Zhong Zhen Goh¹, Lauren Kim¹

¹Tissue Pathology & Diagnostic Oncology, Institute of Clinical Pathology and Medical Research, Westmead Hospital, Westmead, NSW, Australia

 

Massive localised lymphoedema (MLL) is a pseudoneoplastic process seen in morbidly obese patients who typically weigh more than 300 pounds.¹ The lesion most commonly develops in the medial thigh, but can also develop in the lower abdominal wall, scrotum and proximal arm.² We present a case of recurrent massive localised lymphoedema in the mons pubis.

 

A 64-year-old female with a BMI of 66, was seen in consultation for a slow-growing mass in her mons pubis. Reportedly, the mass first appeared 45 years ago, which was removed. However, the mass reappeared 6 years ago and has affected her mobility. The lesion was excised, which weighed 6550g and measured 38cm x 29 cm x 7.5cm. The nature of the mass was described as subcutaneous fat with prominent fibrous septa with overlying thickened skin. Microscopic examination showed expanded subcutaneous septa between lobules of mature adipose tissue with septal oedema and increased atypical fibroblasts, which were in keeping with MLL.

 

MLL is a benign entity seen in morbidly obese patients. The thickened subcutaneous septa in MLL could mimic the fibrous bands in well-differentiated lipoma-like and sclerosing liposarcoma and cause morphologic confusion.¹ Recognition of this entity is important to avoid erroneous misdiagnosis.

 

1. Rosenberg A. Pseudosarcomas of Soft Tissue. Arch Pathol Lab Med 1 April 2008; 132 (4): 579–586. doi: https://doi.org/10.5858/2008-132-579-POST

2. Lindberg M. Massive Localized Lymphedema. ExpertPath. Retrieved October 25, 2024, from https://app.expertpath.com/document/massive-localized-lymphedema/85608433-d411-40e4-b14c-1418474381b9?searchTerm=Massive%20Localized%20Lymphedema

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