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Lymphangioma circumscriptum
These lesions are either considered as hamartomas or as localized abnormalities of the cutaneous lymphatic drainage. They present as a number of clear or slightly haemorrhagic cutaneous vesicles, often associated with subcutaneous thickening in the underlying fat. Whimster thought that a lymphangioma circumscriptum was the result of defective lymphatic drainage from the subcutaneous tissue where a number of cisterns ‘pump’ lymph back into the overlying skin. These areas should be excised if they are unsightly or painful. They often occur on the trunk and it is important to excise a generous amount of subcutaneous tissue well beyond the ellipse of skin bearing the vesicles in order to remove the subcutaneous bladders described by Whimster. It is often quite difficult to excise all the skin lesions and they have a propensity to recur: excisional surgery is only required if they are symptomatic.
Cystic hygroma
In this developmental abnormality of the lymphatic system, lymphatic fluid collects in a cystic space which is often multilocular and situated in the base of the neck. Cystic hygroma commonly appears in childhood and presents as a soft, brilliantly translucent swelling in the base of the neck. Aspiration and injection of sclerosant may be attempted, but the swellings often recur and may require excision. Cystic hygromas must be dissected with great care as a number of important structures lie adjacent to them.
Mesenteric cysts
These localized lymphatic cysts within the mesentery appear as well-circumscribed mobile lumps within the abdomen. The diagnosis can be confirmed by ultrasound or CT scanning. They are treated by resection, often in association with the overlying area of small bowel. Although harmless, they may reach a considerable size if left untreated.
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