A morbidly obese patient may develop massive localized lymphedema (MLL).


Clinical features:

(1) The patient is morbidly obese.

(2) The patient develops one or more large localized masses that may be pedunculated.

(3) The lesions are often longstanding.

(4) The skin is often thickened and has a cobblestone appearance.

(5) The lesion cannot be explained by another process (previous surgery, etc).

(6) The lesion may recur after resection if the patient remains morbidly obese.

(7) Some patients have hypothyroidism (which can cause lymphedema).


Lesions may involve:

(1) the thigh

(2) the lower leg

(3) the upper arm

(4) abdomen

(5) perineum or external genitalia

(6) the inguinal region


Biopsy of the lesion shows:

(1) dermal fibrosis with fibrous septae in the subcutaneous fat

(2) lymphatic proliferation

(3) lymphangiectasia

(4) stromal cellularity

(5) lacks the nuclear atypia seen in sarcomas



(1) A lesion may clinically be diagnosed as a sarcoma (making it a pseudosarcoma).

(2) The patient may not complain of the lesion until it is large enough to interfere with activities, if it becomes ulcerated or if cellulitis develops.


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