Liquid silicone used for esthetic purposes as a potentiator for occurrence of post-radiotherapy genital lymphedema: case report

Abstract

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.RESUMO CONTEXTO: O linfedema consiste de retenção de fluido extracelular causada por obstrução linfática. Nas formas crônicas, observa-se acúmulo de tecido adiposo e fibrose. O linfedema genital é uma doença rara em países desenvolvidos e pode ter etiologia primária ou adquirida, em geral cursando com disfunções urinária e sexual, bem como com prejuízo do convívio social. O tratamento clínico é, em geral, pouco efetivo, indicando-se com frequência a abordagem cirúrgica, com excisão da área afetada. RELATO DE CASO: Relata-se o caso de paciente feminina transgênero, encaminhada para tratamento de linfedema genital crônico. Havia antecedente pessoal de tratamento de câncer de canal anal com radioterapia pélvica e de injeções de silicone líquido em glúteos e coxas com finalidade estética. Exames radiológicos mostraram tanto sinais de infiltração tecidual por silicone líquido como granulomas e linfadenopatia como de linfedema. Foi realizado o tratamento cirúrgico da área afetada, com excisão do tecido linfadenomatoso do escroto, preservando o pênis e testículos, com resultado satisfatório. A análise histopatológica mostrou achados compatíveis com infiltração tecidual por material exógeno, bem como com linfedema crônico. CONCLUSÃO: O linfedema genital pode ser causado pela associação de lesão por injeção de silicone líqui-do e radioterapia na região pélvica. As decisões no tratamento de neoplasias em pacientes previamente submetidos a injeção de silicone líquido devem levar em conta esse fato, já que pode representar fat...

Pleasurable and problematic receptive anal intercourse and diseases of the colon, rectum and anus

“…Radiation for anorectal cancer might also influence cosmesis associated with genital-affirming surgery 331 , influencing the ability and desire of a patient to engage in RAI. For example, a transfeminine person who underwent radiotherapy for anal cancer developed lymphoedema due to the interaction between radiation and injected liquid silicone in the pelvis 332 . It is important to counsel people experiencing gender incongruence who underwent or are planning to undergo genital-affirming procedures on the implications of radiation treatment on cosmetic outcomes 333,334 .…”

Genital Lymphedema after Cancer Treatment: A Narrative Review

“…In developing countries, filariasis is the main cause of secondary forms of genital lymphedema [ 5 , 6 , 7 ]. In industrialized countries, although the main cause of secondary lymphedema is cancer treatment [ 8 , 9 ], other possible causes are given in Table 1 [ 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 ]. Herein, we describe genital lymphedema after cancer treatment in males and females, highlighting potential diagnostic pitfalls.…”