Elephantiasis of the Arm

NZMJ, 1924.

By Farquhar Matheson, M.B., Apia, Samoa.

This case is so unusual that a few notes may be of interest.

The patient, a Samoan woman, æt. 36 years, has lived all her life in Samoa. In childhood she began to have attacks of “Mumu”—the native name for lymphangitis, which is associated with filariasis and the precursor of elephantiasis. About ten years ago, the arm and leg became elephantoid, increase in size taking place, gradually at first, but more rapidly since 1918. Her condition on admission to the Apia Hospital is shown in the photograph. It will be noticed that the right forearm also shows elephantoid changes. Operation for removal of arm tumour presented no special difficulties, the only trouble being in the formation of skin flaps. Sufficient healthy skin was not available to cover the raw area, but a large U-shaped flap was dissected off from the upper, inner surface of the tumour. This, although part of the elephantoid mass, acted admirably and caused no anxiety as to its viability after the operation. The deep fascia of the arm, which was closely incorporated in the tumour, was dissected off the muscles, thus converting the case into a Kondoleon’s operation. There was no shock attached to the operation, and convalescence was uneventful with the exception of a little superficial suppuration. The latter is almost unavoidable, as it is a matter of extreme difficulty to make elephantoid skin surgically clean. After removal the tumour weighed 43lbs.; but, as elephantoid tissue loses much blood and serum when cut into, the “live” weight must have been much greater. Yet, in spite of her tremendous handicap, the woman was able to walk about unaided. In 1917, Dr. Trail saw a similar case, the patient being a man; and the tumour was so large that the unfortunate man required the assistance of two men to carry his arm in a piece of sacking when he wished to walk.

The epitrochlear glands are among the first to show evidence of filarial infection, but, while swellings and thickening if the tissues in this region are not uncommon, tumours of this size appear to be very rare.

View Figure.