From Frogs to Skin: The Striking Spawn-like Sign of Lymphangioma Circumscriptum
Year: 2025
Type: article
Study design: Case Report
Abstract: A 12-year-old boy presented with a 5-year history of asymptomatic, pink to red lesions in the right axilla. These lesions were notable for multiple, clustered, translucent vesicles, imparting a frog-spawn-like appearance [Figure 1]. Dermoscopy revealed multiple pink and yellowish-pink lacunae, separated by pale septa, with a few reddish lacunae corresponding to blood collection [Figure 2]. Histopathological examination of a skin biopsy showed dilated, thin-walled lymphatic channels lined by bland, flat endothelial cells, some of which contained eosinophilic proteinaceous material. These findings, along with the presence of lymphocytes in the papillary dermis, confirmed the diagnosis of lymphangioma circumscriptum [Figure 3].Figure 1: A cluster of coalesced translucent vesicles, some hemorrhagic, resembling the characteristic “frog-spawn appearance.” A few discrete clear vesicles are noted at the periphery, located in the right axillary regionFigure 2: Polarized dermoscopy showing multiple pink and yellowish-pink lacunae, surrounded by pale septa (blue arrow), resembling the “frog-spawn appearance.” A few reddish lacunae are visible, indicating blood collection (black arrow)Figure 3: Hematoxylin and eosin stain at × 40. The epidermis shows hyperkeratosis, focal parakeratosis, and acanthosis. The papillary dermis demonstrates multiple thin-walled, dilated lymphatic channels (yellow arrow) lined by bland, flat endothelial cells, with some channels containing pale eosinophilic proteinaceous material (red arrow), surrounded by lymphocytesLymphangioma circumscriptum is a superficial congenital malformation of the lymphatic system, typically presenting as clusters of translucent vesicles. While the classical variant manifests at birth, predominantly on proximal extremities, localized variants may present at any age or anatomical site. The underlying lymphatic vessels occupy the dermal papillae, exerting upward pressure against the epidermis, resulting in a saccular configuration of the vesicles, commonly referred to as the frog-spawn appearance.[1,2] Cutaneous metastases in a patient with lung adenocarcinoma have presented as frog-spawn eruptions on the skin.[3] Declaration of consent The authors certify that they have obtained all appropriate consent forms, duly signed by the parent(s)/guardian(s) of the patient. In the form, the parent(s)/guardian(s) has/have given his/her/their consent for the images and other clinical information of their child to be reported in the journal. The parents understand that the names and initials of their child/children will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed. Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest.
Institution: Sri Manakula Vinayagar Medical College and Hospital
Language: English
Subfield: Surgery
Field: Medicine
Domain: Health Sciences
Open Access status: diamond
OpenAlex ID: W4411520037