Massive scrotal elephantiasis: A case report.

The condition known as scrotal elephantiasis is a debilitating rarity where the scrotum undergoes significant swelling, typically arising from chronic obstructive lymphedema. A case is presented of a 60-year-old man who had suffered severe and persistent enlargement of his scrotum for multiple years. This affliction greatly affected both his ability to function effectively and caused detrimental psychosocial consequences. After a clinical evaluation, the patient was diagnosed with scrotal elephantiasis. A comprehensive strategy was adopted, utilizing scrotal volume reduction surgery to yield a significant enhancement in the quality of life following the operation.

Isolated scrotal lymphedema in a 43-year old male patient: A case report.

INTRODUCTION: Lymphedema of the external genitalia is a rare condition characterized by swelling of the scrotal skin and subcutaneous tissue, resulting from a pathology in lymphatic drainage. Over time, the development of fibrosis leads to a considerable impairment in the patient's quality of life. While conservative management is generally the first-line approach, surgical cases may necessitate surgical intervention to achieve comprehensive and lasting improvements. CASE PRESENTATION: We present the case of a 43-year-old obese male patient who presented to the clinic with a complaint of persistent bilateral scrotal swelling for three months. Clinical examination revealed a pressure-indolent, soft, and massively enlarged swelling of the scrotum on both sides. Ultrasound findings confirmed a diffusely thickened edematous scrotal wall. The patient was advised to start physiotherapy and adhere to conservative management. Due to the debilitating size of the mass, the patient opted for excision of the scrotal swelling followed by scrotoplasty. CLINICAL DISCUSSION: This case report explores the presentation, signs and symptoms, impact on patients' lives, and various management options for scrotal lymphedema. It underscores the intricacies involved in the diagnosis and treatment decision-making process, emphasizing the need for a tailored and multidisciplinary approach. CONCLUSION: It is imperative to initially rule out life-threatening causes of scrotal lymphedema to ensure optimal patient care. The integration of surgical interventions should be carefully considered in the overall management strategy for optimal and comprehensive results. Scrotoplasty, in the context of scrotal lymphedema, not only improves the quality of life but also positively influences sexual function. COMPETENCIES: Interpersonal and communication skills, Medical knowledge, Patient care, Practice-based learning and improvement.

Giant scrotal lymphedema after paraffinoma injection: A case report.

Scrotal lymphedema is a rare condition characterized by blocked lymphatic drainage to the scrotum, resulting in physical and psychological discomfort for sufferers. Here, we present a case study of a 27-year-old male with giant scrotal lymphedema resulting from paraffinoma injection. The patient experienced scrotal enlargement since 2019, which engulfed the penis and was surrounded by edema. After confirming the absence of filariasis parasites, the patient underwent paraffinoma excision and scrotoplasty, resulting in a 13 kilograms scrotal specimen with no signs of malignancy. Giant scrotal lymphedema can be distressing, but surgical excision can improve the patient's quality of life.

Surgical reconstruction of massive scrotal lymphedema associated with hidradenitis suppurativa: a case report.

Hidradenitis suppurativa (HS) is a chronic, recurrent inflammatory cutaneous disease affecting apocrine glands. It can be associated with lymphedema of the surrounding tissues and most commonly affects scrotum. As a debilitating complication of HS, lymphedema can cause significant morbidity and further exacerbate HS condition, thus causing a vicious cycle. Surgery was reported to be the most common treatment for this complication. Here, we present a 41-year-old patient with massive scrotal lymphedema following a 2-year history of HS. To reduce the volume of the scrotal mass and improve the appearance and function of the scrotum, we modified the Charle's procedure by complete excision of the affected tissue while retaining the scrotal septum, preserving the subcutaneous lymphatic tissue flap, turnover of the perididymis, and primary closure. We found that this approach achieved satisfactory cosmetic results, maintained cutaneous sensation and restored erections. There was no adverse event following surgery. No recurrence occurred over 6-month of follow-up. We believe that this modified Charles' procedure can improve the morphology and lymphatic function of the scrotum and recommend its use whenever possible. While rare, HS associated lymphedema should alert clinician to the potential consequence of an advanced disease situation. Collaborative approach with surgery in the management of this condition should be considered at early stage.

Successful surgical treatment of giant scrotal lymphedema associated with Hodgkin's lymphoma: A rare case report.

Scrotal lymphedema is a rare disease, caused by obstruction of the lymphatic vessels draining into the scrotum, and may be induced by malignant lymphoma. A 27-year-old male, who was treated for Hodgkin's lymphoma, presented with scrotal swelling for 3 years. We observed huge scrotal swelling with extension to the suprapubic region and lower right limb, a significantly thickened scrotal wall, and nonpalpable testes. The patient underwent scrotal lymphedema excision followed by surgical scrotal and penile reconstruction. Treatment of scrotal lymphedema is challenging. However, we were satisfied with our surgical result. Our patient experienced both physical and psychological improvements.

Surgical management of male genital lymphedema: A systematic review.

Genital lymphedema (GL) is an uncommon and disabling disease that manifests as enlargement of the genital region resulting from the disturbance of lymphatic drainage. Although conservative treatment such as decompression is typically the first-line approach, surgical intervention has been shown to be effective in certain cases. This study aimed to systematically review studies evaluating available surgical alternatives for the treatment of male GL. A systematic search strategy using keyword and subject headings was applied to PubMed, Scopus, EMBASE, and Cochrane Library in May 2019. Studies investigating various surgical techniques to treat penile and scrotal lymphedema were included. The potential risk of bias of included trials was evaluated using the methodological index for non-randomized studies (MINORS). In total, 13 studies met the inclusion criteria, nine of which were determined to be high-quality. The average MINORS score was 12.45 for studies involving excision and 14 for studies involving lymphovenous anastomosis (LVA). The most common reason for a low score was a failure to describe the inclusion criteria. Recurrence of lymphedema during follow-up was reported in four studies involving excision and in no studies involving LVA. In general, the quality of the included literature was considered to be fair. Although surgical intervention might not always prevent the recurrence of lymphedema, all of the studies reported improved quality of life after the procedure. This study could be used as the basis for evidence-based guidelines to be applied in clinical practice for managing male GL.

Multiple lymphatic-venous anastomoses (MLVA) for microsurgical drainage of primary peno-scrotal lymphedema: A case report.

Single site Multiple Lymphatic-Venous Anastomoses (MLVA) provides optimal functional and cosmetic results with low complication rates in treatment of lower limb lymphedema. However, no evidence exists in literature concerning the use of this technique in treatment of peno-scrotal lymphedema. We report a case of a 44-year-old male patient who developed secondary peno-scrotal lymphedema with severe lymphorrhea, following a laser treatment for scrotal pustolosis, leading to recurrent infections and finally an established peno-scrotal lymphedema. Utilizing MLVA, a complete remission of scrotal lymphedema was achieved with significant volume reduction of the penile lymphedema. The post-operative course was uneventful with clear improvement in lymphatic flow demonstrable on lymphoscintigraphy (6 months) and no recurrence of scrotal lymphedema at 2 years follow-up. This article reports very promising results of a novel application of MLVA in the treatment of genital lymphedema and suggests that MLVA provides the possibility to shunt both superficial and deep lymphatics to improve the lymphatic drainage from the peno-scrotal area using a single surgical site.

Surgical treatment of scrotal lymphedema: modified surgical technique.

Lymphedema is a chronic disease in which lymph accumulates under the subcutaneous tissue. The condition may be due to either congenital or acquired lymphatic system abnormalities. Genital lymphedema (scrotal lymphedema) has a high psychological and functional impact, and many surgical techniques have been tried in an attempt to improve function and cosmetic appearance. The aim of this study is to present our experience in treatment of a series of patients with scrotal lymphedema. Twenty patients suffering from moderate to severe scrotal lymphedema underwent treatment by using three flaps technique (2 inguinoscrotal flap and one perineoscrotal flap). The technique showed improvement in cosmetic, sexual, and voiding function with low incidence of recurrence up to 23 months of followup.

Manejo quirúrgico del linfedema escrotal severo / Surgical management of severe scrotal lymphedema

Resumen:El linfedema consiste en la retención de líquido linfático en los tejidos, causada por una obstrucción del sistema linfático. El sistema linfático devuelve el líquido intersticial al conducto torácico y este luego al torrente sanguíneo, y de allí se recircula a los tejidos. Puede ser un fenómeno aislado o no, tal como manifestación de una displasia linfática congénita (primaria), desarrollada durante la etapa tardía de linfangiogénesis; o puede ser secundario, es decir, causado por una lesión u obstrucción en los vasos linfáticos, ya sea por disección quirúrgica radical, irradiación, malignidad, linfangitis con linfagioesclerosis, trauma o causa idiopática. Los síntomas pueden incluir fatiga grave, edema focal o generalizado en algunas regiones del cuerpo, así como descoloración de la piel que recubre el linfedema y, finalmente, la deformidad, que en el caso de las extremidades inferiores se llama elefantiasis. El linfedema no solo puede causar desfiguración, sino también limitación del estilo de vida, e incluso trastornos psicológicos. Se presenta el caso de un paciente de 45 años, portador de linfedema severo (elefantiasis) de miembros inferiores crónico y del saco escrotal, valorado y manejado quirúrgicamente en el Servicio de Cirugía Plástica y Reconstructiva del Hospital México.

Abstract:Lymphedema is a localized retention of lymphatic fluid in the tissues, usually caused by a blockage of the vessels that carry lymph. The lymphatic system returns the interstitial fluid to the thoracic duct and this in turn, brings it to the bloodstream, where it is recirculated to the tissues. It may be an isolated phenomenon or not, as a manifestation of a congenital lymphatic dysplasia (primary) developed during the late stage of lymphangiogenesis; or it may be secondary, caused by an injury or blockage to the lymphatic vessels, either by radical surgical dissection, irradiation, malignancy, lymphangitis with lymphangiosclerosis, trauma or of an idiopathic cause. Symptoms may include severe fatigue, focal or generalized edema of some regions of the body, as well as discoloration of the skin overlying the affected area, and eventually deformity, which is called elephantiasis when it refers to the lower limbs. Lymphedema not only may cause disfiguration, but also can limit lifestyle, and even cause psychological disorders. We present the case of a 45-year old patient with severe chronic lower limb (elephantiasis), and scrotal sac lymphedema, who was evaluated and successfully treated by the Department of Plastic and Reconstructive Surgery at the Hospital Mexico.

Verrucous localized lymphedema of genital areas: clinicopathologic report of 18 cases of this rare entity.

BACKGROUND: Localized lymphedema is a nonneoplastic condition associated with obesity and predominantly involving the legs. This condition has distinctive clinical and histologic features and only rarely has been mentioned in the dermatologic literature. OBJECTIVE: We sought to evaluate the clinical and histopathologic features. METHODS: The clinicopathologic features in patients with localized lymphedema of the genital region were studied. RESULTS: We identified 18 patients with localized lymphedema clinically presenting as large polypoid or verrucous lesions. The patients were 5 men and 13 women with a mean age of 46.5 years. Twelve patients were obese at diagnosis. Thirteen patients presented with tumors involving the vulva, 4 patients with tumors in the penis and scrotum, and 1 patient with scrotal and pubic lesions. Histologically, all cases showed marked dermal edema along with dilated lymphatic spaces, fibroplasia, and verrucous epidermal changes (papillomatous and hyperplastic epidermis). LIMITATIONS: Only 18 cases were included in our study. CONCLUSIONS: This condition is an uncommon and recently described entity that could potentially be clinically and histologically misdiagnosed as a neoplasm; thus, it needs to be included in the differential diagnosis of polypoid and verrucous skin tumors with extensive dermal edema and fibroplasia.

Squamous cell carcinoma of the penis and scrotum in a patient with chronic scrotal and penile lymphedema.

Squamous cell carcinoma arising from tissue affected by chronic lymphedema is rare, though it is recognized that a variety of malignant tumors can arise in chronic congenital or acquired lymphedema. We describe, a case of scrotal and penile squamous cell carcinoma arising in a patient with a history of chronic scrotal and penile lymphedema of filarial origin. We here discuss the management and possible etiology of this unusual case.