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Hyphema-like sign in dermatoscopy of a lymphangioma

2020, JAAD Case Reports

the Departments of Dermatology and Internal Medicine, niversity of Minnesota. ing sources: None. licts of interest: None disclosed. espondence to: Juan P. Jaimes, MD, MS, Department of ermatology, 516 Delaware St SE, Minneapolis, MN 55455. mail: jaim0004@umn.edu. JAAD Case Reports 2020;6:959-60. 2352-5126 a 2020 by the American Academy of Dermatology, Inc. Published by Elsevier, Inc. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-ncnd/4.0/). https://doi.org/10.1016/j.jdcr.2020.08.014

DERMOSCOPY CASE OF THE MONTH Hyphema-like sign in dermatoscopy of a lymphangioma Gowri Kabbur, MD,a,b and Juan P. Jaimes, MD, MSa Minneapolis, Minnesota Key words: dermatoscopy; dermoscopy; hyphema-like; lymphangioma. CLINICAL PRESENTATION A woman in her late 20s presented to the dermatology clinic for a single irritated, painful lesion on the back, present for many years. On physical examination, there was a 5-mm oval, pink-to-orange papule with an eccentric dark red area located on the lower back (Fig 1). Fig 1. Clinical image of lymphangioma. Solitary oval, pink-to-orange papule with an eccentric dark red area, located on the lower back. DERMATOSCOPIC APPEARANCE Dermatoscopic examination found red-to-purple clods and several 2-color clods with a red crescentshaped dependent bottom corresponding to blood and a clear to serous color superiorly corresponding to lymph (Fig 2). Fig 2. Polarized dermatoscopy shows 2-color clods with a red crescent-shaped bottom (arrows) corresponding to blood and a clear to serous color on top corresponding to lymph. From the Departments of Dermatologya and Internal Medicine,b University of Minnesota. Funding sources: None. Conflicts of interest: None disclosed. Correspondence to: Juan P. Jaimes, MD, MS, Department of Dermatology, 516 Delaware St SE, Minneapolis, MN 55455. E-mail: jaim0004@umn.edu. JAAD Case Reports 2020;6:959-60. 2352-5126 ª 2020 by the American Academy of Dermatology, Inc. Published by Elsevier, Inc. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-ncnd/4.0/). https://doi.org/10.1016/j.jdcr.2020.08.014 959 960 Kabbur and Jaimes JAAD CASE REPORTS OCTOBER 2020 HISTOLOGIC DIAGNOSIS Histopathology found proliferations of thin-walled, dilated lymphatics containing pale pink proteinaceous lymph in the upper dermis, with focal hemorrhage within superficial vessels. KEY MESSAGE Lymphangiomas are rare lymphatic malformations that comprise roughly 4% of vascular tumors.1 Typically seen in children, lymphangiomas are subdivided into superficial and deep variants, of which lymphangioma circumscriptum is the most common. They are characterized by clusters of translucent lymph-filled vesicles resembling ‘‘frog spawn,’’ which frequently exhibit extravasated red blood cells.1 Common dermatoscopic findings include red, yellow, or multicolored lacunae, vascular structures, and white lines.1 Two-tone crescent-shaped clods have previously been described in lymphangiomas as hypopyon-like, mimicking the ophthalmologic hypopyon sign of dependent leukocyte sediments in the anterior chamber of the eye.2 In this case of lymphangioma, the designation hyphema-like sign would be more appropriate to describe the crescentic erythrocyte sedimentation, as hyphema classically refers to hemorrhage in the anterior chamber of the eye.2 The hyphema-like sign is a unique dermatoscopic finding to lymphangiomas that can aid in clinical diagnosis. REFERENCES 1. Zaballos P, Del Pozo LJ, Argenziano G, et al. Dermoscopy of lymphangioma circumscriptum: a morphological study of 45 cases. Australas J Dermatol. 2018;59(3):e189-e193. 2. Kumar S, Acharya S, Beuerman R. Deposition of particles on ocular tissues and formation of Krukenberg spindle, hyphema, and hypopyon. J Biomech Eng. 2007;129(2):174-186.