Pediatric scrotal lymphatic malformation: a 15-case series and a proposed diagnostic and management algorithm.

Authors

Lei Kang, Guangyu Zhu, Rui Jia, Tao Guo, Gaofeng Zhang, Ming Bai

Published in

Frontiers in pediatrics. Volume 14. Pages 1898362. Epub Sep 09, 2026.

Abstract

To investigate the clinical characteristics, risks of misdiagnosis, and diagnostic and management strategies for pediatric scrotal lymphatic malformation.
A retrospective analysis was conducted on clinical data (demographics, symptoms, diagnostic work-up, and treatment) of 15 pediatric cases with scrotal lymphatic malformation treated at our institution between 2012 and 2025. Additionally, a targeted literature review of previously reported cases with diagnostic challenges was performed.
All lesions showed a characteristic extratesticular distribution outside the tunica vaginalis. The overall accuracy rates of preoperative color Doppler ultrasound and clinical diagnosis were only 46.7% (7/15) and 40.0% (6/15), respectively. Furthermore, 26.7% (4/15) of cases had an indeterminate preoperative diagnosis, and 33.3% (5/15) were completely misdiagnosed. Surgical excision was performed in all patients, achieving complete resection in 10 cases and incomplete resection in 5 cases. Over a follow-up period ranging from 3 months to 6 years (mean, 22 months), 3 cases developed ipsilateral scrotal or inguinal recurrence, and 1 case presented with a gluteal lymphatic malformation one year postoperatively. A literature review identified an additional 12 reported cases with incorrect or indeterminate preoperative diagnoses. Indeterminate diagnosis was the largest category (41.7%), and among the definite misdiagnoses, hydrocele was the most common (25%), which closely mirrored the pattern observed in our series.
Pediatric scrotal lymphatic malformation is a rare entity that is highly prone to misdiagnosis and recurrence. Based on our 15-case series and reported cases, we propose a diagnostic and management algorithm integrating clinical evaluation, stepwise imaging, surgical excision, and selective sclerotherapy to improve diagnostic accuracy and optimize surgical outcomes.

PMID:
42780250
Bibliographic data and abstract were imported from PubMed on 24 Sep 2026.

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