Massive localized lymphedema in the morbidly obese : A histologically distinct reactive lesion simulating liposarcoma
Identifieur interne : 00B665 ( Main/Exploration ); précédent : 00B664; suivant : 00B666Massive localized lymphedema in the morbidly obese : A histologically distinct reactive lesion simulating liposarcoma
Auteurs : G. Farshid [États-Unis] ; S. W. Weiss [États-Unis]Source :
- The American journal of surgical pathology [ 0147-5185 ] ; 1998.
Descripteurs français
- KwdFr :
- Adulte, Adulte d'âge moyen, Diagnostic différentiel, Femelle, Fibrome (anatomopathologie), Humains, Liposarcome (anatomopathologie), Lymphoedème (anatomopathologie), Lymphoedème (imagerie diagnostique), Lymphoedème (étiologie), Membres (), Membres (anatomopathologie), Membres (imagerie diagnostique), Mâle, Obésité morbide (), Obésité morbide (anatomopathologie), Peau (anatomopathologie), Sujet âgé, Système lymphatique (anatomopathologie), Tissu adipeux (anatomopathologie), Tomodensitométrie, Études de suivi.
- MESH :
- anatomopathologie : Fibrome, Liposarcome, Lymphoedème, Membres, Obésité morbide, Peau, Système lymphatique, Tissu adipeux.
- imagerie diagnostique : Lymphoedème, Membres.
- étiologie : Lymphoedème.
- Pascal (Inist)
- Adulte, Adulte d'âge moyen, Diagnostic différentiel, Femelle, Humains, Lymphoedème, Localisé, Membre, Liposarcome, Membres, Mâle, Obésité, Obésité morbide, Sujet âgé, Tomodensitométrie, Exploration clinique, Anatomopathologie, Diagnostic différentiel, Etude cas, Adulte, Sarcome, Etat nutritionnel, Études de suivi.
- Wicri :
- topic : Adulte.
English descriptors
- KwdEn :
- Adipose Tissue (pathology), Adult, Aged, Case study, Clinical investigation, Computerized axial tomography, Diagnosis, Differential, Differential diagnostic, Extremities (blood supply), Extremities (diagnostic imaging), Extremities (pathology), Female, Fibroma (pathology), Follow-Up Studies, Humans, Limb, Liposarcoma, Liposarcoma (pathology), Localized, Lymphatic System (pathology), Lymphedema, Lymphedema (diagnostic imaging), Lymphedema (etiology), Lymphedema (pathology), Male, Middle Aged, Nutritional status, Obesity, Obesity, Morbid (complications), Obesity, Morbid (pathology), Pathology, Sarcoma, Skin (pathology), Tomography, X-Ray Computed.
- MESH :
- blood supply : Extremities.
- complications : Obesity, Morbid.
- diagnostic imaging : Extremities, Lymphedema.
- etiology : Lymphedema.
- pathology : Adipose Tissue, Extremities, Fibroma, Liposarcoma, Lymphatic System, Lymphedema, Obesity, Morbid, Skin.
- Adult, Aged, Diagnosis, Differential, Female, Follow-Up Studies, Humans, Male, Middle Aged, Tomography, X-Ray Computed.
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 Ibs; 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 (1-10 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.
Affiliations:
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d'âge moyen</term><term>Diagnostic différentiel</term><term>Femelle</term><term>Fibrome (anatomopathologie)</term><term>Humains</term><term>Liposarcome (anatomopathologie)</term><term>Lymphoedème (anatomopathologie)</term><term>Lymphoedème (imagerie diagnostique)</term><term>Lymphoedème (étiologie)</term><term>Membres ()</term><term>Membres (anatomopathologie)</term><term>Membres (imagerie diagnostique)</term><term>Mâle</term><term>Obésité morbide ()</term><term>Obésité morbide (anatomopathologie)</term><term>Peau (anatomopathologie)</term><term>Sujet âgé</term><term>Système lymphatique (anatomopathologie)</term><term>Tissu adipeux (anatomopathologie)</term><term>Tomodensitométrie</term><term>Études de suivi</term></keywords><keywords scheme="MESH" qualifier="anatomopathologie" xml:lang="fr"><term>Fibrome</term><term>Liposarcome</term><term>Lymphoedème</term><term>Membres</term><term>Obésité morbide</term><term>Peau</term><term>Système lymphatique</term><term>Tissu 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type="abstract" xml:lang="en">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 Ibs; 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 (1-10 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.</div></front></TEI><affiliations><list><country><li>États-Unis</li></country><region><li>Michigan</li></region></list><tree><country name="États-Unis"><region name="Michigan"><name sortKey="Farshid, G" sort="Farshid, G" uniqKey="Farshid G" first="G." last="Farshid">G. Farshid</name></region><name sortKey="Weiss, S W" sort="Weiss, S W" uniqKey="Weiss S" first="S. W." last="Weiss">S. W. Weiss</name></country></tree></affiliations></record>Pour manipuler ce document sous Unix (Dilib)
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