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Massive localized lymphedema: additional locations and association with hypothyroidism.
Hum Pathol. 2000 Sep; 31(9):1162-8.HP

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.

Authors+Show Affiliations

Department of Pathology, SUNY at Buffalo, NY, USA.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Case Reports
Journal Article

Language

eng

PubMed ID

11014586

Citation

Wu, D, et al. "Massive Localized Lymphedema: Additional Locations and Association With Hypothyroidism." Human Pathology, vol. 31, no. 9, 2000, pp. 1162-8.
Wu D, Gibbs J, Corral D, et al. Massive localized lymphedema: additional locations and association with hypothyroidism. Hum Pathol. 2000;31(9):1162-8.
Wu, D., Gibbs, J., Corral, D., Intengan, M., & Brooks, J. J. (2000). Massive localized lymphedema: additional locations and association with hypothyroidism. Human Pathology, 31(9), 1162-8.
Wu D, et al. Massive Localized Lymphedema: Additional Locations and Association With Hypothyroidism. Hum Pathol. 2000;31(9):1162-8. PubMed PMID: 11014586.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Massive localized lymphedema: additional locations and association with hypothyroidism. AU - Wu,D, AU - Gibbs,J, AU - Corral,D, AU - Intengan,M, AU - Brooks,J J, PY - 2000/10/3/pubmed PY - 2000/10/21/medline PY - 2000/10/3/entrez SP - 1162 EP - 8 JF - Human pathology JO - Hum. Pathol. VL - 31 IS - 9 N2 - 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. SN - 0046-8177 UR - https://www.unboundmedicine.com/medline/citation/11014586/Massive_localized_lymphedema:_additional_locations_and_association_with_hypothyroidism_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0046-8177(00)61821-X DB - PRIME DP - Unbound Medicine ER -