Massive Localized Lymphedema: Two Rare Case Reports of this Peculiar Entity and Anatomic Distortion

Introduction: Massive localized lymphedema (MLL), also called pseudosarcoma in the literature, constitutes a rare benign clinical disorder presenting in obese patients and characterized by chronic accumulation of lymph and adipose tissue due to lymphatic flow obstruction. Presentation of Case: A 43-year-old, morbidly obese white woman proceeded to our institution with extended lymphedema. In addition, a 54-year-old white man sought medical advice for the same clinical issue. Surgical excision of the soft tissue mass was performed in both cases so that the patients could regain mobility of their limbs. The operation was uneventful. The histopathologic analysis asserted the diagnosis of MLL. A meticulous review of the literature was conducted as well. Discussion: MLL is a scarce, non-malignant clinical entity that may mimic an abundance of soft tissue tumors. Patients with MLL are typically obese females with body mass index (BMI) > 40 kg/m2 who present with non-specific symptoms. The diagnosis of MLL is challenging, and its etiology and treatment are not completely elucidated. Conclusion: Surgeons' deep knowledge regarding this peculiar clinical disorder is the cornerstone for the establishment of a correct diagnosis and warrants the adequate treatment, in addition to the elimination of the potentiality of malignant transformation of MLL to angiosarcoma or liposarcoma and of probable recurrence of MLL.