Reconstruction of massive localised lymphoedema of the scrotum with a novel fasciocutaneous flap: A rare case presentation and a review of the literature

Champaneria, Manish C.; Workman, Adrienne; Kao, Howard; Ray, Andrea O.; Hill, Michael E.

doi:10.1016/j.bjps.2012.06.024

Cited by 24 publications

(28 citation statements)

References 31 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Massive localized lymphedema displays a predilection for the inner thigh, but other sites have been reported, including the lower abdominal wall, suprapubic region, mons pubis, vulva, inguinoscrotal, penis, popliteal fossa, lower leg, and arm. [1][2][3][4][5][6][7][8][9] The etiology and pathogenesis of massive localized lymphedema is unclear but might be multifactorial. In the original paper of Farshid and Weiss, lymphatic obstruction due to massive adipose tissue was proposed as the main etiological factor.…”

mentioning

confidence: 99%

Massive localized lymphedema: a clinicopathologic study of 46 patients with an enrichment for multiplicity

et al. 2016

View full text Add to dashboard Cite

Massive localized lymphedema is a monstrous tumefactive pseudosarcoma seen in middle-aged morbidly obese adults. Since its initial description in 1998, the etiology remains unknown, although associations with trauma, surgeries, and hypothyroidism have been reported. Herein, we report the largest study of massive localized lymphedema and expand upon its clinicopathologic features. Fifty-four cases from 46 patients were retrospectively identified from the institutional archives of The Ohio State University Wexner Medical Center between 2002 and 2015. Forty-six patients (21 males and 25 females, mean age 50 years) presented with large masses developing over a 5-60-month period. The majority of patients were Caucasian (n = 39). All patients were obese with a mean weight of 384.7 lb and a mean body mass index of 59.6 kg/m 2 . Thirty-six patients had a history of atherosclerotic cardiovascular disease and diabetes mellitus type 2 was present in 22 patients. Eight patients had multifocal massive localized lymphedema. The sites included thigh (n = 33), abdomen (n = 17), suprapubic region (n = 1), mons pubis (n = 6), scrotum (n = 2), perianal region (n = 1), and right flank (n = 1). Mostly, the clinical impression was benign processes, including pannus or lymphedema pseudotumor. Grossly, the mean weight was 8237 g and the mean size was 53.2 cm. Histologically, eight cases showed a unique pattern of dystrophic calcifications mimicking hyperchromatic, atypical nuclei that might lead to misdiagnosis of liposarcoma, four cases showed focal metaplastic ossification, and three cases showed multinucleated cells in addition to prototypic features of massive localized lymphedema. We report that this is the largest series of massive localized lymphedema. This is a lesion mostly seen in morbidly obese patients and the thigh is the most common site of involvement. We note a marked racial predilection for Caucasians and a tendency towards multiplicity. We suggest that obesity itself and the related metabolic syndrome have an important role in its pathogenesis.

show abstract

mentioning

confidence: 99%

Massive localized lymphedema: a clinicopathologic study of 46 patients with an enrichment for multiplicity

et al. 2016

View full text Add to dashboard Cite

show abstract

“…6,[8][9][10][11][12][13][14][15][16] Reports on isolated penoscrotal lymphedema cases consist of chronic occurrences. In cases affecting the penis-although not a conclusive concept in treatment-penis reconstructions are performed using skin grafting 7,9,10 and local flaps from surrounding healthy tissues and by advancing the foreskin to the proximal. 1,7,10,12 In scrotal reconstruction, skin flaps taken from the superior or the lateral are used following orchiopexy.…”

Section: Discussionmentioning

confidence: 99%

“…In cases affecting the penis-although not a conclusive concept in treatment-penis reconstructions are performed using skin grafting 7,9,10 and local flaps from surrounding healthy tissues and by advancing the foreskin to the proximal. 1,7,10,12 In scrotal reconstruction, skin flaps taken from the superior or the lateral are used following orchiopexy. In cases which this option is not possible, fasciocutaneous transposition or advancement flaps taken from medial thighs are used.…”

Section: Discussionmentioning

confidence: 99%

Idiopathic Scrotal Elephantiasis

Evrenos¹,

Özkaya²,

Yaman³

et al. 2016

Turk J Plast Surg

View full text Add to dashboard Cite

“…It is associated with obesity but has also been seen in association with immobilization, as well as after surgery or blunt trauma [3]. Most series report a female predominance [2,4], and it usually is seen as a large pedunculated mass arising from the medial thigh [4], although a variety of other foci have been described, including abdominal pannus [5], penis, and scrotum [6,7]. In 1 series, it was noted that many of the cases had been sent out in consultation and that the originating pathologist had frequently not received useful clinical information such as body habitus [4].…”

Section: Discussionmentioning

confidence: 99%

“…Liposarcoma is the most common histopathologic differential lesion. The soft tissue on imaging appears reticular [7]. If needed, a murine double minute 2 stain can be performed and will be positive in liposarcoma and negative in MLL.…”

Section: Discussionmentioning

confidence: 99%