# Giant Hyperkeratotic Lymphangioma Circumscriptum on the Thigh of a 79-Year-Old Woman: A Report of a Rare Case

## TL;DR

A rare case of a large, hyperkeratotic lymphangioma in an elderly woman is reported, highlighting unusual features and the need for biopsy in atypical presentations.

## Contribution

This is the first reported case of giant hyperkeratotic lymphangioma circumscriptum in an elderly patient.

## Key findings

- The patient had a 15 cm × 2 cm hyperkeratotic lesion on her thigh confirmed as LC via histology.
- The case is notable for its atypical features: age, size, and hyperkeratotic presentation.
- The patient's history of DVT and obesity may have contributed to lymphatic dysfunction leading to LC.

## Abstract

Lymphangioma circumscriptum (LC) is a rare benign lymphatic anomaly that often manifests during childhood. We report an atypical instance of enormous hyperkeratotic LC in an older patient, augmenting the little literature on severe manifestations of this illness. This is a case of a 79-year-old woman with a medical history notable for deep vein thrombosis (DVT) and morbid obesity who presented with a developing skin lesion on her left thigh. During the clinical examination, a well-defined, verrucous lesion measuring approximately 15 cm × 2 cm and resembling a cauliflower was identified. The excisional samples obtained for histological analysis to verify the diagnosis revealed an edematous fibro-adipose stroma with dilated lymphatic channels, hyperkeratosis, and moderate papillomatosis, confirming the diagnosis of hyperkeratotic LC. To our knowledge, this is the first reported case involving LC late in life, occurring in an unusual site with gigantic proportions and being hyperkeratotic, which are all regarded as atypical features for LC. The patient, having a history of DVT and being obese, would most likely have lymphatic dysfunction, predisposing her to the development of LC. The form of hyperkeratotic LC seen in this case is even less common than the more familiar presentation of LC, which typically forms large, translucent bullae. This case highlights the different clinical presentations of LC and emphasizes that it should be regarded as a differential diagnosis for verrucous lesions, especially in older people. It also emphasizes the significance of a biopsy in validating instances with unusual manifestations, such as in older age groups, bigger lesion sizes, and atypical sites. Further research is necessary to elucidate the etiopathogenetic causes of acquired LC in adults and develop therapeutic procedures for large lesions.