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Massive localized lymphedema in the morbidly obese: a histologically distinct reactive lesion simulating liposarcoma.
Am J Surg Pathol. 1998 Oct; 22(10):1277-83.AJ

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 lbs; 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 (I-IO 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.

Authors+Show Affiliations

Department of Pathology, University of Michigan Hospitals, Ann Arbor, USA.No affiliation info available

Pub Type(s)

Case Reports
Journal Article
Review

Language

eng

PubMed ID

9777990

Citation

Farshid, G, and S W. Weiss. "Massive Localized Lymphedema in the Morbidly Obese: a Histologically Distinct Reactive Lesion Simulating Liposarcoma." The American Journal of Surgical Pathology, vol. 22, no. 10, 1998, pp. 1277-83.
Farshid G, Weiss SW. Massive localized lymphedema in the morbidly obese: a histologically distinct reactive lesion simulating liposarcoma. Am J Surg Pathol. 1998;22(10):1277-83.
Farshid, G., & Weiss, S. W. (1998). Massive localized lymphedema in the morbidly obese: a histologically distinct reactive lesion simulating liposarcoma. The American Journal of Surgical Pathology, 22(10), 1277-83.
Farshid G, Weiss SW. Massive Localized Lymphedema in the Morbidly Obese: a Histologically Distinct Reactive Lesion Simulating Liposarcoma. Am J Surg Pathol. 1998;22(10):1277-83. PubMed PMID: 9777990.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Massive localized lymphedema in the morbidly obese: a histologically distinct reactive lesion simulating liposarcoma. AU - Farshid,G, AU - Weiss,S W, PY - 1998/10/20/pubmed PY - 1998/10/20/medline PY - 1998/10/20/entrez SP - 1277 EP - 83 JF - The American journal of surgical pathology JO - Am. J. Surg. Pathol. VL - 22 IS - 10 N2 - 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 lbs; 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 (I-IO 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. SN - 0147-5185 UR - https://www.unboundmedicine.com/medline/citation/9777990/Massive_localized_lymphedema_in_the_morbidly_obese:_a_histologically_distinct_reactive_lesion_simulating_liposarcoma_ L2 - http://dx.doi.org/10.1097/00000478-199810000-00013 DB - PRIME DP - Unbound Medicine ER -