Selected Case From the Arkadi M. Rywlin International Pathology Slide: Massive Localized Lymphedema in Morbid Obesity...

A 59-year-old morbidly obese female developed an ulcerated, slowly growing, 25 cm, subcutaneous, pendulous mass in the right groin which became infected and was excised in January 2014. The excised skin and subcutaneous fat weighed 1901 g. The skin exhibited a cobblestone appearance, the dermis was thickened and edematous, and the subcutaneous fat was traversed by fibrous septae. Histologically, there were dilated, thin-walled vessels, perivascular chronic inflammatory cells, slightly atypical macrophages, and expanded subcutaneous fibrous septae surrounding degenerating adipocytes resembling lipoblasts. Nearly all the Club members agreed with the submitted diagnosis of massive localized lymphedema in morbid obesity. Postoperatively, the wound healed well, there has been no recurrence or further infection as of July 2015, but the patient suffers from diabetes and congestive cardiac, the more common complications of morbid obesity.