Dilated channels are seen in the dermis. Note the overlying epidermis.
These channels are lined by attenuated bland endothelial cells.
D2-40 highlights the lining cells.
This second example contains more open cystic spaces.
The dilated lymphatic spaces are again lined by bland inconspicuous endothelial cells.
Lymphangiomas are thought to be congenital malformations of lymphatic vessels. Some lymphangiomas may be acquired, developing as a result of lymphatic obstruction secondary to trauma, inflammation or surgery.
Lymphangioma circumscriptum is the common form of cutaneous lymphangioma, is characterized by persistent, multiple clusters of translucent vesicles that usually contain clear lymph fluid. These vesicles form from saccular dilations of lymphatic vessels in the dermal papillae and push upward against the epidermis. These tend to arise on the extremities, trunk, axilla, tongue and scrotum (Schwartz).
Cavernous lymphangioma are uncommon and arise during infancy, with the most frequent anatomic locations being the head and neck. These lymphangiomas are deep in the dermis and do not involve the overlying epidermis. Some experts consider cystic hygromas (cystic lymphagiomas) as a form of cavernous lymphangiomas. Cystic hygromas tend to arise in the head and neck, especially the posterior triangle (Acevedo).
Histologically, lymphangiomas are characterized by variably-sized lymphatic vessels. The stroma of the vessel walls can contain smooth muscle, lymphoid aggregates (especially in deeper lesions), foam cells and cholesterol clefts. D2-40 will outline the endothelial cells lining the lymphatic channels.
Lymphangiomas tend to be congenital or develop in childhood. However, lesions in adults have been reported and these tend to be deep-seated.
Acevedo JL, et al. Cystic hygromas: eMedicine. Last updated on June 22 2011. Available at: emedicine.medscape.com/article/994055
Schwartz RA, et al. Lymphangiomas: eMedicine. Last updated on May 13 2011. Available at: