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I read with some interest the recent Off-Center Fold “Giant Subcutaneous Tumors on the Thighs” by Bae and colleagues,1 published in a recent issue of the Archives. Regrettably, Bae and coworkers appear to have missed the clinical and pathologic significance of the giant thigh masses in their patient. Based on the clinical history, the provided clinical photograph, and the photomicrographs, these “tumors” would appear to be indisputable examples of massive localized lymphedema of the morbidly obese, a distinctive pseudoneoplasm first reported by Farshid and Weiss2 in TheAmerican Journal of Surgical Pathology in 1998 and subsequently reported in a number of additional publications.3 - 12
As in the case presented by Bae et al,1 massive localized lymphedema is almost always seen in morbidly obese patients, where it presents as giant, pendulous masses of the medial thighs. On gross pathologic examination, massive localized lymphedema displays striking dermal thickening and fibrosis with prominent stromal edema and expansion of the fibrous septa between the individual fat lobules. As the photographs provided by Bae and coworkers nicely illustrate, the microscopic features of massive localized lymphedema include prominent lymphangiectasia and lymphatic proliferation, chronic inflammatory cell aggregates, and myxofibrous expansion of the intralobular septa, with scattered stellate to dendritic fibroblasts and myofibroblasts.2 CD34 expression, a largely nonspecific finding, may be seen in these reactive fibroblasts.
Massive localized lymphedema is thought to be due to local lymphatic obstruction by abundant adipose tissue. Although massive localized lymphedema has typically been thought of as quite rare, we have seen easily 20 or more cases in our soft-tissue pathology consultation practice at Mayo Clinic over the past year or so, likely reflecting the increased prevalence of obesity in the American population. This letter does not permit a lengthy discussion of so-called dendritic fibromyxolipoma, this purported entity is regarded by most soft-tissue experts as simply a myxoid variant of spindle cell lipoma, and is not included as a distinct entity in the most recent World Health Organization classification of soft-tissue tumors.13
Correspondence: Dr Folpe, College of Medicine, Mayo Clinic, 200 First St SW, Rochester, MN 55905 (Folpe.Andrew@Mayo.edu).
Financial Disclosure: None reported.
Country-Specific Mortality and Growth Failure in Infancy and Yound Children and Association With Material Stature
Use interactive graphics and maps to view and sort country-specific infant and early dhildhood mortality and growth failure data and their association with maternal
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