Giant scrotal elephantiasis of inflammatory etiology: a case report
Identifieur interne : 001C10 ( Pmc/Corpus ); précédent : 001C09; suivant : 001C11Giant scrotal elephantiasis of inflammatory etiology: a case report
Auteurs : Stefan Denzinger ; Elke Watzlawek ; Maximilian Burger ; Wolf F. Wieland ; Wolfgang OttoSource :
- Journal of Medical Case Reports [ 1752-1947 ] ; 2007.
Abstract
Scrotal lymphedema is rare outside endemic filariasis regions in Africa and Asia. It is of variable origin in the western world.
We present a case of a 40-year-old European man with massive elephantiasis of the scrotum attributed to chronic inflammation of the lower urinary tract caused by urinary outlet obstruction and diabetes mellitus. The patient underwent subtotal scrotectomy saving penis, testes and spermatic cords and followed by scrotal reconstruction with adequate cosmetic and functional outcome.
In this report we discuss a rare case of scrotal elephantiasis in an European patient, reflect on the etiology and the diagnostic and therapeutic approaches. Surgery can be successful even in giant scrotal elephantiasis.
Url:
DOI: 10.1186/1752-1947-1-23
PubMed: 17543128
PubMed Central: 1894979
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PMC:1894979Le document en format XML
<record><TEI><teiHeader><fileDesc><titleStmt><title xml:lang="en">Giant scrotal elephantiasis of inflammatory etiology: a case report</title><author><name sortKey="Denzinger, Stefan" sort="Denzinger, Stefan" uniqKey="Denzinger S" first="Stefan" last="Denzinger">Stefan Denzinger</name><affiliation><nlm:aff id="I1">Department of Urology, University of Regensburg, Landshuterstraße 65, 93053 Regensburg, Germany</nlm:aff></affiliation></author><author><name sortKey="Watzlawek, Elke" sort="Watzlawek, Elke" uniqKey="Watzlawek E" first="Elke" last="Watzlawek">Elke Watzlawek</name><affiliation><nlm:aff id="I1">Department of Urology, University of Regensburg, Landshuterstraße 65, 93053 Regensburg, Germany</nlm:aff></affiliation></author><author><name sortKey="Burger, Maximilian" sort="Burger, Maximilian" uniqKey="Burger M" first="Maximilian" last="Burger">Maximilian Burger</name><affiliation><nlm:aff id="I1">Department of Urology, University of Regensburg, Landshuterstraße 65, 93053 Regensburg, Germany</nlm:aff></affiliation></author><author><name sortKey="Wieland, Wolf F" sort="Wieland, Wolf F" uniqKey="Wieland W" first="Wolf F" last="Wieland">Wolf F. Wieland</name><affiliation><nlm:aff id="I1">Department of Urology, University of Regensburg, Landshuterstraße 65, 93053 Regensburg, Germany</nlm:aff></affiliation></author><author><name sortKey="Otto, Wolfgang" sort="Otto, Wolfgang" uniqKey="Otto W" first="Wolfgang" last="Otto">Wolfgang Otto</name><affiliation><nlm:aff id="I1">Department of Urology, University of Regensburg, Landshuterstraße 65, 93053 Regensburg, Germany</nlm:aff></affiliation></author></titleStmt><publicationStmt><idno type="wicri:source">PMC</idno><idno type="pmid">17543128</idno><idno type="pmc">1894979</idno><idno type="url">http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1894979</idno><idno type="RBID">PMC:1894979</idno><idno type="doi">10.1186/1752-1947-1-23</idno><date when="2007">2007</date><idno type="wicri:Area/Pmc/Corpus">001C10</idno><idno type="wicri:explorRef" wicri:stream="Pmc" wicri:step="Corpus" wicri:corpus="PMC">001C10</idno></publicationStmt><sourceDesc><biblStruct><analytic><title xml:lang="en" level="a" type="main">Giant scrotal elephantiasis of inflammatory etiology: a case report</title><author><name sortKey="Denzinger, Stefan" sort="Denzinger, Stefan" uniqKey="Denzinger S" first="Stefan" last="Denzinger">Stefan Denzinger</name><affiliation><nlm:aff id="I1">Department of Urology, University of Regensburg, Landshuterstraße 65, 93053 Regensburg, Germany</nlm:aff></affiliation></author><author><name sortKey="Watzlawek, Elke" sort="Watzlawek, Elke" uniqKey="Watzlawek E" first="Elke" last="Watzlawek">Elke Watzlawek</name><affiliation><nlm:aff id="I1">Department of Urology, University of Regensburg, Landshuterstraße 65, 93053 Regensburg, Germany</nlm:aff></affiliation></author><author><name sortKey="Burger, Maximilian" sort="Burger, Maximilian" uniqKey="Burger M" first="Maximilian" last="Burger">Maximilian Burger</name><affiliation><nlm:aff id="I1">Department of Urology, University of Regensburg, Landshuterstraße 65, 93053 Regensburg, Germany</nlm:aff></affiliation></author><author><name sortKey="Wieland, Wolf F" sort="Wieland, Wolf F" uniqKey="Wieland W" first="Wolf F" last="Wieland">Wolf F. Wieland</name><affiliation><nlm:aff id="I1">Department of Urology, University of Regensburg, Landshuterstraße 65, 93053 Regensburg, Germany</nlm:aff></affiliation></author><author><name sortKey="Otto, Wolfgang" sort="Otto, Wolfgang" uniqKey="Otto W" first="Wolfgang" last="Otto">Wolfgang Otto</name><affiliation><nlm:aff id="I1">Department of Urology, University of Regensburg, Landshuterstraße 65, 93053 Regensburg, Germany</nlm:aff></affiliation></author></analytic><series><title level="j">Journal of Medical Case Reports</title><idno type="eISSN">1752-1947</idno><imprint><date when="2007">2007</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en"><sec><title>Background</title><p>Scrotal lymphedema is rare outside endemic filariasis regions in Africa and Asia. It is of variable origin in the western world.</p></sec><sec><title>Case presentation</title><p>We present a case of a 40-year-old European man with massive elephantiasis of the scrotum attributed to chronic inflammation of the lower urinary tract caused by urinary outlet obstruction and diabetes mellitus. The patient underwent subtotal scrotectomy saving penis, testes and spermatic cords and followed by scrotal reconstruction with adequate cosmetic and functional outcome.</p></sec><sec><title>Conclusion</title><p>In this report we discuss a rare case of scrotal elephantiasis in an European patient, reflect on the etiology and the diagnostic and therapeutic approaches. Surgery can be successful even in giant scrotal elephantiasis.</p></sec></div></front><back><div1 type="bibliography"><listBibl><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct></listBibl></div1></back></TEI><pmc article-type="research-article"><pmc-dir>properties open_access</pmc-dir>
<front><journal-meta><journal-id journal-id-type="nlm-ta">J Med Case Reports</journal-id><journal-title>Journal of Medical Case Reports</journal-title><issn pub-type="epub">1752-1947</issn><publisher><publisher-name>BioMed Central</publisher-name><publisher-loc>London</publisher-loc></publisher></journal-meta><article-meta><article-id pub-id-type="pmid">17543128</article-id><article-id pub-id-type="pmc">1894979</article-id><article-id pub-id-type="publisher-id">1752-1947-1-23</article-id><article-id pub-id-type="doi">10.1186/1752-1947-1-23</article-id><article-categories><subj-group subj-group-type="heading"><subject>Case Report</subject></subj-group></article-categories><title-group><article-title>Giant scrotal elephantiasis of inflammatory etiology: a case report</article-title></title-group><contrib-group><contrib id="A1" contrib-type="author"><name><surname>Denzinger</surname><given-names>Stefan</given-names></name><xref ref-type="aff" rid="I1">1</xref><email>stefandenzinger@gmx.de</email></contrib><contrib id="A2" contrib-type="author"><name><surname>Watzlawek</surname><given-names>Elke</given-names></name><xref ref-type="aff" rid="I1">1</xref><email>ewatzlawek@gmx.de</email></contrib><contrib id="A3" contrib-type="author"><name><surname>Burger</surname><given-names>Maximilian</given-names></name><xref ref-type="aff" rid="I1">1</xref><email>maximilianburger@gmx.de</email></contrib><contrib id="A4" contrib-type="author"><name><surname>Wieland</surname><given-names>Wolf F</given-names></name><xref ref-type="aff" rid="I1">1</xref><email>wieland@caritasstjosef.de</email></contrib><contrib id="A5" corresp="yes" contrib-type="author"><name><surname>Otto</surname><given-names>Wolfgang</given-names></name><xref ref-type="aff" rid="I1">1</xref><email>wolfgang1.otto@klinik.uni-regensburg.de</email></contrib></contrib-group><aff id="I1"><label>1</label>Department of Urology, University of Regensburg, Landshuterstraße 65, 93053 Regensburg, Germany</aff><pub-date pub-type="collection"><year>2007</year></pub-date><pub-date pub-type="epub"><day>2</day><month>6</month><year>2007</year></pub-date><volume>1</volume><fpage>23</fpage><lpage>23</lpage><ext-link ext-link-type="uri" xlink:href="http://www.jmedicalcasereports.com/content/1/1/23"></ext-link><history><date date-type="received"><day>15</day><month>2</month><year>2007</year></date><date date-type="accepted"><day>2</day><month>6</month><year>2007</year></date></history><permissions><copyright-statement>Copyright © 2007 Denzinger et al; licensee BioMed Central Ltd.</copyright-statement><copyright-year>2007</copyright-year><copyright-holder>Denzinger et al; licensee BioMed Central Ltd.</copyright-holder><license license-type="open-access" xlink:href="http://creativecommons.org/licenses/by/2.0"><p>This is an Open Access article distributed under the terms of the Creative Commons Attribution License (<ext-link ext-link-type="uri" xlink:href="http://creativecommons.org/licenses/by/2.0"></ext-link>), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.</p><pmc-comment>
Denzinger
Stefan
stefandenzinger@gmx.de
Giant scrotal elephantiasis of inflammatory etiology: a case report
2007 Journal of Medical Case Reports 1(1): 23-. (2007) 1752-1947(2007)1:1<23> urn:ISSN:1752-1947
</license></permissions><abstract><sec><title>Background</title><p>Scrotal lymphedema is rare outside endemic filariasis regions in Africa and Asia. It is of variable origin in the western world.</p></sec><sec><title>Case presentation</title><p>We present a case of a 40-year-old European man with massive elephantiasis of the scrotum attributed to chronic inflammation of the lower urinary tract caused by urinary outlet obstruction and diabetes mellitus. The patient underwent subtotal scrotectomy saving penis, testes and spermatic cords and followed by scrotal reconstruction with adequate cosmetic and functional outcome.</p></sec><sec><title>Conclusion</title><p>In this report we discuss a rare case of scrotal elephantiasis in an European patient, reflect on the etiology and the diagnostic and therapeutic approaches. Surgery can be successful even in giant scrotal elephantiasis.</p></sec></abstract></article-meta></front><body><sec><title>Background</title><p>Massive scrotal lymphedema, also termed elephantiasis, can be caused by obstruction, aplasia or hypoplasia of lymphatic vessels. It is usually caused by acquired infection e.g. lymphogranuloma venereum or filarial infestation with Wuchereria bancrofti. Scrotal elephantiasis is extremely rare outside endemic regions in Africa and India [<xref ref-type="bibr" rid="B1">1</xref>,<xref ref-type="bibr" rid="B2">2</xref>]. Occasionally it has been attributed to radiotherapy, neoplasm and lymphadenectomy [<xref ref-type="bibr" rid="B3">3</xref>,<xref ref-type="bibr" rid="B4">4</xref>].</p><p>Primary lymphedema i.e. congenital elephantiasis, is an extremely rare condition. Patients develop edema at adolescence without restriction to the external genitalia. In hereditary elephantiasis of the Meige type, lymphedema of the external genitalia occurs due to malformation of lymphatic vessels [<xref ref-type="bibr" rid="B4">4</xref>]. In some cases hidradenitis suppurativa and lichen sclerosus et atrophicus have also been described [<xref ref-type="bibr" rid="B5">5</xref>].</p><p>Scrotal elephantiasis is both emotionally distressing and physically disabling. Difficulties with hygiene, urinary incontinence, unesthetic appearance, loss of libido and immobility are severely debilitating symptoms. The etiology of the lymphedema usually determines the natural course and the therapeutic approach.</p></sec><sec><title>Case presentation</title><sec><title>Case report</title><p>In April 2005, a 40-year-old Caucasian male was admitted to the Department of Urology of the University of Regensburg, Germany, with massive scrotal elephantiasis. He had been undergoing antibiotic treatment in another hospital for the previous three weeks.</p><p>The patient had a history of spina bifida with paralysis of the lower extremities, neurogenic bladder dysfunction, insulin dependent diabetes mellitus type 2 and slight mental retardation. Up to the age of 30 the patient was mobile by the use of a wheelchair, however the increasing size of his scrotum had made him bed-ridden for the past 10 years. Suprapubic cystostomy had been performed outside our institution ten years ago due to residual urine and recurrent urinary tract infections. There was no history of sexual contact, surgery, irradiation or travel.</p><p>On examination, the patient had a massively enlarged scrotum extending below his knees. The huge solid verrucous scrotal mass of 65 × 55 × 25 cm made it impossible to differentiate the anatomic structures (figure <xref ref-type="fig" rid="F1">1</xref>) and the urethral orifice emerged as a deep pit on the anterior surface of the mass. The scrotal skin was thickened and edematous hiding the penis. No inguinal adenopathy was found. Many superficial decubitus ulcers were found on the dorsal aspect of the scrotum. There was no accompanying swelling of the lower extremities. The testes and cords were not palpable, but no abnormalities were shown by ultrasonography. A CT scan of the abdomen indicated no cause of the condition. Laboratory testing, including human immunodeficiency virus, markers for testicular cancer, antibodies to schistosomes, Chlamydia trachomatis and filariae, were all in the normal range.</p><fig position="float" id="F1"><label>Figure 1</label><caption><p>Preoperative view of the patient with massive scrotal elephantiasis.</p></caption><graphic xlink:href="1752-1947-1-23-1"></graphic></fig><p>We decided to perform a subtotal scrotectomy with preservation of the penis and both testes and subsequent reconstruction of the scrotum by rotation flap. Primary closure of the wound was achieved.</p><p>The excised scrotal tissue weighed 11.6 kg. Grossly, the specimen contained multiple fluid-filled cysts. Histopathologic examination showed nonspecific chronic inflammation with areas of epidermal thickening and dermal fibrosis. Possibly due to the patient's diabetes mellitus, wound healing was impaired necessitating repeated wound debridement, vacuum assisted closure therapy for two weeks and the use of a mesh skin graft. Finally, wound healing was achieved with acceptable cosmetic results and only moderate distortion of the penis (figure <xref ref-type="fig" rid="F2">2</xref>).</p><fig position="float" id="F2"><label>Figure 2</label><caption><p>Appearance of the scrotum 12 weeks postoperatively.</p></caption><graphic xlink:href="1752-1947-1-23-2"></graphic></fig></sec><sec><title>Discussion</title><p>Scrotal elephantiasis is a rare condition outside regions endemic for Chlamydia trachomatis or Wuchereria bancrofti. McDougal presented an overview of etiologic factors of lymphedema of the external genitalia in 2003. Besides infections, neoplasms or chronic inflammation, scrotal lymphedema is rarely caused by congenital conditions, e.g. the rare Meige syndrome leading to malformation of lymphatic vessels of the external genitalia [<xref ref-type="bibr" rid="B3">3</xref>].</p><p>In this case extensive diagnostics indicated no other cause than chronic lower urinary tract infection and thus the case presented here was attributed to inflammation. Residual urine related to the patient's neurogenic bladder led to chronic inflammation that was further enhanced by his type 2 diabetes mellitus. Postoperatively, even after meticulous histopathologic and electron microscopic preparation of the tissue, no other etiologic evidence was found apart from nonspecific inflammatory reactions.</p><p>Some cases of scrotal lymphedema warrant elimination of the cause of the disease e.g. by antibiotic therapy. Usually there is no permanent damage to the skin, lymphatic or subcutaneous tissue [<xref ref-type="bibr" rid="B1">1</xref>,<xref ref-type="bibr" rid="B6">6</xref>,<xref ref-type="bibr" rid="B7">7</xref>]. However, in a case of persistent scrotal lymphedema, irreversible damage of the involved tissue can occur with the danger of necrotising fasciitis.</p><p>In this case we finally opted for surgical intervention. In extensive disease, complete excision of all elephantoid tissue, preferably saving the penis, spermatic cord and testes, is appropriate [<xref ref-type="bibr" rid="B2">2</xref>,<xref ref-type="bibr" rid="B8">8</xref>,<xref ref-type="bibr" rid="B9">9</xref>]. In accordance with the desires of the patient we preserved the spermatic cords and both testes despite the extent of the disease. If available, scrotal flaps are most suitable for reconstruction of the scrotum. Medial thigh flaps can be used in the absence of adjacent scrotal tissue. Mesh skin graft is widely accepted for use in penile skin defects [<xref ref-type="bibr" rid="B10">10</xref>].</p><p>Despite protracted wound healing taking 10 weeks until final closure, the patient gained considerably in quality of life. The patient now is able to move himself by wheelchair again. After a follow-up period of 18 months the patient's erectile function was reestablished enabling sexual intercourse. This case shows that surgical therapy can provide good functional and cosmetic results even in massive scrotal elephantiasis.</p></sec></sec><sec><title>Conclusion</title><p>Scrotal lymphedema is a rare syndrome outside regions of endemic Chlamydia trachomatis or Wuchereria boncrofti like Africa or Asia. Scrotal lymphedema in the western world is of variable origin. We present one European patient with scrotal lymphedema caused by chronic lower urinary tract infection and discuss the diagnostical and therapeutical approach. In the case presented here extensive excision of elephantoid tissue saving penis, spermatic cord and testes was performed with adequate cosmetic and functional results.</p></sec><sec><title>Competing interests</title><p>The author(s) declare that they have no competing interests.</p></sec><sec><title>Authors' contributions</title><p>SD and WO drafted the manuscript, EW and MB helped to draft the manuscript. WFW supervised treatment and draft of the manuscript. All authors have read and approved the final manuscript.</p></sec></body><back><ack><sec><title>Acknowledgements</title><p>The authors thank Cornelia Mohaupt and Ingrid Gebhard for excellent assistance. Written consent was obtained from the patient for publication of the study.</p></sec></ack><ref-list><ref id="B1"><citation citation-type="journal"><person-group person-group-type="author"><name><surname>Nelson</surname><given-names>RA</given-names></name><name><surname>Alberts</surname><given-names>GL</given-names></name><name><surname>King</surname><given-names>LE</given-names><suffix>Jr</suffix></name></person-group><article-title>Penile and scrotal elephantiasis caused by indolent Chlamydia trachomatis infection</article-title><source>Urology</source><year>2003</year><volume>61</volume><fpage>224</fpage><pub-id pub-id-type="pmid">12559311</pub-id><pub-id pub-id-type="doi">10.1016/S0090-4295(02)02078-2</pub-id></citation></ref><ref id="B2"><citation citation-type="journal"><person-group person-group-type="author"><name><surname>Kuepper</surname><given-names>D</given-names></name></person-group><article-title>Giant scrotal elephantiasis</article-title><source>Urology</source><year>2005</year><volume>65</volume><fpage>389</fpage><pub-id pub-id-type="pmid">15708070</pub-id><pub-id pub-id-type="doi">10.1016/j.urology.2004.08.051</pub-id></citation></ref><ref id="B3"><citation citation-type="journal"><person-group person-group-type="author"><name><surname>Mc Dougal</surname><given-names>WS</given-names></name></person-group><article-title>Lymphedema of the external genitalia</article-title><source>J Urol</source><year>2003</year><volume>170</volume><fpage>711</fpage><lpage>716</lpage><pub-id pub-id-type="pmid">12913680</pub-id><pub-id pub-id-type="doi">10.1097/01.ju.0000067625.45000.9e</pub-id></citation></ref><ref id="B4"><citation citation-type="journal"><person-group person-group-type="author"><name><surname>Tammer</surname><given-names>ME</given-names></name><name><surname>Plogmeier</surname><given-names>K</given-names></name><name><surname>Schneider</surname><given-names>W</given-names></name></person-group><article-title>Surgical therapy of scrotal edema in elephantiasis congenita hereditaria (Meige type)</article-title><source>Urol A</source><year>2002</year><volume>41</volume><fpage>493</fpage><lpage>495</lpage><pub-id pub-id-type="doi">10.1007/s00120-001-0156-0</pub-id></citation></ref><ref id="B5"><citation citation-type="journal"><person-group person-group-type="author"><name><surname>Wille</surname><given-names>S</given-names></name><name><surname>Niesel</surname><given-names>T</given-names></name><name><surname>Breul</surname><given-names>J</given-names></name><name><surname>Hartung</surname><given-names>R</given-names></name></person-group><article-title>Elephantiasis of the legs with lichen sclerosus et atrophicus of the penis and scrotum</article-title><source>J Urol</source><year>1997</year><volume>157</volume><fpage>2262</fpage><pub-id pub-id-type="pmid">9146642</pub-id><pub-id pub-id-type="doi">10.1016/S0022-5347(01)64747-5</pub-id></citation></ref><ref id="B6"><citation citation-type="journal"><person-group person-group-type="author"><name><surname>Bernhard</surname><given-names>P</given-names></name><name><surname>Magnussen</surname><given-names>P</given-names></name><name><surname>Lemnge</surname><given-names>MM</given-names></name></person-group><article-title>A randomized, double-blind, placebo-controlled study with diethylcarbamazine for the treatment of hydrocele in an area of Tanzania endemic for lymphatic filariasis</article-title><source>Trans R Soc Trop Med Hyg</source><year>2001</year><volume>95</volume><fpage>534</fpage><lpage>536</lpage><pub-id pub-id-type="pmid">11706668</pub-id><pub-id pub-id-type="doi">10.1016/S0035-9203(01)90031-8</pub-id></citation></ref><ref id="B7"><citation citation-type="journal"><person-group person-group-type="author"><name><surname>Makunde</surname><given-names>WH</given-names></name><name><surname>Kamugisha</surname><given-names>LM</given-names></name><name><surname>Massaga</surname><given-names>JJ</given-names></name><name><surname>Makunde</surname><given-names>RW</given-names></name><name><surname>Savael</surname><given-names>ZX</given-names></name><name><surname>Akida</surname><given-names>J</given-names></name><name><surname>Salum</surname><given-names>FM</given-names></name><name><surname>Taylor</surname><given-names>MJ</given-names></name></person-group><article-title>Treatment of coinfection with bancroftian filariasis and onchocerciasis: a safety and efficacy study of albendazole with ivermectin compared to treatment of single infection with bancroftian filariasis</article-title><source>Filaria J</source><year>2003</year><volume>2</volume><fpage>15</fpage><pub-id pub-id-type="pmid">14613509</pub-id><pub-id pub-id-type="doi">10.1186/1475-2883-2-15</pub-id></citation></ref><ref id="B8"><citation citation-type="journal"><person-group person-group-type="author"><name><surname>Apesos</surname><given-names>J</given-names></name><name><surname>Anigian</surname><given-names>G</given-names></name></person-group><article-title>Reconstruction of penile and scrotal lymphedema</article-title><source>Ann Plast Surg</source><year>1991</year><volume>27</volume><fpage>570</fpage><lpage>573</lpage><pub-id pub-id-type="pmid">1793244</pub-id><pub-id pub-id-type="doi">10.1097/00000637-199112000-00010</pub-id></citation></ref><ref id="B9"><citation citation-type="journal"><person-group person-group-type="author"><name><surname>Slama</surname><given-names>A</given-names></name><name><surname>Jaidane</surname><given-names>M</given-names></name><name><surname>Elleuch</surname><given-names>A</given-names></name><name><surname>Ben Sorba</surname><given-names>N</given-names></name><name><surname>Yacoubi</surname><given-names>MT</given-names></name><name><surname>Mosbah</surname><given-names>AF</given-names></name></person-group><article-title>Surgical treatment of penile-scrotal elephantiasis</article-title><source>Prog Urol</source><year>2002</year><volume>12</volume><fpage>337</fpage><lpage>339</lpage><pub-id pub-id-type="pmid">12108357</pub-id></citation></ref><ref id="B10"><citation citation-type="journal"><person-group person-group-type="author"><name><surname>Costa-Ferreira</surname><given-names>A</given-names></name><name><surname>Martins</surname><given-names>A</given-names></name><name><surname>Amarante</surname><given-names>J</given-names></name><name><surname>Silva</surname><given-names>A</given-names></name><name><surname>Reis</surname><given-names>J</given-names></name></person-group><article-title>Giant penoscrotal elephantiasis</article-title><source>Eur J Plast Surg</source><year>1999</year><volume>22</volume><fpage>397</fpage><lpage>399</lpage><pub-id pub-id-type="doi">10.1007/s002380050222</pub-id></citation></ref></ref-list></back></pmc></record>Pour manipuler ce document sous Unix (Dilib)
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