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Lower lip capillary malformation occurs in all patients with CLAPO syndromeCLAPO syndrome: Lower lip marks seen in all 31 patients

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Key Takeaway
Recognize lower lip capillary malformation as a predominant manifestation in patients with CLAPO syndrome.

This case report and retrospective review examines the clinical features of CLAPO syndrome in a cohort of 31 patients. The analysis focuses on identifying common physical manifestations associated with this condition within the PIK3CA-related overgrowth spectrum.

The authors synthesize data showing that lower lip capillary malformation was present in all 31/31 patients, suggesting it is a predominant manifestation. Other findings include lymphatic malformations in 25/31 cases and venous malformations in 17/31 cases. Tissue overgrowth was observed in 10/31 patients. Additionally, the authors note that enlarged venous vessels on the median raphe of the tongue may be considered a specific clinical feature.

The study acknowledges limitations including a small sample size due to the low incidence of the disease. Clinical utility is focused on identifying these features for diagnostic purposes. Because of the limited sample size and retrospective nature, results should be interpreted with caution in clinical practice.

A new review of 31 people with CLAPO syndrome, a rare condition that affects blood vessels and tissue growth, found that every single patient had a capillary malformation (a type of birthmark) on their lower lip. This finding confirms that the lower lip mark is a key feature of the syndrome.

The study also reported that 25 out of 31 patients had lymphatic malformations (abnormal fluid-filled spaces), 17 had venous malformations (abnormal veins), and 10 had tissue overgrowth. The researchers noted that enlarged veins on the underside of the tongue may be another clue for doctors.

Because CLAPO syndrome is very rare, the study included only 31 people. This small number means the findings may not apply to everyone with the condition. The study was a case review, not a controlled trial, so it cannot prove cause and effect.

For patients and families, this review helps clarify what to expect with CLAPO syndrome. If you or your child has these symptoms, talk to a specialist familiar with vascular anomalies.

What this means for you:
Lower lip birthmark is a consistent sign of CLAPO syndrome, seen in all 31 cases reviewed.

Common questions

What is CLAPO syndrome?

CLAPO syndrome is a rare condition that causes capillary malformations (birthmarks), lymphatic and venous malformations, and tissue overgrowth. It is part of the PIK3CA-related overgrowth spectrum.

How common is the lower lip mark in CLAPO syndrome?

In this review of 31 patients, every single one (31 out of 31) had a capillary malformation on their lower lip. This suggests it is a very common feature.

What other symptoms were seen in the study?

The study found lymphatic malformations in 25 patients, venous malformations in 17, and tissue overgrowth in 10. Enlarged veins on the underside of the tongue may also be a clue.

Is this study reliable?

The study is a case review with a small sample of 31 patients, which limits how much the findings can be generalized. It provides useful information but is not definitive.

Study Details

Study typeSystematic review
EvidenceLevel 1
PublishedJul 2026
View Original Abstract ↓
BackgroundCLAPO syndrome, a condition potentially associated with the PIK3CA-related overgrowth spectrum, is a rare vascular malformation that was first reported in 2008 and formally incorporated into the ISSVA classification in 2018.ObjectiveThis study intends to investigate the clinical features of CLAPO syndrome.MethodsWe report one clinical case of CLAPO syndrome admitted to our hospital and retrospectively summarize findings of all previously published relevant cases.ResultsTogether with the current case in this study, a total of 31 patients across 11 publications were enrolled for analysis. All 31 patients exhibited lower lip capillary malformation (CM). Additionally, lymphatic malformations were observed in 25 cases, venous malformations in 17 cases, and varying degrees of tissue overgrowth in 10 patients.LimitationsDue to the extremely low incidence of this disease, the sample size is relatively small. Further studies are required to clarify its pathogenesis, therapeutic efficacy and genetic characteristics.ConclusionLower lip CM serves as a predominant manifestation of CLAPO syndrome. Clinicians should raise the suspicion of CLAPO syndrome in patients presenting with lower lip CM. Notably, enlarged venous vessels visible on the median raphe of the tongue may also be regarded as a clinical feature of CLAPO syndrome.
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