Giant scrotal elephantiasis of inflammatory etiology: a case report

Denzinger, Stefan; Watzlawek, Elke; Burger, Maximilian; Otto, Wolfgang

doi:10.1186/1752-1947-1-23

Cited by 18 publications

(16 citation statements)

References 10 publications

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“…Histopathologically, lymphedema is a fibroinflammatory process 7,8 . Typically, elephantiasis diffusely involves the body part affected by lymphedema (legs more than arms and genitalia episodically); 8 exceptionally, lymphedema involves circumscribed region of skin producing a solitary, large polyp, 9–29 indurated (solid) plaque, 30–68 papillomatous plaque, 69–80 pendulous swelling 81–90 or large, sarcoma‐like mass 91–115 . Herein, we report the clinicopathologic findings of a consecutive series of 24 cases of localized lymphedema (elephantiasis) and review the literature on this phenomenon.…”

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confidence: 99%

Localized lymphedema (elephantiasis): a case series and review of the literature

Tran

Jones

et al. 2008

J Cutan Pathol

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Background: Lymphedema typically affects a whole limb. Rarely, lymphedema can present as a circumscribed plaque or an isolated skin tumor. Objective: To describe the clinical and pathologic characteristics and etiologic factors of localized lymphedema. Methods: Case–control study of skin biopsy and excision specimens histologically diagnosed with lymphedema and presenting as a localized skin tumor identified during a 4‐year period. Results: We identified 24 cases of localized lymphedema presenting as solitary large polyps (11), solid or papillomatous plaques (7), pendulous swellings (4), or tumors mimicking sarcoma (2). Patients were 18 females and 6 males with a mean age of 41 years (range 16–74). Anogenital involvement was most frequent (75%) – mostly vulva (58%), followed by eyelid (13%), thigh (8%) and breast (4%). Causative factors included injury due to trauma, surgery or childbirth (54%), chronic inflammatory disease (rosacea, Crohn’s disease) (8%), and bacterial cellulitis (12%). Eighty‐five percent of these patients were either overweight (50%) or obese (35%). Compared with a series of 80 patients with diffuse lymphedema, localized lymphedema patients were significantly younger (41 vs. 62 years old, p = 0.0001), had no history of cancer treatment (0% vs. 18%, p = 0.03), and had an injury to the affected site (54% vs. 6%, p = 0.0001). Histologically, all cases exhibited dermal edema, fibroplasia, dilated lymphatic vessels, uniformly distributed stromal cells and varying degrees of papillated epidermal hyperplasia, inflammatory infiltrates and hyperkeratosis. Tumor size significantly and positively correlated with history of cellulitis, obesity, dense inflammatory infiltrates containing abundant plasma cells, and lymphoid follicles (p < 0.05). A history of cellulitis, morbid obesity, lymphoid follicles and follicular cysts predicted recurrent or progressive swelling despite excision (p < 0.05). Conclusions: Localized lymphedema should be considered in the etiology of skin tumors when assessing a polyp, plaque, swelling or mass showing dermal edema, fibrosis and dilated lymphatics on biopsy. A combination of lymph stasis promoting factors (trauma, obesity, infection and/or inflammatory disorders) produces localized elephantiasis.

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confidence: 99%

Localized lymphedema (elephantiasis): a case series and review of the literature

Tran

Jones

et al. 2008

J Cutan Pathol

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“…Though it can be caused by a neoplasm, radiotherapy or lymphadenectomy, most cases are usually caused by infection as a result of lymphogranuloma venereum or filarial infestation with Wuchereria bancrofti [1-3]. Giant scrotal lymphedema is common in the tropics and sub-tropics [4,5].…”

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confidence: 99%

Giant scrotal lymphedema of unclear etiology: a case report

et al. 2009

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IntroductionScrotal lymphedema is common in the tropics and subtropics. The giant variants can cause a lot of physical disability and psychological disturbances.Case presentationWe present a 25-year-old Nigerian male with giant scrotal lymphedema with severe debilitating symptoms, immobility and emotional disturbance. He benefited from a modified Charles' procedure and reconstruction of the penile shaft using a split-thickness skin graft.ConclusionGiant scrotal lymphedema related to poverty, ignorance and neglect, is amenable to surgery. Surgery provides a cosmetically acceptable and functionally satisfying outcome.

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“…[1112] Various type of successful reconstructive surgery has also been reported in cases of primary scrotal lymphedema but there is need of selecting and individualizing appropriate surgical procedure according to the individual's need and pathogenesis of lymphedema. [612–14]…”

Section: Discussionmentioning

confidence: 99%

Bilateral axillary lymph node uptake of radiotracer during lower extremity and scrotal lymphoscintigraphy in a case of primary scrotal lymphoedema

Jain

Jaimini

2011

Indian J Nucl Med

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Lymphoscintigraphy is a useful technique for the evaluation of lymphatic function in the presence of limb swelling. The authors report a case where genital swelling in a 20-year-old man was investigated by lymphoscintigraphy. We performed lower limb lymphoscintigraphy and scrotal lymphoscintigraphy in the patient on two different days. Lower limb revealed dermal backflow pattern in lower limbs, inguinoscrotal reflux of the lymph and unexpected avid radiotracer uptake in the axillae bilaterally. Scrotal lymphoscintigraphy revealed slow movement of the lymph from the scrotal skin and again unexpected avid radiotracer uptake in the axillae bilaterally. Findings were concluded as congenital hypoplasia of lymphatics in lower limbs, congenital lymphectasia/compensatory megalymphatics in scrotum and aberrant lymphatic pathway, possibly due to malfunctioning/nonfunctioning thoracic duct.

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Giant scrotal elephantiasis of inflammatory etiology: a case report

Cited by 18 publications

References 10 publications

Localized lymphedema (elephantiasis): a case series and review of the literature

Localized lymphedema (elephantiasis): a case series and review of the literature

Giant scrotal lymphedema of unclear etiology: a case report

Bilateral axillary lymph node uptake of radiotracer during lower extremity and scrotal lymphoscintigraphy in a case of primary scrotal lymphoedema

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