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Vignes S. Genital Lymphedema after Cancer Treatment: A Narrative Review. Cancers (Basel) 2022; 14:5809. [PMID: 36497291 PMCID: PMC9739141 DOI: 10.3390/cancers14235809] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2022] [Revised: 11/18/2022] [Accepted: 11/24/2022] [Indexed: 11/29/2022] Open
Abstract
Genital lymphedema may affect males and females after cancer treatment (gynecological, such as cervical, uterine or ovarian, melanoma, prostate, anus…). It is frequently associated with lower limb lymphedema, and is responsible for discomfort, cosmetic disfigurement and functional disturbances. Impacts on body image, sexual function and quality of life are major, and difficult to explore because cancer treatment itself and lymphedema are so closely interwoven. Local complications, e.g., papillomatosis, warty growth, lymph vesicles with embarrassing lymph oozing and cellulitis, may occur. Usual lymphedema therapies, like bandaging and elastic compression, are poorly adapted to these sites. Surgery, essentially based on cutaneous resection techniques, is the primary symptomatic treatment; it achieves good efficacy, in adults and children, with possible recurrence requiring reintervention.
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Affiliation(s)
- Stéphane Vignes
- Department of Lymphology, Centre National de Référence des Maladies Vasculaires Rares (Lymphoedèmes Primaires), Hôpital Cognacq-Jay, 15, rue Eugène-Millon, 75015 Paris, France
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2
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Pérez-Bertólez S, Alonso V. Milroy disease with predominant preputial involvement. Pediatr Dermatol 2022; 39:836-837. [PMID: 35510811 DOI: 10.1111/pde.15025] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Accepted: 04/17/2022] [Indexed: 11/28/2022]
Abstract
Milroy disease is a form of congenital primary lymphedema that usually affects the lower limbs. Predominant genital lymphedema in Milroy disease is uncommon and disabling. When conservative management is ineffective, surgical treatment becomes necessary. Here, we present a rare case of congenital primary penile lymphedema in a 4-year-old child.
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Affiliation(s)
- Sonia Pérez-Bertólez
- Pediatric Urology Unit, Department of Pediatric Surgery, Hospital Sant Joan de Déu. University of Barcelona, Barcelona, Spain
| | - Verónica Alonso
- Department of Pediatric Surgery, Hospital Universitario de Burgos, Burgos, Spain
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3
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Rhee A, Flug JA, Casey WJ, Roarke MC, Rebecca AM, Yang M. Diagnosis of Primary Scrotal Lymphedema Using 99mTc-Sulfur Colloid Lymphoscintigram: Correlation With MR Lymphangiogram. Clin Nucl Med 2022; 47:e417-e418. [PMID: 35293355 DOI: 10.1097/rlu.0000000000004132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
ABSTRACT We report a case of a 19-year-old man who presented with severe scrotal swelling. His medical history was notable for severe global edema at birth. Most areas of swelling had resolved by adolescence with exception of the scrotum and the left lower extremity. 99mTc-filtered sulfur colloid lymphoscintigraphy of the lower extremities demonstrated prominent dermal backflow into the superficial scrotum and thighs, which were confirmed on the SPECT/CT images, and correlated with findings on MR lymphangiogram. Lymphoscintigram and MR lymphangiogram may provide complementary information to aid diagnosis and management of primary scrotal lymphedema.
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Genital Lymphedema and How to Deal with It: Pearls and Pitfalls from over 38 Years of Experience with Unusual Lymphatic System Impairment. MEDICINA (KAUNAS, LITHUANIA) 2021; 57:medicina57111175. [PMID: 34833393 PMCID: PMC8618468 DOI: 10.3390/medicina57111175] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Revised: 10/26/2021] [Accepted: 10/26/2021] [Indexed: 11/18/2022]
Abstract
Background and Objectives: Conservative treatment represents an essential pillar of lymphedema management, along with debulking and physiologic surgeries. Despite the consistent number of treatment options, there is currently no agreement on their indications and possible combinations. When dealing with unusual lymphedema presentation as in the genitalia (Genital Lymphedema—GL), treatment choice becomes even more difficult. The authors aimed to present their targeted algorithm of single and combined treatment modalities for rare GL in order to face this paucity of information. Materials and Methods: Data were collected from a prospectively maintained database since January 1983, and cases of GL that were managed in the authors’ department were selected. Only patients that were treated in the authors’ institution and presented a minimum follow-up of 3 months were admitted to the current study. Results: From January 1983 to July 2021, 19 patients with GL were recruited. All the patients were male, and their ages ranged from 21 to 73 years old (average: 52). Ten cases (52.6%) presented with ISL (International Society of Lymphology) stage I, five (26.3%) were stage II and four (21.1%) were stage III. GL was managed with conservative treatment (12 cases), LVA (LymphaticoVenous Anastomosis) (3) or surgical excision (4). In a mean follow-up of 7.5 years (range: 3 months—11 years), no major complications occurred, and all cases reached improvements in functional and quality of life terms. Conclusions: Contrary to the predominant thought of the necessity to avoid surgery in unusual lymphedema presentations such as GL, they can be managed using targeted multimodal approaches or by adapting well-known procedures in unusual ways to achieve control of disease progression and improve patients’ quality of life.
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Vignes S, Albuisson J, Champion L, Constans J, Tauveron V, Malloizel J, Quéré I, Simon L, Arrault M, Trévidic P, Azria P, Maruani A. Primary lymphedema French National Diagnosis and Care Protocol (PNDS; Protocole National de Diagnostic et de Soins). Orphanet J Rare Dis 2021; 16:18. [PMID: 33407666 PMCID: PMC7789008 DOI: 10.1186/s13023-020-01652-w] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2020] [Accepted: 12/19/2020] [Indexed: 11/10/2022] Open
Abstract
Primary lymphedema is a rare chronic pathology associated with constitutional abnormalities of the lymphatic system. The objective of this French National Diagnosis and Care Protocol (Protocole National de Diagnostic et de Soins; PNDS), based on a critical literature review and multidisciplinary expert consensus, is to provide health professionals with an explanation of the optimal management and care of patients with primary lymphedema. This PNDS, written by consultants at the French National Referral Center for Primary Lymphedema, was published in 2019 (https://has-sante.fr/upload/docs/application/pdf/2019-02/pnds_lymphoedeme_primaire_final_has.pdf).
Primary lymphedema can be isolated or syndromic (whose manifestations are more complex with a group of symptoms) and mainly affects the lower limbs, or, much more rarely, upper limbs or external genitalia. Women are more frequently affected than men, preferentially young. The diagnosis is clinical, associating mild or non-pitting edema and skin thickening, as confirmed by the Stemmer’s sign (impossibility to pinch the skin on the dorsal side or the base of the second toe), which is pathognomonic of lymphedema. Limb lymphoscintigraphy is useful to confirm the diagnosis. Other causes of swelling or edema of the lower limbs must be ruled out, such as lipedema. The main acute lymphedema complication is cellulitis (erysipelas). Functional and psychological repercussions can be major,
deteriorating the patient’s quality of life. Treatment aims to prevent those complications, reduce the volume with low-stretch bandages, then stabilize it over the long term by exercises and wearing a compression garment. Patient education (or parents of a child) is essential to improve observance.
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Affiliation(s)
- Stéphane Vignes
- Department of Lymphology and Reference Center for Rare Vascular Diseases, Cognacq-Jay Hospital, 15, rue Eugène-Millon, 75015, Paris, France.
| | | | - Laurence Champion
- Department of Nuclear Medicine, René Huguenin-Curie Hospital, 35, rue Dailly, 92210, Saint-Cloud, France
| | - Joël Constans
- Department of Vascular Medicine, Saint-André Hospital, CHU de Bordeaux, 1, rue Jean-Burguet, 33000, Bordeaux, France
| | - Valérie Tauveron
- Department of Dermatology and Reference Center for Rare Diseases and Vascular Malformations (MAGEC), CHRU Tours, 37044, Tours Cedex 9, France
| | - Julie Malloizel
- Department of Vascular Medicine, Rangueil Hospital, 1, avenue du Pr Jean-Poulhès, 31059, Toulouse, France
| | - Isabelle Quéré
- Department of Vascular Medicine and Reference Center for Rare Vascular Diseases, CHU Montpellier, 80, avenue Augustin-Fliche, 34090, Montpellier, France
| | - Laura Simon
- Department of Lymphology and Reference Center for Rare Vascular Diseases, Cognacq-Jay Hospital, 15, rue Eugène-Millon, 75015, Paris, France
| | - Maria Arrault
- Department of Lymphology and Reference Center for Rare Vascular Diseases, Cognacq-Jay Hospital, 15, rue Eugène-Millon, 75015, Paris, France
| | | | - Philippe Azria
- Department of Internal Medicine, Saint-Joseph Hospital, 185, rue Raymond-Losserand, 75014, Paris, France
| | - Annabel Maruani
- Department of Dermatology and Reference Center for Rare Diseases and Vascular Malformations (MAGEC), CHRU Tours, 37044, Tours Cedex 9, France.,INSERM 1246 - SPHERE, Universities of Tours and Nantes, 37000, Tours, France
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Haemophilus parainfluenzae-related cellulitis of the penis following tearing of a short frenulum. Ann Dermatol Venereol 2020; 147:370-372. [PMID: 31952954 DOI: 10.1016/j.annder.2019.08.022] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2018] [Revised: 02/12/2019] [Accepted: 08/20/2019] [Indexed: 11/23/2022]
Abstract
INTRODUCTION Infectious cellulitis is a common disease, mostly affecting the lower extremities and the face but only rarely the genitalia. OBSERVATION A 24-year-old male patient presented with acute erythematous edema of the penile shaft and foreskin present for 48hours. Gentle retraction of the foreskin revealed a short frenulum with a small area (2-3mm) of erosion. He had had unprotected genital and orogenital sex three days before with his usual female partner and reported tearing of the frenulum during intercourse. Ampicillin-sensitive Haemophilus parainfluenzae was isolated from the swab taken from the erosion of the frenulum. Clinical remission was obtained following oral administration of amoxicillin and clavulanic acid. DISCUSSION We describe not only the first case of Haemophilus parainfluenzae-associated cellulitis of the penis but also the first report of penile cellulitis following erosion of a short frenulum during sexual intercourse.
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Lobato RC, Zatz RF, Cintra Junior W, Modolin MLA, Chi A, Van Dunem Filipe de Almeida YK, Gemperli R. Surgical treatment of a penoscrotal massive localized lymphedema: Case report. Int J Surg Case Rep 2019; 59:84-89. [PMID: 31121427 PMCID: PMC6529784 DOI: 10.1016/j.ijscr.2019.05.022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2019] [Revised: 05/04/2019] [Accepted: 05/09/2019] [Indexed: 10/31/2022] Open
Abstract
INTRODUCTION Massive localized lymphedema is an aggressive type of lymphedema that causes great functional impairment for the patient, depriving from one's basic life activities. The treatment of this type of lesion is eminently surgical, requiring ablative surgery (complete surgical resection of the lesion), but the possible techniques not always provide a good functional result. PRESENTATION OF CASE We reported a case of a penoscrotal massive lymphedema treated by our Body Contour Group/Plastic surgery department of our institute. We performed the resection of the giant penoscrotal lesion, used a posterior scrotal flap for defect's reconstruction and a split-thickness skin graft for penis' body reconstruction, closed with Z-plasty. DISCUSSION Contrary to what the literature says, we prefer to use the split-thickness skin graft to reconstruct the penis' body in these cases, against local flaps. According to our experience with some similar cases, this technique provides a better functional result once it allows the penis to a better expansion during erection. The key maneuver to avoid contracture of the graft and retraction of the penis is to perform a broken line suture (Z-plasty) in the topography of the median raphe. CONCLUSION In cases of penoscrotal massive lymphedema, the treatment's option with better results is the surgical one. The use of a scrotal flap associated with split-thickness skin graft for penis provides good aesthetic and functional outcomes.
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Affiliation(s)
- Rodolfo Costa Lobato
- Plastic Surgery Department, Hospital das Clinicas, University of São Paulo, Brazil.
| | - Rafael Ferreira Zatz
- Plastic Surgery Department, Hospital das Clinicas, University of São Paulo, Brazil
| | - Wilson Cintra Junior
- Plastic Surgery Department, Hospital das Clinicas, University of São Paulo, Brazil
| | | | - Alex Chi
- Plastic Surgery Department, Hospital das Clinicas, University of São Paulo, Brazil
| | | | - Rolf Gemperli
- Plastic Surgery Department, Hospital das Clinicas, University of São Paulo, Brazil
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Gennaro P, Gabriele G, Aboh IV, Cascino F, Zerini F, Aboud MG. Ultramicrosurgery: A new approach to treat primary male genital lymphedema. JPRAS Open 2019; 20:72-80. [PMID: 32158873 PMCID: PMC7061607 DOI: 10.1016/j.jpra.2019.01.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2017] [Accepted: 01/20/2019] [Indexed: 11/30/2022] Open
Abstract
Background Lymphedema is a chronic pathology characterized by progressive swelling due to lymphatic dysfunction (1). Literature contains few studies that focus on male genital lymphedema. A variety of surgical techniques as part of the male genital lymphedema therapeutic strategy has been described. Supramicrosurgical lymphatico-venular anastomosis s-LVA, based on connecting lymphatic collectors to venules, has evidenced efficient outcomes thus far. However, the peculiarity of the genital area may lead to an innovative and even more accurate surgical technique as a treatment of male genital lymphedema: lymphatic pre-collectors located superficially over the fascial layer can be used to perform the ultramicrosurgical anastomosis. Purpose of the study In this paper, the authors report their experience of this new surgical concept based on anastomosing lymphatic precollectors to venules. Methods We performed a retrospective study from 2014 to 2016. Six male patients with primary genital lymphedema underwent ultramicrosurgical lymphatico-venular anastomosis in Siena University Hospital, Italy. Results Ultramicrosurgical lymphatico-venular anastomosis has evidenced positive outcomes in terms of prognosis, infectious complications, volume reduction, and quality of life. The average cellulitis rate dropped from 2.5 episodes a year to 0.5 episodes after surgical intervention. The mean satisfaction index passed from 1.33 before the intervention to 2.83. Conclusion Ultramicrosurgical lymphatico-venular anastomosis represents a challenging physiological approach for male genital lymphedema with promising outcomes.
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Affiliation(s)
- P Gennaro
- Department of Maxillofacial surgery, University of Siena, Azienda Ospedaliera Universitaria Senese, Siena, Italy
| | - G Gabriele
- Department of Maxillofacial surgery, University of Siena, Azienda Ospedaliera Universitaria Senese, Siena, Italy
| | - I V Aboh
- Department of Maxillofacial surgery, University of Siena, Azienda Ospedaliera Universitaria Senese, Siena, Italy
| | - F Cascino
- Department of Maxillofacial surgery, University of Siena, Azienda Ospedaliera Universitaria Senese, Siena, Italy
| | - F Zerini
- Department of Maxillofacial surgery, University of Siena, Azienda Ospedaliera Universitaria Senese, Siena, Italy
| | - M G Aboud
- Department of Maxillofacial surgery, University of Siena, Azienda Ospedaliera Universitaria Senese, Siena, Italy
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Dauendorffer JN, Artus PM, Janier M, Bagot M, Fouéré S. [Infectious cellulitis of the penis and scrotum]. Ann Dermatol Venereol 2018; 145:548-551. [PMID: 30007582 DOI: 10.1016/j.annder.2018.06.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2018] [Revised: 06/03/2018] [Accepted: 06/12/2018] [Indexed: 10/28/2022]
Affiliation(s)
- J-N Dauendorffer
- Service de dermatologie, centre des MST, hôpital Saint-Louis, 1, avenue Claude-Vellefaux, 75010 Paris, France; Groupe infectiologie dermatologique et infections sexuellement transmissibles (GrIDIST), société française de dermatologie, 10, cité Malesherbes, 75009 Paris, France.
| | - P Mongiat Artus
- Servie d'urologie, hôpital Saint-Louis, 1, avenue Claude-Vellefaux, 75010 Paris, France
| | - M Janier
- Service de dermatologie, centre des MST, hôpital Saint-Louis, 1, avenue Claude-Vellefaux, 75010 Paris, France; Groupe infectiologie dermatologique et infections sexuellement transmissibles (GrIDIST), société française de dermatologie, 10, cité Malesherbes, 75009 Paris, France
| | - M Bagot
- Service de dermatologie, centre des MST, hôpital Saint-Louis, 1, avenue Claude-Vellefaux, 75010 Paris, France
| | - S Fouéré
- Service de dermatologie, centre des MST, hôpital Saint-Louis, 1, avenue Claude-Vellefaux, 75010 Paris, France; Groupe infectiologie dermatologique et infections sexuellement transmissibles (GrIDIST), société française de dermatologie, 10, cité Malesherbes, 75009 Paris, France
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Bengtsson BOS, van Houten JP. Late-onset pubic-phallic idiopathic edema in premature recovering infants. CASE REPORTS IN PERINATAL MEDICINE 2018. [DOI: 10.1515/crpm-2017-0069] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Abstract
Objective
Several cases of isolated localized edema of the genital area in extremely low birth weight (ELBW) infants within the last 5 years prompted a search for possible explanations and a search of the literature.
Study design
A retrospective chart review of all cases of localized genital area edema in our 16-bed community level-3 neonatal intensive care unit (NICU) between January 2007 and December 2017.
Results
A total of six patients with localized edema of the genital area were found. Among the six cases, five provided descriptions of time of onset. Only one case had a plausible etiology [inguinal hernia (IH)].
Conclusions
To our knowledge, this entity is not well described in the literature. Etiologies are speculative. Prolonged observation in the NICU by virtue of ELBW-status suggests that there are no detrimental effects, the condition does not appear to preclude discharge and cautious expectant management and reassurance are therefore in order.
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Affiliation(s)
- Bengt-Ola S. Bengtsson
- Pediatrix Medical Group of California , Department of Pediatrics , Neonatal Intensive Care Unit, Community Memorial Hospital of San Buenaventura , 147 N. Brent Street , Ventura, CA 93003 , USA
- Western University of Health Sciences , College of Osteopathic Medicine of the Pacific , Pomona, CA , USA
| | - John P. van Houten
- Pediatrix Medical Group of California , Department of Pediatrics , Neonatal Intensive Care Unit, Community Memorial Hospital of San Buenaventura , Ventura, CA 93003 , USA
- Western University of Health Sciences , College of Osteopathic Medicine of the Pacific , Pomona, CA , USA
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Vignes S, Vidal F, Arrault M, Boccara O. [Primary lymphedema in childhood]. Arch Pediatr 2017; 24:766-776. [PMID: 28651791 DOI: 10.1016/j.arcped.2017.05.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2016] [Revised: 01/27/2017] [Accepted: 05/23/2017] [Indexed: 12/20/2022]
Abstract
Lymphedema results from impaired lymphatic transport with increased limb volume and is divided into primary and secondary forms. In children, primary lymphedema is the most frequent, with a sporadic, rarely familial form or associated with complex malformative or genetic disorders. Diagnosis of lymphedema is mainly clinical and lymphoscintigraphy is useful to assess the lymphatic function of both limbs precisely. The main differential diagnosis is overgrowth syndrome. Erysipelas (cellulitis) is the main complication, but psychological or functional discomfort may occur throughout the course of lymphedema. Lymphedema management is based on multilayer low-stretch bandage, skin care, and eventually manual lymph drainage. The objective of treatment is to reduce lymphedema volume and then stabilize it. Multilayer low-stretch bandage and elastic compression are the cornerstone of treatment. Parent's motivation, including self-management, is required to ensure the child's compliance and improve quality of life.
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Affiliation(s)
- S Vignes
- Unité de lymphologie, Centre national de référence des maladies vasculaires rares (lymphœdèmes primaires), hôpital Cognacq-Jay, 15, rue Eugène-Millon, 75015 Paris, France.
| | - F Vidal
- Unité de lymphologie, Centre national de référence des maladies vasculaires rares (lymphœdèmes primaires), hôpital Cognacq-Jay, 15, rue Eugène-Millon, 75015 Paris, France
| | - M Arrault
- Unité de lymphologie, Centre national de référence des maladies vasculaires rares (lymphœdèmes primaires), hôpital Cognacq-Jay, 15, rue Eugène-Millon, 75015 Paris, France
| | - O Boccara
- Service de dermatologie, hôpital Necker, AP-HP, 149, rue de Sèvres, 75012 Paris, France
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Romics M, Tasnadi G, Sulya B, Kiss A, Merksz M, Nyirady P. Congenital lymphovascular malformations with urological symptoms: a report of two cases and review of the literature. Int Urol Nephrol 2016; 48:1771-1775. [DOI: 10.1007/s11255-016-1365-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2016] [Accepted: 06/30/2016] [Indexed: 01/30/2023]
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13
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Spontaneous Cystic Penile Vascular Malformation in an Adolescent and Review of the Literature. Urology 2016; 97:197-199. [PMID: 27112512 DOI: 10.1016/j.urology.2016.04.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2016] [Revised: 04/04/2016] [Accepted: 04/15/2016] [Indexed: 11/22/2022]
Abstract
Vascular malformations rarely involve the male genitalia, and even fewer appear as cystic lesions on the penile shaft. We report an uncommon case of spontaneous swelling near the coronal margin of the penis that was found to arise from a vascular malformation. We review the pathologic findings and the literature regarding vascular malformations of the penis and other penile cystic structures that have similar clinical appearance, and discuss treatment options for penile vascular malformations.
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