Lymphangioma involving the urogenital system in childhood

• Lymphangiomas are benign lesions that rarely involve the urogenital system.
• Preoperative diagnosis of urogenital lymphangiomas can be difficult.
• Lymphangioma should be considered in any multicystic scrotal lesion.
• Complete excision of scrotal lymphangioma with overlying skin is recommended.
• Partial cystectomy for bladder lymphangioma is the preferred treatment.

Lymphangioma of the urogenital system is extremely rare and we present two cases treated at our institution over a one year period. The first case is a 3 year-old boy who presented with scrotal swelling and was initially thought to have a complex hydrocele. On surgical exploration, an extratesticular multiloculated cystic mass was discovered and testis-sparing excision of the mass was performed. Pathology revealed lymphangioma. The second case is a 5 year-old male who initially presented with gross hematuria. Ultrasound was unremarkable but cystoscopy revealed varicosities extending from the bladder wall. On transurethral resection, histology showed non-specific benign vascular malformation. Magnetic resonance imaging (MRI) was obtained because of persistent hematuria and showed multiple bladder lesions suggestive of lymphatic malformation. Partial cystectomy was ultimately performed and histology confirmed lymphangioma. To the author's knowledge, this represents the fifth reported case of lymphangioma of bladder.