A Small Perianal Lesion Revealing a Large Hemolymphangioma in a Pediatric Patient-The Hidden Iceberg Phenomenon: Case Report

Abstract

Fouzia Hali, Sara Boujloud* and Soumiya Chiheb

Background: Hemolymphangioma is a rare vascular and lymphatic malformation that poses diagnostic and therapeutic challenges. Treatment depends on the severity and location. Electrocoagulation and other physical modalities may offer temporary relief for superficial lesions. Hemolymphangioma management requires a multidisciplinary approach due to its complexity. Given its rarity, each case contributes valuable insights into optimal management strategies.

Case Presentation: A North African 10-year-old girl was presented with congenital right-sided gluteal asymmetry, which progressively evolved with the appearance of a painful, bleeding perianal lesion. Clinical examination revealed lymphangiectasias overlying a port-wine stain, prone to bleeding upon minor irritation. Ultrasonography and MRI confirmed a hemolymphangioma with a mixed cystic lymphatic component. Electrocoagulation was performed to control superficial bleeding while preserving the infiltrative subcutaneous component for ongoing clinical monitoring. To date, an eight-month follow-up has shown no recurrence of superficial lymphangiectasias and no clinically significant increase in gluteal volume.

Conclusion: Hemolymphangioma is a rare and challenging entity that necessitates individualized management strategies. A multidisciplinary approach is essential to optimize treatment outcomes, prevent complications, and improve the patient’s quality of life.

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