A 68-year-old man presented with generalized blisters in the scrotum for more than ten years. The patient developed several pale blisters, ranging from needle tip to grain size, with a smooth surface on the scrotum without obvious cause. He had no apparent symptoms and was diagnosed with "scrotal eczema" at a local hospital. Although he was given a glucocorticoid ointment (unspecified), the symptoms did not resolve. In the last three years, blisters increased significantly and spread over the entire scrotal surface without itching and pain. Some blisters fused into a bulla, and some blisters ruptured and exuded. Therefore, he came to our hospital for treatment. He had no history of chronic diseases such as hypertension, diabetes, coronary heart disease, and cerebral infarction and no history of infection such as tuberculosis and malaria. Similarly, he reported no history of drug or food allergies. The patient's parents, younger brother, and sister did not show similar skin lesions.
Physical examination revealed no superficial lymph node enlargement in the groin. The thickened skin and the deepened folds on both sides of the scrotum were observed. The scrotal surface was covered with numerous blisters without peculiar smell and tenderness. The blister wall was thick with a clear boundary. The blister was filled with colorless or reddish serous exudates. Some blisters fused into a bulla (Figure 1A and B). No similar lesions were observed in other parts of the body.
All laboratory results were normal. The acetowhite test was also negative. The abdominal CT and B-ultrasound showed no abnormalities. Histopathological examination of the skin revealed that the cystic spaces of dermal cells were mainly filled with light red serous fluid, and a few inflammatory cells were observed around the cystic spaces, which was consistent with the pathological diagnosis of lymphangioma (Figure 2A and B). Immunohistochemistry showed positive CD31 (Figure 2C and D) and D2-40 protein (Figure 2E and F). Therefore, the patient was diagnosed with a simple-acquired lymphangioma of the scrotum. Thus, the patient received a carbon dioxide laser (CO2 laser) to individually cauterize the blisters at the skin lesions and remove the blisters until normal tissue was visible. The patient was also instructed to apply potassium permanganate solution (1:8000) to the wounds apart from laser therapy once a day and fusidic acid ointment twice a day. The patient was followed up continuously, and during one year of the follow-up, no relapse, scars, or other complications occurred.