Pseudosarcoma - massive localized lymphoedema in morbidly obese - a rare entity: Case report.

2012

**Editors note: massive localized lymphedema is generally always in the legs if a morbidly obese patient has it, this is why I wanted to put this piece in our Leg Lymphedema blog. Pat - blog editor

Narayanarao T, Suvarchala A, Krishnababu G.

Source

Andhra Medical College, Chief Surgeon, King George Hospital,Visakhapatnam, Andhra Pradesh, India.

Abstract

INTRODUCTION:

Massive localized lymphoedema (MLL) first described in 1998 by Farshid and Weiss. Usually MLL present like huge pedunculated mass and appear like sarcoma hence called Pseudosarcoma. Morbid obesity is a growing epidemic in our society. Morbid obesity is usually associated with hypertension, Diabetes mellitus, dermatological complications like Acanthosis nigricans, skin tags, leg ulcers, edema, lymphoedema, plantar hyperkeratosis and massive localizedlymphoedema (MLL) is one of the complications of morbid obesity. Pseudosarcoma is due to derangement of lymphatic channels secondary to excessive deposition of adipose tissue.

PRESENTATION OF CASE:

We report a patient afflicted with this unique disorder presented with huge mass arising from monspubis in morbidly obese individual with body mass index (BMI) 55.

DISCUSSION:

Massive localized lymphedema presenting like pseudosarcoma in morbidly obese individuals is rare. Awareness of this disease is essential to avoid misdiagnosis as soft tissue neoplasm. It is a term used to describe a benign over growth of lymhoproliferative tissue in morbidly obese patients. Because of its size patients have difficult to do daily activities. Histopathologically characterized by dilated lymphatic channels with fibrotic and edematous tissue, without evidence of malignancy. Patient seeks treatment only if there is huge swelling causing discomfort, complications like excoriation, wound break down occur. The treatment of choice is complete excision.

CONCLUSION:

Surgical treatment is effective if done along with bariatric surgery. Functional rehabilitation was achieved. No recurrence was observed within the follow up period of twenty months and BMI was reduced to 28.

PMC

Leg Swelling following Inguinal and Ilioinguinal Dissection of Melanoma Metastases

April 2012

Pratsch AL, Kretschmer L.

Source

Georg-August-Universität Göttingen, Abteilung für Dermatologie, Venerologie und Allergologie, Göttingen, Deutschland.

Abstract

Key words: inguinal - iliac - lymph node dissection - melanoma - leg oedema - volumetry

Background: With respect to survival and local disease control, the adequate extent of lymph node dissection for melanoma metastasis to the groin is controversial. Since the methods for accurate quantification of leg oedemas are not well standardised, it remains also unclear whether the iliac part of a radical ilioinguinal lymph node dissection contributes to postoperative lymphoedema. 

Patients and Methods: Using a questionnaire and clinical examinations, we prospectively studied 65 persons for the presence of leg swellings (11 with inguinal lymph node dissection (sCLND), 23 with ilioinguinal dissection (rCLND), and 31 without nodal surgery and without signs of venous insufficiency). Exact volumetry of the legs was performed using the Image 3 D method. 

Results: The mean interval between the lymphadenectomy and the examination for swellings was 24 ± 30 months. Compared with sCLND, the amount of postoperative drainage fluid was significantly higher after rCLND (1960 ± 1390 mL versus (vs.) 898 ± 578 mL). Patients with rCLND perceived more frequently leg swellings (83 % vs. 55 %, p = 0.09), however, also 23 % of the control persons perceived leg swellings. Clinical signs of swelling were found slightly more frequently in the rCLND group (52 % vs. 45 %). After rCLND, the gain in volume of the ipsilateral thigh was significantly higher than after sCLND (7.01 ± 4.83 % vs. 1.29 ± 6.12 %, p = 0.01). Patients with rCLND more frequently needed manual lymph drainage (70 % vs. 45 %). In the control persons, the volumes of the right (mostly dominant) and the left legs did not differ significantly. 

Conclusions: Our results suggest that the iliac part of an ilioinguinal lymph node dissection significantly contributes to lymphoedema. Because of the multitude of reasons for swellings of the lower leg, volumetry of the thigh seems to be most adequate for quantifying the amount of postoperative lymphoedema.

Thieme E-Journal

Primary lymphedema complicated by weeping chylous vesicles in the leg and scrotum: report of a case.

May 2012

Division of Vascular Surgery, Department of Surgery and Clinical Science, Yamaguchi University Graduate School of Medicine, 1-1-1 Minamikogushi, Ube, Yamaguchi, 755-8505, Japan, ksuehiro-circ@umin.ac.jp.

Abstract

We report a case of primary lymphedema complicated by leaking chylous vesicles in the toe and scrotum, caused by lymphangiectasia, which was eventually managed with lymphaticovenular anastomoses after conservative treatments proved ineffective. The patient was a 25-year-old man with a 5-year history of massive swelling with chylous weeping of his right legand scrotum. Lymphangioscintigraphy (LAS) showed dilated iliac lymph trunks causing lymph reflux. Although he was instructed in standard methods of complex therapy, it did not alleviate his symptoms. Because of the increasing frequency of cellulitis, lymphatic surgery was finally indicated. The operation consisted of lymphaticovenous anastomoses (LVA) in the ankle and groin, using a super-micro-surgical technique. After surgery, his symptoms resolved and have been controlled by self-care. Thus, early LAS to confirm the dilated iliac lymph trunks causing lymph reflux, followed by LVA might be beneficial for the management of this disease.

Springerlink

Chronic edema of the lower extremities: international consensus recommendations for compression therapy clinical research trials.

August 2012

Stout N, Partsch H, Szolnoky G, Forner-Cordero I, Mosti G, Mortimer P, Flour M, Damstra R, Piller N, Geyer MJ, Benigni JP,Moffat C, Cornu-Thenard A, Schingale F, Clark M, Chauveau M.

Source

Breast Care Department, Walter Reed National Military Medical Center, Bethesda, MD, USA2 Department of Dermatology, Medical University of Vienna, Vienna, Austria3 Department of Dermatology and Allergology, University of Szeged, Szeged, Hungary4 Lymphoedema Unit, University Hospital La Fe Valencia, Spain5 Barbantini-Hospital, Lucca, Italy6 Cardiac anc Vascular Sciences St George's, University of London, London, UK7 Department of Dermatology, University Hospital KU, Leuven, Belgium8 Department of Dermatology, Nij Smellinghe Hospital, Drachten, The Netherlands 9 Department of Surgery, School of Medicine, Flinders Medical Centre, Bedford Park, Australia10 Department of Rehabilitation Science and Technology, University of Pittsburgh, Pittsburgh, PA, USA11 Hospital Begin, Paris, France12 Thames Valley University, London, UK13 Phlebology Department, Saint Antoine Hospital, Paris, France14 Lympho-Opt Clinic, Pommelsbrunn, Germany15 Wound Healing Research, Cardiff University, UK16 Boucicaut, Fontenay aux Roses, France.

Abstract

Chronic edema is a multifactorial condition affecting patients with various diseases. Although the pathophysiology of edema varies, compression therapy is a basic tenant of treatment, vital to reducing swelling. Clinical trials are disparate or lacking regarding specific protocols and application recommendations for compression materials and methodology to enable optimal efficacy. 

Compression therapy is a basic treatment modality for chronic leg edema; however, the evidence base for the optimal application, duration and intensity of compression therapy is lacking. The aim of this document was to present the proceedings of a day-long international expert consensus group meeting that examined the current state of the science for the use of compression therapy in chronic edema. 

An expert consensus group met in Brighton, UK, in March 2010 to examine the current state of the science for compression therapy in chronic edema of the lower extremities. Panel discussions and open space discussions examined the current literature, clinical practice patterns, common materials and emerging technologies for the management of chronic edema. This document outlines a proposed clinical research agenda focusing on compression therapy in chronic edema. 

Future trials comparing different compression devices, materials, pressures and parameters for application are needed to enhance the evidence base for optimal chronic oedema management. Important outcomes measures and methods of pressure and oedema quantification are outlined. Future trials are encouraged to optimize compression therapy in chronic edema of the lower extremities.

PubMed

15th Annual State of GA Lymphedema Education Program

Winship Cancer Institute of Emory University

and The Lighthouse Lymphedema Network

Cordially invite you to the

15th State of Georgia Lymphedema Education & Awareness Conference

Saturday, October 27, 2012

Emory University Hospital Midtown, 550 Peachtree Street, Atlanta, GA 30308

7:30am-4:30pm

Speakers include: Jane Armer, PhD, Richard Mistretta, DPM,

Joseph Feldman, MD, and David W. Chang, MD

The Conference Brochure may be viewed by clicking here:

http://lighthouselymphedema.org/announcements/15th-annual-state-of-georgia-lymph\
edema-education-and-awareness-program

You may register online by clicking here:

http://lighthouselymphedema.org/get-involved/secureregistration.htm

INFO PAGE:

http://lighthouselymphedema.org/announcements/15th-annual-state-of-georgia-lymph\
edema-education-and-awareness-program

Regional diagnosis of lymphoedema and selection of sites for lymphaticovenular anastomosis using elastography.

Aug 2011

Mihara M, Hayashi Y, Murai N, Moriguchi H, Iida T, Hara H, Todokoro T, Narushima M, Uchida G, Koshima I.

Source

Department of Plastic Surgery and Reconstructive Surgery, The University of Tokyo, Tokyo 113-8655, Japan. mihara@keiseigeka.name

Abstract

AIM:

To evaluate the use of ultrasound elastography as a basis for determining the most appropriate sites for lymphaticovenular anastomosis (LVA) for treatment of lymphoedema.

MATERIALS AND METHODS:

Preoperative elastography and LVA were performed in 11 patients (11 legs) with leglymphoedema, including two cases of primary oedema and nine of secondary oedema.

RESULTS:

The mean number of LVAs applied per leg was 4.4 (range 3-7). The mean reduction in the leg circumference was 91.7%, and 10 of the 11 cases (90.0%) were improved. Hardness was reduced from a mean of 1.6 before surgery to 0.9 after surgery, and improvement was also noted in 10 cases (90.9%). The severity of oedema was determined in five regions in each leg, and was classified as elastography stage (ES) 0 in 11 regions, ES1 in 23, ES2 in 15, and ES3 in six.

CONCLUSIONS:

These results demonstrate the value of ultrasound elastography for the diagnosis of early-stagelymphoedema and determination of LVA sites. This is the first report of diagnosis of lymphoedema using elastography and the findings suggest that this procedure followed by LVA could be used as a new therapeutic method for early-stage lymphoedema.

ElsevierSciVerse

Treating chronic lower limb lymphedema with the charles procedure in a renal allograft recipient.

Jan 2012

Wu HS, Cheng HT, Chen HC.

Source

Department of Surgery, Subdivision of Plastic and Reconstructive Surgery, China Medical University Hospital, China Medical University, Taichung City, Taiwan. hsiaosu.wu@gmail.com

Abstract

We report our experience in applying the Charles procedure to a female renal allograft recipient for her left lower leglymphedema. This is a rare comorbidity in limb lymphedema victims, and the use of the Charles procedure has not been reported in such an immunocompromised patient. After surgery, infection was well controlled, and there was minimal scar in the affected limb.

Lippincott, Williams Wilkins Annals of Plastic Surgery

Editor's Note: I posted this page for informational purposes only. I am opposed to surgical reduction of lymphedema except in the most severe cases of lymphedema that does NOT respond to other treatment modalities. This "glowing" article does not even touch on all the complications that can/are associated with surgical debulking surgeries.

Complications of Lymphedema Debulking Surgery

Thompsons's Procedure (The surgery I had)

Charles Procedure

Sistrunk Procedure

Kondolean Procedure

Homan's-Miller Procedure