1Alali Meshari Ali,2Ji Hoon Shin,, 2Ji Hoon Shin,, 3Chengshi Chen, 2Jeoung In Shinaria

1AlMajmaah University College of Medicine, 2University of Ulsan College of Medicine, 3The Affiliated Cancer Hospital of Zhengzhou University

Background:

This case report is for 26-year-old woman who had an 18-year history of vulvar and vaginal lymphorrhea which confirmed by  MRI, and Conventional lipiodol lymphangiography. Patient was treated successfully via percutaneous puncture of this tubular lymphatic and embolization.

We believe that our case report makes a significant contribution to the literature because it shows that feasibility and efficacy of conventional lipiodol lymphangiography and adjunctive glue embolization for vulvar and vaginal lymphorrhea.

Material(s) and Method(s):

A 26-year-old woman had an 18-year long history of vulvar and vaginal lymphorrhea and multiple millet-like lesions on her vulva. On magnetic resonance image, multiple T2 high signal intensities were noted at the bilateral vulvar areas and pelvic cavity. Conventional lipiodol lymphangiography showed lymphatic reflux to the vulvar areas, possibly originating from prominent tubular lymphatics in the right lower abdominal wall. After percutaneous puncture of this tubular lymphatic structure, its distal portion was embolized using microcoils to prevent upward glue propagation; this was followed by glue embolization of the tubular lymphatic structure. The patient was without skin lesions or symptoms at follow-up of one year after the procedure.

Result(s):

Good clinical outcome was achieved in the patient in this case because lymphatic flow into the vagina and vulva was effectively blocked by percutaneous NBCA embolization. Minimal amount of reflux can persist after the embolization procedure, but the minimal amount of refluxed lymphatic fluid can be resorbed; therefore, symptom improvement or resolution can be expected. When blocking abnormal lymphatic channels with NBCA embolization at a certain level, reducing the upward lymphatic flow with distal coil embolization may facilitate greater NBCA embolization of targeted reflux, as seen in this patient.

Conclusion(s):

This report demonstrated feasibility and efficacy of conventional lipiodol lymphangiography and adjunctive glue embolization for vulvar and vaginal lymphorrhea..