Vulval Lymphangiectasia In Pregnancy

Author Information

Mhaske N*, Fonseca MN**, Kharat D***, Prasad M****.
(* Second Year Resident, ** Additional Professor, *** Assistant Professor, **** Senior Resident. Department of Obstetrics/Gynecology, LTMMC and LTMGH, Mumbi, India)


 Lymphangiectasias are acquired lymphatic disorders. Vulval lymphangiectasias can mimic other disorders. Vulval lymphangiectasias occurring with pregnancy is a rarity. A case of post-tuberculous vulval lymphangiectasia accompanying pregnancy is described here.


Common vulval disorders in pregnancy include viral warts and herpetic lesions. Rare lesions such as lymphangiectasia can also exist, especially in the setting of risk factors like previous tuberculosis or malignancy and radiotherapy.

Case Report

A 24 year old primigravida presented in outpatient department in early second trimester with vulval vesicular lesions. Patient had tuberculous lymphadenitis of neck three years prior, with no involvement of other systems, for which treatment was completed. Lesions in the vulval region, initially noticed few months prior to pregnancy, were gradually progressive. There were no complaints of pain, bleeding, discharge or pruritus.
Local genital examination revealed multiple erythematous grouped vesicles over the vulval and pubic region, resembling the classically described “frogspawn” appearance.   There was no regional lymphadenopathy or lower limb edema.  Specialist dermatological opinion was taken and clinical diagnosis of lymphangiectasia was reached. Watchful expectancy was maintained. Investigations including urinalysis, HIV, HBsAg, HCV,VDRL were all negative. Antenatal visits were regular, uneventful.

Figure 1. Multiple papulovesicular lesions over the vulva.

Onset of labor was spontaneous at 38 weeks of gestation. Abdominal examination revealed a full term uterus with a live fetus in cephalic presentation and per vaginal examination revealed adequate pelvis. As shown in figure 1, vulval examination revealed multiple vesicular lesions. 
In the second stage of labor, with descent of the presenting part, the labia splayed out and the vesicular lesions got displaced laterally. Thus there was adequate room for a mediolateral episiotomy, delivering a healthy female child of 2570 g. Episiotomy was sutured without disturbing the lesions. Oral antibiotics were given as per usual hospital protocol. Post-delivery period was uneventful.
Post-delivery biopsy (figure 2) showed hyperkeratotic atrophic epidermis, multiple dilated lymphatic channels, chronic inflammatory cells and dilated capillaries, suggestive of lymphangiectasis secondary to chronic infective condition. Post-delivery follow up showed a mild regression in the size of the lesions, and the patient continues to be asymptomatic.

Figure 2. Histopathological appearance of the lesion.


Lymphangiectasia is a disorder of superficial lymphatics which results from an obstruction of previously normal deep lymphatics.[1] It has been long recognized that vulval skin is susceptible to lymphangiectasia, the symptoms of which include vesicular lesions, pain, bleeding and itching.[2]
Few cases of vulval lymphangiectasia have been reported[3] and this entity has been described as a diagnostic challenge.[4] While many causes exist, the associations include malignancy, radiotherapy, tuberculosis and prior pelvic surgical procedures.[5,,6,7,8] Female genital mutilation has also been described as a cause.[9]
Lymphangiectasias associated with pregnancy and spontaneous regression postpartum have been described as a rarity that needs to be reported.[10] Management options include watchful observation, carbon dioxide laser, immunotherapy and surgery.[11]
In pregnancy, a confident diagnosis is needed, because this entity needs to be distinguished from conditions like viral warts and herpes, [3,12]  which have different labor management,  including avoidance of vaginal delivery. It is hoped that this report will add to existing knowledge about this entity during pregnancy.

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Mhaske N, Fonseca MN, Kharat D, Prasad M. Vulval Lymphangiectasia In Pregnancy. JPGO 2015. Volume 2 No. 2. Available from: