title: Cryotherapy for massive vulvar lymphatic leakage complicated with lymphangiomas following gynecological cancer treatment.
abstract: Vulvar lymphatic leakage is a severe complication associated with gynecological cancer treatments. However, standard treatment strategies have not yet been determined. We encountered a rare case of a 76-year-old multiparous woman suffering from massive lymphatic fluid leakage from the entire vulva, and papules developed and were identified as lymphangiomas. A large amount of straw-colored discharge continued from all vulvar papules, which extended over the mons pubis. Nine years ago, the patient had undergone a radical hysterectomy with concurrent chemoradiation for uterine cervical cancer treatment. Her serum albumin level was 1.9 mg/dl, which was attributed to the loss of a large amount of lymph fluid due to leakage from the vulva. Her quality of life gradually decreased because of general fatigue and the need for frequent diaper exchanges every 2 h. The patient received a less-invasive treatment with cryotherapy using liquid nitrogen. She also received a multimodality treatment consisting of the intravenous administration of albumin, massage of the lower limbs and intensive rehabilitation. Cryotherapy was administered once a week for 3 months. Her discharge almost stopped and vulvar lymphangiomas decreased without any major complications. To the best of our knowledge, this is the first case report of massive lymphatic leakage complicated with vulvar lymphangiomas. Additionally, this case may represent the first successful treatment of vulva lymph leakage by cryotherapy without recurrence. Cryotherapy may have the potential to improve the quality of life as a less-invasive treatment for gynecological cancer survivors without serious complications.
authors.affiliation: Department of Obstetrics and Gynecology, Faculty of Medicine, Kagoshima University, Kagoshima s-yana@kagomc2.hosp.go.jp.
authors.forename: Shintaro
authors.initials: S
authors.lastname: Yanazume
authors.affiliation: Dozono Medical House, Kagoshima.
authors.forename: Haruhiko
authors.initials: H
authors.lastname: Douzono
authors.affiliation: Department of Dermatology, Faculty of Medicine, Kagoshima University, Kagoshima, Japan.
authors.forename: Hidemichi
authors.initials: H
authors.lastname: Kubo
authors.affiliation: Department of Obstetrics and Gynecology, Faculty of Medicine, Kagoshima University, Kagoshima.
authors.forename: Tomomi
authors.initials: T
authors.lastname: Nagata
authors.affiliation: Department of Obstetrics and Gynecology, Faculty of Medicine, Kagoshima University, Kagoshima.
authors.forename: Tsutomu
authors.initials: T
authors.lastname: Douchi
authors.affiliation: Department of Obstetrics and Gynecology, Faculty of Medicine, Kagoshima University, Kagoshima.
authors.forename: Hiroaki
authors.initials: H
authors.lastname: Kobayashi
mesh_terms: D000368:Aged; D059248:Chemoradiotherapy; D003131:Combined Modality Therapy; D017679:Cryotherapy; D005260:Female; D006801:Humans; D007044:Hysterectomy; D008202:Lymphangioma / Q000628:therapy*; D011788:Quality of Life; D016896:Treatment Outcome; D002583:Uterine Cervical Neoplasms / Q000628:therapy*; D014846:Vulvar Neoplasms / Q000628:therapy*
keywords: cryotherapy; lymphangioma; lymphatic leakage; vulva