Cause and effect of treatment in lymphoedema of the left lower extremity: A case report

Abstract

A female child received a laparotomy with a subtotal resection of a yolk-sac tumour, extending from her left groin to her left lower abdominal quadrant, the perianal, left labial and sacrococcygeal regions, presenting as stage III disease, at age three. She had abnormal venous engorgement of the left labial region, groin, and lower abdominal wall apart from the huge tumour mass. Further to the surgical treatment she received vincristine 1.5 mg/m2/week, actinomycin-D 15 mcg/kg/day*5, cyclophosphomide 500 mg/m2/week chemotherapy for six cycles to be followed by 3300 cCy pelvic, 5500 cCy upper left femoral irradiation. This resulted in the disappearance of the tumour but her pelvic bony structures failed to grow with her age, along with a necrosed femoral head, hip dislocation and a massive lymphoedema of the left lower extremity thus crippling her to wheelchair status. She had failed to show up at the outpatients clinic for the next decade, but did appear at our unit one day with gross lower extremity lymphoedema, at age thirteen. Her main complaint at the time of admission was being unable to lift up her left leg and walk without aid. Though the other portions of her body had grown normally, her pelvis was extremely small, measuring only 20 centimeters in diameter. Her left leg was twice the diameter of her contralateral side with enhanced lymphoedema distal to the upper one-third of left femoral region. Medical imaging techniques and radiocontrast roentgenography failed to show any lymphatic structure. The same patient at sixteen, is presently able to walk properly and wear nylon stockings and skirt for the first time in her life, after extensive excision of her lymphoedematous left lower limb skin and subcutaneous tissue, and application of split-thickness skin grafting in three separate operative sessions. After some psycho and physiotherapy she is presently able to attend her formal secondary education; much more attentative in her physical activities and enjoys a better self-esteem.