Milroy's disease and scrotal lymphoedema: pathological insight.

To cite: Butler C, Osterberg C, Horvai A, et al. BMJ Case Rep Published online: [please include Day Month Year] doi:10.1136/ bcr-2016-215396 DESCRIPTION We highlight a case of Milroy’s disease in a 28-year-old man. He originally presented with fleshy, exophytic coliform lesions that carpeted his scrotum and penile shaft (figure 1). His prior treatments included laser therapy and electrocautery, but the lesions recurred. Ultimately, he underwent a complex scrotal and phalloplasty, excision of coliform lesions and split thickness skin grafting. Postoperative findings are demonstrated in figure 2. Gross pathology revealed yellow-pink friable coliform excrescences (figure 3). H&E stained microscopic sections showed papillary outgrowths of dermis with overlying epidermal hyperplasia and hyperkeratosis. The deeper dermis was oedematous and fibrotic with a dense chronic inflammatory infiltrate and lymphangiectasia (figures 4–7). The histological findings were consistent with chronic lymphatic obstruction. Three years later, the patient developed mild, asymptomatic penile oedema and a small, solitary coliform lesion at the base of his penis, over the graft site and right groin (figure 8). A shave biopsy