Barw Barw Medical Journal 2960-1959 2025 09 22 Unusual Presentation of Mixed Lymphatic Malformation: A Case Report with Literature Review 71 76 10.58742/bmj.vi.206 eng Ronak S. Ahmed Shahid Nabaz Dermatology Teaching Center for Treatment of Skin Diseases, Sulaimani Directorate of Health, Sulaymaniyah, Iraq. ronakahmed76@gmail.com Shvan O. Siddiq Shahid Nabaz Dermatology Teaching Center for Treatment of Skin Diseases, Sulaimani Directorate of Health, Sulaymaniyah, Iraq. shvan.siddiq@gmail.com Lawen J. Mustafa Rheumatology Department, Ministry of Health, Shorsh Street, Sulaymaniyah, Iraq. lawen.mustafa@gmail.com Omed M. Hussein Rheumatology Department, Ministry of Health, Shorsh Street, Sulaymaniyah, Iraq. omed.hussein@gmail.com Sakar O. Arif Scientific Affairs Department, Smart Health Tower, Madam Mitterrand Street, Sulaymaniyah, Iraq. sakar.arif@gmail.com Dana HB. Mohammed Saeed College of Medicine, University of Sulaimani, Madam Mitterrand Street, Sulaymaniyah, Iraq. dana.saeed@gamil.com Farman J. Ahmed Cardiology Department, Suleimani Centre for Heart Disease, Qanat Street, Sulaymaniyah, Iraq. farman.ahmed@gmail.com Dilan Hikmat Department of Internal Medicine, University of Michigan, Sparrow Hospital, Lansing, Michigan, USA. dilan.sarmad.hiwa@gmail.com Jihad I. Hama Research Center, University of Halabja, Ababaile Village, Halabja, Iraq. jihad.hama@gmail.com 2025 07 25 Introduction There is a scarcity of reports on mixed lymphatic malformation. This case highlights a child with an extensive mixed lymphatic malformation, disfiguring multiple parts of the body. Case presentation A 3.5-year-old boy presented with multiple vesicular “frog-spawn” lesions that affected the right mid-axillary region, left axilla, and left upper back. The patient also had marked bilateral cervical swelling, extending laterally on both sides, with prominent bulges measuring approximately up to 10 cm that extended to involve the entire right upper limb dawn to the hand. Bilateral axillary swelling was observed. Additionally, swelling was evident in the entire middle and upper back, with a pronounced rounded bulge in the right upper back. Surgical intervention of the left axillary mass was performed, which was consistent with macrocystis lymphatic malformation on histopathology, but the condition recurred during follow-up. Literature review Few cases of microcystic lymphatic malformation with extensive deep lymphatic involvement have been reported in the literature. There was a female predilection with reported involvement of the forearm, thigh, vulva, axilla, jaw, and even the tongue. The patients' ages ranged from infancy to adulthood, with some patients complaining of skin lesions and recurrent cellulitis for years, sometimes leading to sepsis and death. There is variable outcome for surgical intervention in such cases. Conclusion Mixed lymphatic malformation can present extensively affecting several parts of the body causing significant disfigurement with possible recurrence after surgical intervention.