It is impossible to draw a sharp line between lymphangiomata which should properly represent tumors composed of newly formed lymph vessels, and lymphangiectasis which is a simple dilation of the lymphatics. Hence the general condition is hard to describe satisfactorily but the simplest division would seem to be that of Wegner who classifies them as simple, cystic, and cavernous lymphangiomata. The last form will be considered in this book under the name of lymphangioma circumscriptum.
Simple lymphangioma embraces both dilated and new growths, and might properly include lymphangiectasis. However, the usual formations may be described as isolated or grouped, circumscribed, compressible, variously sized elastic swellings, often connected with dilated lymphatics. They favor the genitalia, lips and mouth but may be situated anywhere. There may be edema and thickening, even slight elephantiasis when the condition is localized. Fine, transparent vesicles may be present on the surface causing more or less exudation. When these growths appear on the anterior portion of the tongue they are termed macroglossia and when on the lip, macrocheilia. The variety described by Kaposi as lymphangioma tuberosum multiplex is usually considered to be a form of multiple benign cystic epithelioma. Other writers have used the same term to describe conditions more properly included among the lymphangiomata.
Cystic lymphangioma is a surgical condition, congenital in origin, composed of large multilocular cysts, usually on the upper part of the neck (hygromata colli).
Lymphangioma circumscriptum presents pin-head-to small pea-sized, deep-seated, translucent vesicles of yellowish, pinkish or normal skin tint. They may be few or many, grouped or scattered and are frequently surrounded by inflammatory areas. They usually occur upon the chest and upper extremities and the increase in size or peripheral extensions of patches may produce circinate, annular or gyrate figuration.
Etiology and Pathology. – The cause is not fully known but it is probably that in most cases beginning in infancy and childhood, it is due to congenital defects. The origin of some cases may be traced to local injuries, irritations, or actual obstructions to the lymphatic flow. The pathology may be briefly summed up as a dilation of the lymph structures with some new formations of the same.
Diagnosis. – Verruca should never be confused with the circumscribed variety because it lacks vesicular characteristics. Chronic abscesses or varicose veins may be differentiated by the fact that no lymph can be withdrawn from these growths.
Prognosis and Treatment. – These growths have a tendency toward extension and rarely disappear spontaneously. The treatment is by electrolysis, the vesicles being destroyed by inserting the negative needle into the center of each individual growth. The same result may be accomplished by caustics, solidified carbon dioxid or excision but the last method, to be effective, needs to be carried well beyond the growth to prevent a recurrence and is hardly adapted for the removal of large patches. Dilated lymphatics should be treated in the same way as varicose veins, that is by support with elastic bandages and rest in a horizontal position. Internal medication is of much importance and the following remedies have been useful: Calcarea phos. Carbo. veg., Hydrocot., Pet., Phosphorus, Sul., Vipera.