Massive Buffalo Hump

A 78-year-old man presented to our wound clinic with bilateral lower-extremity weeping ulcerations. He had been diagnosed with lymphedema 5 years previously after sigmoidectomy for obstructing adenocarcinoma. Intraoperatively, there was no evidence of gross adenopathy or metastasis. He declined further treatment or imaging at that time, and was noncompliant with lymphedema therapy. His medical history included worsening renal insufficiency and cardiac murmurs for which he declined workup. There was no history of thyroid disorder or recent travel abroad. Lower-extremity examination demonstrated stage III lymphedema of elephantine proportions …