Lymphatic malformation consistent with, in the appropriate clinical setting, lymphangioma.
The specimen exhibits compact hyperkeratosis, papillomatous epidermal hyperplasia, focal acanthosis, a sparse superficial perivascular lymphocytic infiltrate, and multiple dilated, irregular thin-walled vessels lined by a single layer of bland endothelial cells in the papillary dermis.

IMPRESSION:  Vascular anomaly: Lymphangioma    

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