Penis and scrotum - Massively localized lymphedema in morbidly obese patients

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Penis and scrotum

Non-neoplastic lesions of scrotum

Massively localized lymphedema in morbidly obese patients

Editors: Antonio Cubilla, M.D. and Alcides Chaux, M.D.

Revised: 19 May 2010, last major update May 2010

Definition

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● Benign tumor-like condition affecting the scrotum

Terminology

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● A type of localized massive lymphedema

Sites

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● Scrotum, also thigh, popliteal fossa, abdomen, suprapubic and inguinal region

Etiology

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● Obstruction of efferent lymphatic drainage by either massive abdominal pannus (usually patients weigh > 250 pounds) or prior surgery

● Associated with hypothyroidism (Hum Pathol 2000;31:1162)

Clinical features

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● Huge mass resembling neoplasm (mean 50 cm, range 38-75 cm), of 9 months to 18 years duration

Gross description (Macroscopy)

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● Poorly defined, non-encapsulated

● Skin indurated with peau d’orange appearance

● Marbled appearance with fibrous bands intersecting adipose tissue lobules

Gross images

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Massive scrotal edema

Micro description (Histopathology)

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● Lobules of adipose tissue intersected by fibrous bands

● Lymphatic vascular ectasia, chronic inflammatory infiltrates, fibrosis, edema between collagen fibers, infarction and fat necrosis

● May have floret like giant cells or smooth muscle hyperplasia (Int J Surg Pathol 2008 Jul 8 [Epub ahead of print])

Micro description (Histopathology)

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Figure7 (not from scrotum)

Differential Diagnosis

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● Filarial infection (Rev Inst Med Trop Sao Paulo 2009;51:179)

● Well-differentiated sclerosing liposarcoma: presence of atypical stromal cells, atypical adipocytes, lipoblasts (Am J Surg Pathol 1998;22:1277)

End of Penis and scrotum > Non-neoplastic lesions of scrotum > Massively localized lymphedema in morbidly obese patients

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