Acquired vulvar lymphangioma mimicking genital warts. A case report and review of the literature

A 44-year-old female developed confluent, dusky red, pruritic labial papules clinically suspected to be genital warts. She had a long-standing history of Crohn's disease with vulvar fistulae. The papular eruption developed after several bouts of cellulitis in a region of vulvar lymphedema. Shave biopsy of a papule exhibited papillated epidermal hyperplasia overlying a dermis with a 'Swiss-cheese' appearance secondary to lymphedema and superficial ectatic thin-walled vascular spaces characteristic of lymphangiectasias. Review of published cases reveals that acquired lymphangiomas often affect the vulva compared to other cutaneous sites and can be associated with surgery, radiation therapy, infection (e.g., erysipelas, tuberculosis), Crohn's disease, congenital dysplastic angiopathy and congenital lymphedema. Rather than translucent vesicles ('frog spawn') typical of extragenital cutaneous lymphangiomas, vulvar lymphangiomas often present as verrucous papules that can be mistaken for genital warts. In this case, we believe that the combination of vulvar Crohn's disease and recurrent cellulitis resulted in local lymphatic destruction, lymphedema and ultimately symptomatic lymphangiectasias that mimicked genital warts.