V08_No_3_Final.pdf


Pictorial Urology

178 Urology Journal    Vol 8    No 3    Summer 2011

Giant Vulval Filariasis
An Uncommon Problem in Endemic Region

A 40-year-old woman presented with complaint of mass in her genitalia associated with dragging pain and 
difficulty in coitus and walking for the past five years. 
On examination, two nontender irreducible well-defined bosselated vulval masses were detected, right and left 
measuring 45 × 38 cm and 22 × 20 cm in size, respectively. There were multiple nodular swellings on the outer 
surface of each mass.
On laboratory investigation, hemoglobin 11 g/dL, leukocyte count 6400 cells/mm3, and absolute eosinophil 
count 200 were observed. Serum level of anti-filarial IgE found significantly raised.
Pre-operatively, 2-week therapy of diethylcarbamazine was started. Excision of both right and left masses 
weighing 15 and 8 kg, respectively, was done with vulvoplasty. The postoperative period was uneventful.
On histopathlogical examination, stratified squamous epithelium with hyperkeratosis was seen. Underlying 
stroma showed dermal fibrosis and collagenization with mixed inflammatory infiltrate suggestive of chronic 
inflammatory pathology.
Wuchereria bancrofti commonly affects the lower limb and genitalia than the arms and breasts.(1) 
However, the genitalia is rarely affected with Brugia malayi infection.(2) Patients with lymphedema are 
treated with a combination of limb elevation, compression garment, and compression pump therapy, 
and surgery, if necessary.(3) Surgical treatment helps reduce the weight of the affected organ, minimize 
inflammatory attacks, improve cosmesis, and reduce the risk of secondary angiosarcoma.(4)

Sudheer Rathi, Abhishek Jain,* Rajesh Sharma
Department of Surgery, LLRM Medical College, Meerut, U.P, India

*E-mail: jain2k2@yahoo.com

REFERENCES
1. Tayel Sel S, Sharapy Ael D, El Shazly AM, Shahat SA, Zaalouk T, Al Sayed MY. Clinical, parasitological and social studies on 

Wuchereria bancrofti in Egypt. J Egypt Soc Parasitol. 2011;41:179-97.

2. Bernhard P, Makunde RW, Magnussen P, Lemnge MM. Genital manifestations and reproductive health in female residents of 
a Wuchereria bancrofti-endemic area in Tanzania. Trans R Soc Trop Med Hyg. 2000;94:409-12.

3. Pipinos II, Baxter TB. The lymphatics. In: Townsend CM, Beauchamp RD, Evers BM, Mattox KL, eds. Sabiston Textbook of 
Surgery. 18 ed. Philadelphia: Saunders Elsevier; 2008:2023-5.

4. Miller TA, Wyatt LE, Rudkin GH. Staged skin and subcutaneous excision for lymphedema: a favorable report of long-term 
results. Plast Reconstr Surg. 1998;102:1486-98; discussion 99-501.

Urol J. 2011;8:178. 
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