Massive localized lymphedema in the morbidly obese : A histologically distinct reactive lesion simulating liposarcoma
Identifieur interne : 000A64 ( PascalFrancis/Checkpoint ); précédent : 000A63; suivant : 000A65Massive 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.
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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.
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<record><TEI><teiHeader><fileDesc><titleStmt><title xml:lang="en" level="a">Massive localized lymphedema in the morbidly obese : A histologically distinct reactive lesion simulating liposarcoma</title><author><name sortKey="Farshid, G" sort="Farshid, G" uniqKey="Farshid G" first="G." last="Farshid">G. Farshid</name><affiliation wicri:level="2"><inist:fA14 i1="01"><s1>Department of Pathology, University of Michigan Hospitals</s1><s2>Ann Arbor, Michigan</s2><s3>USA</s3><sZ>1 aut.</sZ><sZ>2 aut.</sZ></inist:fA14><country>États-Unis</country><placeName><region type="state">Michigan</region></placeName></affiliation></author><author><name sortKey="Weiss, S W" sort="Weiss, S W" uniqKey="Weiss S" first="S. W." last="Weiss">S. W. Weiss</name><affiliation wicri:level="2"><inist:fA14 i1="01"><s1>Department of Pathology, University of Michigan Hospitals</s1><s2>Ann Arbor, Michigan</s2><s3>USA</s3><sZ>1 aut.</sZ><sZ>2 aut.</sZ></inist:fA14><country>États-Unis</country><placeName><region type="state">Michigan</region></placeName></affiliation></author></titleStmt><publicationStmt><idno type="wicri:source">INIST</idno><idno type="inist">98-0492971</idno><date when="1998">1998</date><idno type="stanalyst">PASCAL 98-0492971 INIST</idno><idno type="RBID">Pascal:98-0492971</idno><idno type="wicri:Area/PascalFrancis/Corpus">000A66</idno><idno type="wicri:Area/PascalFrancis/Curation">001042</idno><idno type="wicri:Area/PascalFrancis/Checkpoint">000A64</idno><idno type="wicri:explorRef" wicri:stream="PascalFrancis" wicri:step="Checkpoint">000A64</idno></publicationStmt><sourceDesc><biblStruct><analytic><title xml:lang="en" level="a">Massive localized lymphedema in the morbidly obese : A histologically distinct reactive lesion simulating liposarcoma</title><author><name sortKey="Farshid, G" sort="Farshid, G" uniqKey="Farshid G" first="G." last="Farshid">G. Farshid</name><affiliation wicri:level="2"><inist:fA14 i1="01"><s1>Department of Pathology, University of Michigan Hospitals</s1><s2>Ann Arbor, Michigan</s2><s3>USA</s3><sZ>1 aut.</sZ><sZ>2 aut.</sZ></inist:fA14><country>États-Unis</country><placeName><region type="state">Michigan</region></placeName></affiliation></author><author><name sortKey="Weiss, S W" sort="Weiss, S W" uniqKey="Weiss S" first="S. W." last="Weiss">S. W. Weiss</name><affiliation wicri:level="2"><inist:fA14 i1="01"><s1>Department of Pathology, University of Michigan Hospitals</s1><s2>Ann Arbor, Michigan</s2><s3>USA</s3><sZ>1 aut.</sZ><sZ>2 aut.</sZ></inist:fA14><country>États-Unis</country><placeName><region type="state">Michigan</region></placeName></affiliation></author></analytic><series><title level="j" type="main">The American journal of surgical pathology</title><title level="j" type="abbreviated">Am. j. surg. pathol.</title><idno type="ISSN">0147-5185</idno><imprint><date when="1998">1998</date></imprint></series></biblStruct></sourceDesc><seriesStmt><title level="j" type="main">The American journal of surgical pathology</title><title level="j" type="abbreviated">Am. j. surg. pathol.</title><idno type="ISSN">0147-5185</idno></seriesStmt></fileDesc><profileDesc><textClass><keywords scheme="KwdEn" xml:lang="en"><term>Adult</term><term>Case study</term><term>Clinical investigation</term><term>Computerized axial tomography</term><term>Differential diagnostic</term><term>Limb</term><term>Liposarcoma</term><term>Localized</term><term>Lymphedema</term><term>Nutritional status</term><term>Obesity</term><term>Pathology</term><term>Sarcoma</term></keywords><keywords scheme="Pascal" xml:lang="fr"><term>Lymphoedème</term><term>Localisé</term><term>Membre</term><term>Liposarcome</term><term>Obésité</term><term>Tomodensitométrie</term><term>Exploration clinique</term><term>Anatomopathologie</term><term>Diagnostic différentiel</term><term>Etude cas</term><term>Adulte</term><term>Sarcome</term><term>Etat nutritionnel</term></keywords><keywords scheme="Wicri" type="topic" xml:lang="fr"><term>Adulte</term></keywords></textClass></profileDesc></teiHeader><front><div 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><inist><standard h6="B"><pA><fA01 i1="01" i2="1"><s0>0147-5185</s0></fA01><fA02 i1="01"><s0>AJSPDX</s0></fA02><fA03 i2="1"><s0>Am. j. surg. pathol.</s0></fA03><fA05><s2>22</s2></fA05><fA06><s2>10</s2></fA06><fA08 i1="01" i2="1" l="ENG"><s1>Massive localized lymphedema in the morbidly obese : A histologically distinct reactive lesion simulating liposarcoma</s1></fA08><fA11 i1="01" i2="1"><s1>FARSHID (G.)</s1></fA11><fA11 i1="02" i2="1"><s1>WEISS (S. W.)</s1></fA11><fA14 i1="01"><s1>Department of Pathology, University of Michigan Hospitals</s1><s2>Ann Arbor, Michigan</s2><s3>USA</s3><sZ>1 aut.</sZ><sZ>2 aut.</sZ></fA14><fA20><s1>1277-1283</s1></fA20><fA21><s1>1998</s1></fA21><fA23 i1="01"><s0>ENG</s0></fA23><fA43 i1="01"><s1>INIST</s1><s2>18344</s2><s5>354000070610300130</s5></fA43><fA44><s0>0000</s0><s1>© 1998 INIST-CNRS. 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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. 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