title: Vulval elephantiasis as a result of tubercular lymphadenitis: two case reports and a review of the literature.
abstract: BACKGROUND
  Elephantiasis as a result of chronic lymphedema is characterized by gross enlargement of the arms, legs or genitalia, and occurs due to a variety of obstructive diseases of the lymphatic system. Genital elephantiasis usually follows common filariasis and lymphogranuloma venereum. It may follow granuloma inguinale, carcinomas, lymph node dissection or irradiation and tuberculosis but this happens rarely. Vulval elephantiasis as a consequence of extensive lymph node destruction by tuberculosis is very rare. We present two very unusual cases of vulval elephantiasis due to tuberculous destruction of the inguinal lymph nodes.
  
  
  METHODS
  Two Indian women - one aged 40 years and the other aged 27 years, with progressively increasing vulval swellings over a period of five and four years respectively - presented to our hospital. In both cases, there was a significant history on presentation. Both women had previously taken a complete course of anti-tubercular treatment for generalized lymphadenopathy. The vulval swellings were extremely large: in the first case report, measuring 35 × 25 cm on the right side and 45 × 30 cm on the left side, weighing 20 lb and 16 lb respectively. Both cases were managed by surgical excision with reconstruction and the outcome was positive. Satisfactory results have been maintained during a follow-up period of six years in both cases.
  
  
  CONCLUSIONS
  Elephantiasis of the female genitalia is unusual and it has rarely been reported following tuberculosis. We report two cases of vulval elephantiasis as a consequence of extensive lymph node destruction by tuberculosis, in order to highlight this very rare clinical scenario.
authors.affiliation: Department of Surgery, Vardhman Mahavir Medical College, Safdarjang Hospital, New Delhi, India. chintamani7@rediffmail.com.
authors.lastname: Chintamani
authors.forename: Jp
authors.initials: J
authors.lastname: Singh
authors.forename: Megha
authors.initials: M
authors.lastname: Tandon
authors.forename: Rohan
authors.initials: R
authors.lastname: Khandelwal
authors.forename: Tushar
authors.initials: T
authors.lastname: Aeron
authors.forename: Sidharth
authors.initials: S
authors.lastname: Jain
authors.forename: Nikhil
authors.initials: N
authors.lastname: Narayan
authors.forename: Rahul
authors.initials: R
authors.lastname: Bamal
authors.forename: Yashwant
authors.initials: Y
authors.lastname: Kumar
authors.forename: S
authors.initials: S
authors.lastname: Srinivas
authors.forename: Sunita
authors.initials: S
authors.lastname: Saxena