[Surgical treatment of scrotal lymphedema]. / Traitement chirurgical d'un lymphœdème scrotal.

Scrotal elephantiasis is defined as an increase in the scrotal volume which can reach a very large size. This study involved O.H, a married man aged 70 years, father of 4 children, farmer, native of and resident in Agadir (south of Morocco). Symptoms started 7 years before when scrotal edema and then an edema in both feet and legs gradually increasing in volume occurred. Physical examination showed scrotal elephantiasis with a circumference measured 80 cm and elephantiasis in both legs and feet. Locoregional assessment was based on pelvic magnetic resonance imaging (MRI). The patient was scheduled for monoblock scrotal resection under spinal anesthesia with removal of all of the tissue affected by the lymphedema around the testicle which were covered using the remaining skin and of the penis which was skin grafted using thin skin. The treatment aimed to ensure penis function and to manage the disfiguration. Conservative treatment based on lymphovenous bypass surgery or on the dilation of lymph vessels is no longer performed. Treatment is based on surgery. Surgery is avoided when there are absolute contraindications.

[Vitiligo and Koebner phenomenon following platelet-rich plasma injections]. / Vitiligo et phénomène de Koebner suite à des injections de plasma riche en plaquettes.

Vitiligo is a common and acquired skin pigmentation disorder characterized by a selective and often continuous loss of epidermal melanocytes. We report the case of a female patient who developed facial vitiligo following platelet-rich plasma injections. The diagnosis of Koebner phenomenon was retained in order to explain the occurrence of vitiligo on the areas where platelet-rich plasma (PRP) had been injected.

[Complex management of macrodactylia of the hand: between aesthetic and functional prejudice]. / Complexité de prise en charge d'une macrodactylie au niveau de la main: entre préjudice esthétique et fonctionnel.

Macrodactylia is a rare congenital malformation of unknown origin that can affect the fingers or the toes. It is characterized by an increase in the size of all the elements of one or more rays, recognizable at birth or occurring in a progressive manner. Social, aesthetic as well as functional impact imposes early surgical management or even amputations in advanced forms. We report the case of a 18-year old unmarried, left handed patient without a profession, admitted to the Department of Burns, Plastic and Aesthetic Surgery at the University Hospital Mohammed VI in Marrakech, with progressive acrodactylia involving the first and the second ray of the right hand. Clinical examination showed hypertrophy of the first two rays of the right hand associated with predominant fibro-fatty infiltration of the palmar as well as phalanx deviation 90 degrees at the level of the second finger. Given the severity of the macrodactylia, amputation of the second ray associated with reduction of the fatty infiltration of the palmar was proposed to the patient, allowing him to maintain pollici-digital pinch and to return to a social life as close as possible to normal life.

[Advanced lymphomatous tumor of the trunk]. / Tumeur évoluée du tronc d'origine lymphomateuse.

Malignant lymphomas are a group of cancers that arise in the lymphoid tissue, in the lymph nodes or in extranodal sites due to neoplastic lymphocytic cell transformation. Within this group, malignant non-Hodgkin lymphomas are distinctive. We report a case of diffuse advanced and extremely aggressive malignant cutaneous non-Hodgkin lymphoma. The study involved a 30-year old patient, driver, married and father of one child, followed-up in the Department of Hematology and Oncology for 2 years due to malignant non-Hodgkin lymphoma diagnosed on the basis of axillary and inguinal polyadenopathies. The patient underwent 13 chemotherapy sessions. He was admitted to the Department of Plastic, Cosmetic and Burn Surgery at the University Hospital Mohammed VI in Marrakech with skin involvement of his lymphoma manifesting as an advanced left latero-thoracic tumor rapidly increasing in size. On clinical examination, his general condition was quite good. It showed voluminous left latero-thoracic mass adherent to its deeper structure with ipsilateral axillary shield. Partial biopsy was performed. Anatomo-pathological examination confirmed the diagnosis of diffuse malignant large B-cells non-Hodgkin's lymphoma. Immunohistochemical and genetic study was not performed. Serology tests were negative. Serial Computed Tomography (CT) scan showed voluminous left antero-lateral predominantly axillary and thoracic ganglionic mass made of confluent lymph nodes, with persistence of peripheral lymph nodes, skin ulcers and necrotic areas measuring 30cm in diameter. In our Hospital, the patient underwent wide tumor resection, then coverage with a split-thickness skin, thus reducing tumor volume and ensuring better patient's comfort. When the patient started healing, he was referred to the Department of Hematology and Oncology for complementary treatment.

[An unusual cause of alopecia on the scalp]. / Alopécies du scalp d'étiologies atypiques.

Alopecia is defined as a congenital or temporary absence of hair or even as total or partial hair loss. Clinical manifestation is more marked on the scalp and it is more common in men than in women. Nevertheless, a set of extrinsic factors may be responsible for scarring alopecia of the scalp, including tumors, infections or even loss of substance secondary to thermal burns. On the basis of these illustrations, we here report three cases of patients with scarring alopecia of the scalp secondary to so-called "atypical" causes. The first case (A) is that of a 6-year-old child presenting with alopecia on the right parietal scalp. In-depth interview with his mother allowed to discover the cause of the loss of substance: cutaneous necrosis following laborious delivery by vacuum extraction. The second illustration (B) shows the case of a 40-year-old woman seen in consultation for cutaneous necrosis of the occipital scalp secondary to chemical burn. The patient reported the application of a chemical product in order to fix hairstyle. Finally, the third case (C) is that of a 27-year old patient followed-up for bilateral frontoparietal alopecia secondary to the application of poisonous plant having, according to her beliefs, nourishing virtues for the hair.