Dilated lymphatic vessels can be seen in the dermis. Note the rugated epithelium of the scrotum.
These ectatic channels are variably-sized and some of the dilatations are flush against the epidermis.
The lining endothelial cells are bland and attenuated. Not the presence of valves, a helpful feature to distinguish from hemangioma.
Lymphangiomas arising in the scrotum are rare. The differential diagnosis for a cystic mass in the scrotum includes a hydrocele, spermatocele, varicocele, hernia or neoplasms. Paratesticular tumors that arise in the scrotum are usually benign (70% of cases) and those that are malignant (30% of cases) are usually solid lesions (e.g. rhabdomyosarcoma, liposarcoma, fibrosarcoma). Common cystic neoplasms are usually of mesothelial origina (e.g. adenomatoid tumor, benign cystic mesothelioma)(Grossgold).
Lymphangiomas are mostly congenital and seen infants or young children. The most common sites are the head, neck, axilla, mediastinum, retroperitoneum, and rarely, the scrotum. Lymphangiomas are classified as capillary, cavernous and cystic (Lee). The later two types tend to be more deep-seated.
Grossgold ET, Kusuda L. Scrotal lymphangioma in an adult. Urology. 2007 Sep;70(3):590.e1-2.
Lee WC, et al. Sonographic findings in a case of scrotal lymphangioma in a 68-year-old male. J Clin Ultrasound. 2009 Sep;37(7):428-30.