Suscripción a Biblioteca: Guest
Portal Digitalde Biblioteca Digital eLibros Revistas Referencias y Libros de Ponencias Colecciones
Journal of Long-Term Effects of Medical Implants
SJR: 0.145 SNIP: 0.491 CiteScore™: 0.89

ISSN Imprimir: 1050-6934
ISSN En Línea: 1940-4379

Journal of Long-Term Effects of Medical Implants

DOI: 10.1615/JLongTermEffMedImplants.2020034007
pages 225-229

Massive Localized Lymphedema: Two Rare Case Reports of this Peculiar Entity and Anatomic Distortion

Evangelos Dimakakos
Angiologist-Anatomy and Histology Laboratory, Nursing School, University of Athens, Greece
Maria Zarokosta
University Department of Surgery, General and Oncologic Hospital of Kifissia "Agii Anargiri", Athens, Greece and Anatomy and Histology Laboratory, Nursing School, University of Athens, Greece
Theodoros Mariolis-Sapsakos
University Department of Surgery, General and Oncologic Hospital of Kifissia "Agii Anargiri", Athens, Greece and Anatomy and Histology Laboratory, Nursing School, University of Athens, Greece
Georgios Nousios
Department of Anatomy, School of Physical Education and Sport Sciences, Serres, Aristotles University of Thessaloniki, Serres, Greece
Alexandros P. Apostolopoulos
Trauma and Orthopaedic Department, "Korgialenio-Benakio" Hellenic Red Cross Hospital, Athens, Greece; Trauma and Orthopaedic Department, Ealing Hospital, North West University Healthcare NHS Trust, London, United Kingdom
Stavros Angelis
2nd Orthopaedic Department, General Children's Hospital, Athens, Greece; Orthopaedic and Trauma Department, Hellenic Red Cross Hospital, Athens, Greece
Dimitrios Filippou
Department of Anatomy and Surgical Anatomy, Medical School, National and Kapodestrian University of Athens · Athens, GRC


Introduction: Massive localized lymphedema (MLL), also called pseudosarcoma in the literature, constitutes a rare benign clinical disorder presenting in obese patients and characterized by chronic accumulation of lymph and adipose tissue due to lymphatic flow obstruction.
Presentation of Case: A 43-year-old, morbidly obese white woman proceeded to our institution with extended lymphedema. In addition, a 54-year-old white man sought medical advice for the same clinical issue. Surgical excision of the soft tissue mass was performed in both cases so that the patients could regain mobility of their limbs. The operation was uneventful. The histopathologic analysis asserted the diagnosis of MLL. A meticulous review of the literature was conducted as well.
Discussion: MLL is a scarce, non-malignant clinical entity that may mimic an abundance of soft tissue tumors. Patients with MLL are typically obese females with body mass index (BMI) > 40 kg/m2 who present with non-specific symptoms. The diagnosis of MLL is challenging, and its etiology and treatment are not completely elucidated.
Conclusion: Surgeons' deep knowledge regarding this peculiar clinical disorder is the cornerstone for the establishment of a correct diagnosis and warrants the adequate treatment, in addition to the elimination of the potentiality of malignant transformation of MLL to angiosarcoma or liposarcoma and of probable recurrence of MLL.


  1. Goshtasby P, Dawson J, Agarwal N. Pseudosarcoma: massive localized lymphedema of the morbidly obese. Obesity Surg. 2006;16:88-93. .

  2. Bahrami A, Ronaghan JE, O-Yurvati AH. Pseudosarcoma of the thigh: a rare case of massive localized lymphedema. Int Surg. 2015;100(3):461-465. .

  3. Narayanarao T, Suvarchala A, Krishnababu G. Pseudosarcoma-massive localized lymphoedema in morbidly obese-a rare entity: case report. Int J Surg Case Rep. 2012;3(8):389-39. .

  4. Kurt H, Arnold C, Payne J, Miller M, Skoracki R, Iwenofu O. Massive localized lymphedema: a clinicopathologic study of 46 patients with an enrichment for multiplicity. Modern Pathol. 2016;29:75-82. .

  5. Cintra JW, Modolin MLA, Rocha RI, Fernandes TR, Noguiera AB, Gemperli R. Results of surgical treatment of massive localized lymphedema in severely obese patients. Rev Col Bras Cir. 2014;41(1):18-22. .

  6. Agha RA, Fowler AJ, Saetta A, Barai I, Rajmohan S, Orgill DP. The SCARE statement: consensus-based surgical case report guidelines. Int J Surg. 2016;34:180-86. .

  7. Farshid G, Weiss SW. Massive localized lymphedema in the morbidly obese: a histologically distinct reactive lesion simulating liposarcoma. Am J Surg Pathol. 1998;22(10):1277-83. .

  8. Evans RJ, Scilley C. Massive localized lymphedema: a case series and literature review. Can J Plast Surg. 2011;19(3):30-31. .

  9. Asch S, James WD, Castelo-Soccio L. Massive localized lymphedema: an emerging dermatologic complication of obesity. J Am Acad Dermatol. 2008 Nov;59:109-10. .

  10. Brewer MB, Singh DP. Massive localized lymphedema: review of an emerging problem and report of a complex case in the mons pubis. Ann Plast Surg. 2012;68:101-04. .

  11. Fadare O, Brannan SM, Arin-Silasi D, Parkash V. Localized lymphedema of the vulva: a clinicopathologic study of 2 cases and a review of the literature. Int J Gynecol Pathol. 2011;30:306-13. .

  12. Lee S, Han JS, Ross HM, Epstein JI. Massive localized lymphedema of the male external genitalia: a clinicopathologic study of 6 cases. Hum Pathol. 2013;44:277-81. .

  13. McCluggage WG, Nielsen GP, Young RH. Massive vulval edema secondary to obesity and immobilization: a potential mimic of aggressive angiomyxoma. Int J Gynecol Pathol. 2008;27:447-52. .

  14. Modolin ML, Cintra W Jr, Paggiaro AO, Faintuch J, Gemperli R, Ferreira MC. Massive localized limphedema (MLL) in bariatric candidates. Obes Surg. 2006;16(9):1126-30. .

  15. Greene AK, Grant FD, Slavin SA. Lower-extremity lymphedema and elevated body-mass index. N Engl J Med. 2012;366:2136-37. .

  16. Vana J, Adamicova K, Haluska P, Celec J. Massive localized lymphedema in an extremely obese patient. Der Chirurg. 2002;73(4):383-86. .

  17. Wu D, Gibbs J, Corral D, Intengan M, Brooks JJ. Massive localized lymphedema: additional locations and association with hypothyroidism. Hum Pathol. 2000;31:1162-68. .

  18. Kotidis E, Cepaityte D, Petrakis G, Xytiroglou P, Sapalidis K, Kanellos I. Massive localized lymphedema in the morbidly obese patient: a clinical entity mimicking lymphosarcoma. Wounds. 2015 Sept 27(9):249-52. .

  19. Jabbar F, Hammoudeh ZS, Bachusz R, Ledgerwood AM, Lucas CE. The diagnostic and surgical challenges of massive localized lymphedema. Am J Surg. 2015;209(3):584-87. .

  20. Chopra K, Tadisina KK, Brewer M, Holton LH, Banda AK, Singh DP. Massive localized lymphedema revisited: a quickly rising complication of the obesity epidemic. Ann Plast Surg. 2015 Jan;74(1):126-32. .

Articles with similar content:

Massive Soft Tissue Infections: Necrotizing Fasciitis and Purpura Fulminans
Journal of Long-Term Effects of Medical Implants, Vol.15, 2005, issue 1
William B. Long III, Richard Edlich, Kathryne L. Winters, L. D. Britt, Charles R. Woodard
Reflex Sympathetic Dystrophy: A Comprehensive Review
Critical Reviews™ in Physical and Rehabilitation Medicine, Vol.14, 2002, issue 3&4
Alex Moroz, Alex Leali, Mathew Lee, Angela Liu
The Accessory Soleus Muscle: A Narrative Review of the Literature
Journal of Long-Term Effects of Medical Implants, Vol.29, 2019, issue 3
Dimitrios Filippou, George Skarpas, Georgios Nousios, Theodoros Mariolis-Sapsakos, Stavros Angelis, Maria Zarokosta, Aggeliki Bistaraki, Alexandros P. Apostolopoulos
Detrusor Instability in the Female: Controversies in Diagnosis, Etiology, and Management
Critical Reviews™ in Physical and Rehabilitation Medicine, Vol.11, 1999, issue 1
Kate H. Moore
Heterotopic Ossification: A Review of Etiology, Diagnosis, and Clinical Management
Critical Reviews™ in Physical and Rehabilitation Medicine, Vol.27, 2015, issue 2-4
Donald Hamby, Scott Strum, Justice Otchere