PMC7393987_01
Lesion with lymphedema in the left leg. Lateral views.
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On examination, a non-tender, firm mass was palpated in the left inguinal region associated with a large wound on the LL: a friable, vegetating papillomatous plaque with a fetid odor extending from the pretibial region to the medial aspect of the leg (Fig. 1).
PET SCAN showing: Skin thickening associated with densification of the subcutaneous plane of the left leg; Lymph nodes and lymph node enlargement in the left femoral and inguinal chains.
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A PET scan showed lymphadenomegaly (5.7 cm, SUVmax 10.3) in the left femoral and inguinal) (Fig. 2) and in the left common-external iliac and paraaortic chain of 3.1 cm (SUVmax 8.3).
MRI showing the plane of the intact muscle fascia.
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A magnetic resonance imaging showed subcutaneous cellular tissue edema that did not affect the muscle fascia, known as elephantiasis nostra verrucosa, which presented a cleavage plane of dissection between the injured skin and the intact muscle fascia (Fig. 3).
Left leg after resection of the lesion.
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The resected area was treat by a vacuum dressing, and after five days, we performed a skin mesh graft. (Fig. 4, Fig. 5).
Microscopic examination of the lymph node (40x magnification). Lymphoid follicles with atretic germinative centers. Concentric rings of lymphocytes in an "onion skin" pattern.
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The lymph node biopsy showed a cytoarchitectural organization and immunohistochemistry compatible with CD (Fig. 6).
Patient's follow-up (six months).
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