Liquid silicone used for esthetic purposes as a potentiator for occurrence of post-radiotherapy genital lymphedema
case report
Keywords:
Lymphedema, Silicones, Radiotherapy, Reconstructive surgical procedures, Genital diseases, maleAbstract
CONTEXT: Lymphedema consists of extracellular fluid retention caused by lymphatic obstruction. In chronic forms, fat and fibrous tissue accumulation is observed. Genital lymphedema is a rare condition in developed countries and may have primary or acquired etiology. It generally leads to urinary, sexual and social impairment. Clinical treatment usually has low effectiveness, and surgical resection is frequently indicated. CASE REPORT: We report a case of a male-to-female transgender patient who was referred for treatment of chronic genital lymphedema. She had a history of pelvic radiotherapy to treat anal cancer and of liquid silicone injections to the buttock and thigh regions for esthetic purposes. Radiological examinations showed signs both of tissue infiltration by liquid silicone and of granulomas, lymphadenopathy and lymphedema. Surgical treatment was performed on the area affected, in which lymphedematous tissue was excised from the scrotum while preserving the penis and testicles, with satisfactory results. Histopathological examination showed alterations compatible with tissue infiltration by exogenous material, along with chronic lymphedema. CONCLUSION: Genital lymphedema may be caused by an association of lesions due to liquid silicone injections and radiotherapy in the pelvic region. Cancer treatment decisions for patients who previously underwent liquid silicone injection should take this information into account, since it may represent a risk factor for radiotherapy complications.
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References
Halperin TJ, Slavin SA, Olumi AF, Borud LJ. Surgical management of scrotal lymphedema using local flaps. Ann Plast Surg. 2007;59(1):67-72; discussion 72.
Torio-Padron N, Stark GB, Földi E, Simunovic F. Treatment of male genital lymphedema: an integrated concept. J Plast Reconstr Aesthet Surg. 2015;68(2):262-8.
U.S. National Library of Medicine. Meige Disease. Genetics Home Reference. 2016. Available from: https://ghr.nlm.nih.gov/condition/meige-disease Accessed in 2016 (Nov 30).
U.S. National Library of Medicine. Milroy Disease. Genetics Home Reference. 2016. Available from: https://ghr.nlm.nih.gov/condition/milroy-disease Accessed in 2016 (Nov 30).
Vaught SK, Litvak AS, McRoberts JW. The surgical management of scrotal and penile lymphedema. J Urol. 1975;113(2):204-6.
Mukenge S, Pulitanò C, Colombo R, Negrini D, Ferla G. Secondary scrotal lymphedema: a novel microsurgical approach. Microsurgery. 2007;27(8):655-6.
Rahman GA, Adigun IA, Yusuf IF, Aderibigbe AB, Etonyeaku AC. Giant scrotal lymphedema of unclear etiology: a case report. J Med Case Rep. 2009;3:7295.
Machol já 4th, Langenstroer P, Sanger JR. Surgical reduction of scrotal massive localized lymphedema (MLL) in obesity. J Plast Reconstr Aesthet Surg. 2014;67(12):1719-25.
Gaber Y. Secondary lymphoedema of the lower leg as an unusual side-effect of a liquid silicone injection in the hips and buttocks. Dermatology. 2004;208(4):342-4.
Paul S, Goyal A, Duncan LM, Smith GP. Granulomatous reaction to liquid injectable silicone for gluteal enhancement: review of management options and success of doxycycline. Dermatol Ther. 2015;28(2):98-101.
Kumar P, Navaneethan GP. Resection of scrotal lymphedema. Plast Reconstr Surg. 2005;116(2):24e-27e.
Leonardi NR, Compoginis JM, Luce EA. Illicit Cosmetic Silicone Injection: A Recent Reiteration of History. Ann Plast Surg. 2016;77(4):485-90.
Altmeyer MD, Anderson LL, Wang AR. Silicone migration and granuloma formation. J Cosmet Dermatol. 2009;8(2):92-7.
Mustacchio V, Cabibi D, Minervini MI, Barresi E, Amato S. A diagnostic trap for the dermatopathologist: granulomatous reactions from cutaneous microimplants for cosmetic purposes. J Cutan Pathol. 2007;34(3):281-3.
