A Novel Treatment Using Ultrasound-guided Sclerotherapy in a Rare Case of Lymphatic Malformation of the Vulva in a Pediatric Filipino Female

Abstract

Lymphangioma or lymphatic malformations (LMs) are rare vascular anomalies, comprising about 4% of vascular malformations. Its most common symptom is swelling, which often leads to cosmetic deformity. Its most prevalent subtype, the cutaneous/microcystic LM (lymphangioma circumscriptum), seldom presents in the vulvar area, making treatment especially challenging due to potential complications and recurrence risks. This case involves a 10-year-old Filipino female, otherwise healthy, who presented with progressively enlarging, tender, “frog spawn”-like papules on the left vulva since birth. These papules showed partial improvement following surgical excision. Histopathological examination confirmed the diagnosis of a microcystic LM. Over the past year, the patient experienced a recurrence of papules, resulting in vulvar asymmetry and labial swelling. Pelvic magnetic resonance imaging, ultrasound, and fine-needle aspiration biopsy revealed multiple superficial and deep cystic masses consistent with an LM. Long-pulsed Nd: YAG laser was administered to the external lesions, yielding partial improvement. Subsequently, the patient underwent ultrasound-guided sclerotherapy with bleomycin under local anesthesia. This procedure, performed by interventional radiology, successfully resolved the deep cysts and swelling after two sessions, with no reported complications. In cases of LMs, especially in anatomically sensitive regions such as the vulva, imaging plays a crucial role in determining lesion depth and guiding treatment to minimize recurrence. Although no local literature is available, this case highlights the effectiveness and safety of ultrasound-guided sclerotherapy with bleomycin as a novel treatment option for LMs.