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      Gross‐dependent lower limb lymphoedema

      case-report

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          Key Clinical Message

          Gross‐dependent lower limb lymphoedema is an unusual condition which can be painful particularly if ulceration occurs. Focused history and clinical examination in addition to appropriate radiological investigation aid in the diagnosis. It is difficult to treat and requires a multidisciplinary team including vascular surgeons, dermatologists and clinical nurse specialists. The primary treatment option is compression bandaging.

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          Successful treatment of early-stage lower extremity lymphedema with side-to-end lymphovenous anastomosis with indocyanine green lymphography assisted.

          Ran Ito, Chieh-Tsai Wu, Miffy Lin … (2016)
          This study was to investigate intraoperative assessment of side-to-end lymphovenous anastomosis (LVA) with indocyanine green (ICG) and the correlation between its patency and surgical outcome.
          Article 0 comments Cited 23 times – based on 0 reviews     Review now
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            A Comparison of the Quality of Life in Patients With Primary and Secondary Lower Limb Lymphedema: A Mixed-Methods Study.

            Deonni Stolldorf, Mary Dietrich, Sheila H Ridner (2016)
            Patients with lower limb lymphedema experience symptoms that may differ in intensity and distress. This mixed-methods study compares symptom intensity and distress and the impact of lymphedema on patients' quality of life by primary and secondary (cancer and noncancer) lymphedema groups. Individuals completed an online questionnaire (i.e., demographic form, Lymphedema Symptom Intensity and Distress Survey-Leg, and an open-ended question). Analyses included descriptive and inferential statistics (quantitative data) and content analysis (qualitative data). Participants differed statistically significantly by gender, employment status, and lymphedema location. Groups differed significantly in lack of self-confidence, χ(2)(df = 2) = 9.19, p = .010. Cancer patients reported higher intensity and distress scores for some symptoms, but these differences were not statistically significant. Patients reported lacking psychosocial well-being and resources and experiencing physical and functional impairments and treatment and care challenges. Patients with lower limb lymphedema experience psychosocial impairments and problems with quality of and access to care.
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              Massive localized lymphedema: a clinicopathologic study of 46 patients with an enrichment for multiplicity.

              Habibe Kurt, Christina A Arnold, Jason E. Payne … (2016)
              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.
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                Author and article information

                Contributors
                Mairead Marion Hennessy:
                ORCID: http://orcid.org/0000-0002-5470-7699
                mhennessy@muh.ie
                Journal
                Journal ID (nlm-ta): Clin Case Rep
                Journal ID (iso-abbrev): Clin Case Rep
                Journal ID (doi): 10.1002/(ISSN)2050-0904
                Journal ID (publisher-id): CCR3
                Title: Clinical Case Reports
                Publisher: John Wiley and Sons Inc. (Hoboken )
                ISSN (Electronic): 2050-0904
                Publication date (Electronic): 19 January 2017
                Publication date Collection: February 2017
                Volume: 5
                Issue: 2 ( doiID: 10.1002/ccr3.2017.5.issue-2 )
                Pages: 150-153
                Affiliations
                [ 1 ] Department of General & Vascular SurgeryMercy University Hospital CorkIreland
                Author notes
                [*] [* ] Correspondence

                Mairead Marion Hennessy, Department of General & Vascular Surgery, Mercy University Hospital, Grenville Place, T12 WE28 Cork, Ireland. Tel: +353214935000; Fax: +353214935200; E‐mail: mhennessy@ 123456muh.ie

                Author information
                http://orcid.org/0000-0002-5470-7699
                Article
                Publisher ID: CCR3795
                DOI: 10.1002/ccr3.795
                PMC ID: 5290492
                SO-VID: c1e8f5eb-85a6-45cf-8799-26cbc113e204
                Copyright © © 2017 The Authors. Clinical Case Reports published by John Wiley & Sons Ltd.
                License:

                This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.

                History
                Date received : 10 April 2016
                Date revision received : 06 October 2016
                Date accepted : 26 November 2016
                Page count
                Figures: 2, Tables: 0, Pages: 4, Words: 1090
                Categories
                Subject: Case Report
                Subject: Case Reports
                Custom metadata
                source-schema-version-number 2.0
                component-id ccr3795
                cover-date February 2017
                details-of-publishers-convertor Converter:WILEY_ML3GV2_TO_NLMPMC version:5.0.4 mode:remove_FC converted:03.02.2017

                Keywords: bilateral,chronic,lower limb swelling,lymphoedema,treatment
                Data availability:
                Keywords: bilateral, chronic, lower limb swelling, lymphoedema, treatment

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