Massive Localized Lymphedema

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Massive Localized Lymphedema

Postby patoco » Sun Oct 08, 2006 9:46 am

Massive Localized Lymphedema

Lymphedema People

http://www.lymphedemapeople.com

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What is massive localized lymphedema?

Massive localized lymphedema - a rare entity

[Article in German]

Decker P, Gortz M, Sigmund G, Kriegsmann J, Decker D.

Chirurgische Klinik I der Krankenanstalten Mutterhaus der Borromaerinnen Trier. decker@mutterhaus.de

Massive localized lymphedema is a rare disease. Only a few cases have been described in the literature. These monstrous pseudotumors of the subcutis are mostly localized in the inguinal region or at the lower extremity. These tumors often show a slow growth for many years. Besides hernias, lipomatous tumors must be distinguished. The therapy of choice is the excision of the tumor. Relapse is not uncommon in the few cases described in the literature so far. The diagnostic procedure and therapy of an 48-year-old women with a massive localized lymphedema weighing about 22 kg are demonstrated and discussed.

http://www.ncbi.nlm.nih.gov/entrez/quer ... t=Abstract

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Pseudosarcoma: massive localized lymphedema of the morbidly obese.

Obes Surg. 2006 Jan;16(1):88-93

Goshtasby P, Dawson J, Agarwal N.
Department of General and Trauma Surgery, York Hospital, York, PA 17405, USA. parvizmd75@yahoo.com

Massive localized lymphedema is a term used to describe a benign overgrowth of lymphoproliferative tissue in morbidly obese patients, which is characterized by fibrotic and edematous fibroadipose tissue. Because of its large size and similar appearance to sarcomas, it has often been termed a pseudosarcoma. Patients tend to seek treatment only when the masses reach a sufficient size to alter their activities of daily living or have problems with excoriation or wound breakdown. Resection is indicated in these cases or if there is any question as to underlying malignancy of the lesion. Although recurrence is common, overall prognosis is good, with only anecdotal reports of transformation to angiosarcoma in the literature. We report a patient afflicted with this unique disorder.

PMID: 16417764 [PubMed - indexed for MEDLINE]

http://www.ncbi.nlm.nih.gov/entrez/quer ... med_docsum

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Massive localized lymphedema in the morbidly obese : A histologically distinct reactive lesion simulating liposarcoma

Author(s)
FARSHID G. (1) ; WEISS S. W. (1) ;
Affiliation(s) du ou des auteurs / Author(s) Affiliation(s)
(1) Department of Pathology, University of Michigan Hospitals, Ann Arbor, Michigan, ETATS-UNIS

Abstract

We report 14 cases of a soft tissue lesion in the limbs of morbidly obese adults that presents as a large mass and histologically simulates well-differentiated liposarcoma (WDL). Based on its distinctive clinical setting and morphologic identity to diffuse lymphedema we have termed this process massive localized lymphedema (MLL). All cases occurred in morbidly obese adults (mean weight 372 Ibs; mean age 47 years). Women predominated (9 women: 5 men). The lesions affected the proximal medial aspect of the extremities (12 thigh : 2 arm) and were unilateral in all but two patients.

Etiologically significant antecedent events include ipsilateral axillary lymphadenectomy in both patients with arm lesions, chronic lymphedema resulting from vein-stripping 10 years prior in one patient, inguinal lymphadenectomy for anal carcinoma in another patient, and significant blunt trauma to the inner thigh during a motor vehicle accident in a third patient. The tumors were long standing (1-10 years) and extremely large (mean size 33.4 cm. 7408 g). Clinically, they were diffuse, ill-defined masses that histologically consisted of lobules of mature fat interrupted by expanded connective tissue septa.

The constituents of the septa were fine, fibrillary collagen, edema fluid, and uniformly distributed fibroblasts. Clusters of capillaries were frequently found at the interface between fat and connective tissue. The widened septa simulated the fibrous bands of sclerosing WDL, but MLL lacks the degree of nuclear atypia seen in the former.

The consistent clustering of reactive vessels at the interface between the fat and fibrous tissue also contrasted with WDL. Six patients experienced persistent or recurrent lesions within 10 months to 10 years. No aggressive growth or histologic progression was observed during this time, however. Awareness of the features of MLL is important to avoid misclassification of this reactive lesion with WDL.

Revue / Journal Title

The American journal of surgical pathology (Am. j. surg. pathol.) ISSN 0147-5185 CODEN AJSPDX

Source / Source
1998, vol. 22, no10, pp. 1277-1283 (4 ref.)

http://cat.inist.fr/?aModele=afficheN&cpsidt=2412582

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Massive localized lymphedema : Additional locations and association with hypothyroidism

Author(s)

WU Debbie ; GIBBS John ; CORRAL David ; INTENGAN Marilyn ; BROOKS John J. ;
Affiliation(s) du ou des auteurs / Author(s) Affiliation(s)
Department of Pathology, SUNY at Buffalo, Buffalo, NY, ETATS-UNIS
Department of Surgery, Section of Soft Tissue/Melanoma, Section of Urology, and Department of Pathology and Laboratory Medicine, Roswell Park Cancer Institute, Buffalo, NY, ETATS-UNIS

Abstract

We report the second series of a new entity called massive localized lymphedema in morbidly obese patients (MLL), recently described in medical literature. Our 6 cases present additional locations as well as an association with hypothyroidism. Huge masses, of longstanding duration ranging from 9 months to 8 years, afflicted the thigh, popliteal fossa, scrotum, suprapubic and inguinal region, and abdomen of morbidly obese adults.

Although clinical impressions were generally of a benign process, including lipoma and recurrent cellulitis, the possibility of a malignant neoplasm could not be eliminated. Poorly defined and non-encapsulated, these skin and subcutaneous lesions were most remarkable for their sheer size, measuring 50.6 cm in mean diameter (range, 38-75 cm) and weighing a mean of 6764.5 g (range, 2,060-12,000 g) The overlying skin exhibited the induration and peau d'orange characteristic of chronic lymphedema.

Grossly and histologically, a prominent marbled appearance, rendered by fibrous bands intersecting lobules of adipose tissue, simulated sclerosing well differentiated liposarcoma. However, the absence of atypical stromal cells, atypical adipocytes, and lipoblasts precluded the diagnosis of well differentiated liposarcoma. Instead, reactive features, encompassing lymphatic vascular ectasia, mononuclear cell infiltrates, fibrosis, and edema between the collagen fibers, as well as ischemic changes including infarction and fat necrosis, established the diagnosis of MLL.

Although the pathogenesis of MLL may be as simple as obstruction of efferent lymphatic flow by a massive abdominal pannus and/or prior surgery, the presence of hypothyroidism in 2 of our patients suggests an alternative pathogenesis. Recognition of this entity by both clinicians and pathologists should avert a misdiagnosis as a low-grade liposarcoma.

Revue / Journal Title

Human pathology (Human pathol.) ISSN 0046-8177 CODEN HPCQA4
Source / Source

2000, vol. 31, no9, pp. 1162-1168 (29 ref.)

http://cat.inist.fr/?aModele=afficheN&cpsidt=1510894

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Pseudosarcoma: Massive Localized Lymphedema of the Morbidly Obese

Authors: Goshtasby, Parviz1; Dawson, John1; Agarwal, Nikhilesh1

Source: Obesity Surgery, Volume 16, Number 1, January 2006, pp. 88-93(6)

Publisher: FD Communications Inc.

Abstract:

Massive localized lymphedema is a term used to describe a benign overgrowth of lymphoproliferative tissue in morbidly obese patients, which is characterized by fibrotic and edematous fibroadipose tissue. Because of its large size and similar appearance to sarcomas, it has often been termed a pseudosarcoma.

Patients tend to seek treatment only when the masses reach a sufficient size to alter their activities of daily living or have problems with excoriation or wound breakdown. Resection is indicated in these cases or if there is any question as to underlying malignancy of the lesion.

Although recurrence is common, overall prognosis is good, with only anecdotal reports of transformation to angiosarcoma in the literature. We report a patient afflicted with this unique disorder.

Keywords: LYMPHEDEMA; MORBID OBESITY; FIBROMA; LOWER EXTREMITY; PSEUDOSARCOMA; LIPOMA; LIPOSARCOMA

Document Type: Case report

DOI: 10.1381/096089206775222014

Affiliations: 1: Department of General and Trauma Surgery, York Hospital, York, PA, USA

http://www.ingentaconnect.com/content/f ... 1/art00017

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Massive Localized Lymphedema (MLL) in Bariatric Candidates

Authors: Modolin, Miguel L.A.1; Cintra, Wilson1; Paggiaro, André O.1; Faintuch, Joel2; Gemperli, Rolf1; Ferreira, Marcus C.1

Source: Obesity Surgery, Volume 16, Number 9, September 2006, pp. 1126-1130(5)

Publisher: FD Communications Inc.

Abstract:

Background: Mild lymphedema of lower limbs and eventually abdomen is not exceedingly rare in morbid obesity. However, few large symptomatic masses have been reported. In a consecutive series of patients, all requiring resection of the lesion before bariatric treatment, clinical features and surgical findings are described, aiming to clarify the nature of this intricate problem.

Methods: Subjects (n=4, 50% females, age 34.0±13.7 years (19-53), BMI 56.4±10.5 kg/m2 (44.1-73.1) displayed lesions on the anteromedial aspect of the thigh (n=3) and hypogastrium (n=1). All reported episodes of intertrigo of local skin-folds in the preceding years, managed by local care and antibiotics. The mass was described as a serious nuisance, impairing walking, dressing and personal hygiene.

Results: The mass was surgically removed without requirement for blood transfusion except in the case of one huge mass. Complications were relatively minor and consisted of partial skin dehiscence and lymph leakage for 2-3 weeks. Histologically, a complex pattern was observed including skin hypertrophy, edema, fibrosis, foci of microabscesses and dilated blood vessels, along with the pathognomonic lymphangiectasia. On follow-up to 6 months, improvement or restoration of the ability to walk occurred, with no additional skin infection and no recurrence.

Conclusions: 1) Surgical treatment was effective. 2) Functional rehabilitation was achieved. 3) No recurrence was observed within the follow-up period.

Keywords: LYMPHEDEMA; MASSIVE LOCALIZED LYMPHEDEMA; PSEUDOSARCOMA; ELEPHANTIASIS NOSTRAS; BARIATRIC SURGERY; MORBID OBESITY

Document Type: Research article

DOI: 10.1381/096089206778392185

Affiliations: 1: Plastic Surgery, Hospital das Clinicas, São Paulo, SP, Brazil 2: Gastroenterology Service, Hospital das Clinicas, São Paulo, SP, Brazil

http://www.ingentaconnect.com/content/f ... t4lp.alice

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