Lymphangiomyoma: clinicopathologic study and ultrastructural confirmation of its histogenesis

Small lymphangiomas of the eyelids

Three patients are described with focal lymphangiomatous lesions of their eyelids. A child with a partially regressed, congenital lesion presented with evidence of recent hemorrhage, while, of two adults with acquired tumors, one had a blue lesion suggesting a malignant melanoma, and the other had a more obviously cystic lesion, suggesting an epidermal or adnexal cyst. In one case, the lesion was situated entirely within the marginal orbicularis striated muscle, and in the other two cases the lesion was restricted to the dermis of the lid. Abrupt change in the coloration of a lesion in the lid should suggest hemorrhage into a preexistent tumor. Hemorrhage into lymphangiomas is extremely common, and therefore this vascular tumor should be included in the differential diagnosis of previously nondiscolored lesions. Other vascular tumors, such as capillary, cavernous or venous angiomas would be expected to have a longstanding reddish-blue hue.

Pulmonary lymphangiomyomatosis: with particular reference to steroid-receptor assay studies and pathologic correlation

The symptoms of progressive dyspnea, hemoptysis, spontaneous pneumothorax, chylous effusions, and cough in conjunction with ventilatory obstruction and abnormal gas exchange in a young woman should prompt the diagnosis of pulmonary lymphangiomyomatosis. Cytosol steroid-receptor assays and postmortem studies were conducted in an extensive investigation of a case of this disease. A biopsy specimen of the lung disclosed evidence of nuclear translocation of [3H]progesterone and the presence of a cytosolic receptor for progesterone, an indication that this disease could be treated effectively with progestin.

The pathology of head and neck tumors: vasoformative tumors, part 9A

Tumors originating from components of the vascular system vary widely in the degree of morbidity and mortality that they incur. They all have endothelial cells as integral components of their histologic appearance. Vasoformative tumors include hemangiomas, lymphangiomas, and pyogenic granulomas, which are relatively common, and hemangiopericytomas, glomus tumors, and angiosarcomas, which are relatively uncommon. For many vasoformative tumors, including lymphogenous lesions, the head and neck is an area of predilection, and, in some instances, location in the head and neck appears to modify biologic activity.

Pulmonary lymphangiomyomatosis: treatment with castration

Pulmonary lymphangiomyomatosis (PLM) is a rare disease of smooth muscle proliferation that generally leads to an early death due to respiratory insufficiency. The disease only affects women. Exacerbations with pregnancy and after hormonal manipulation have been documented. There is presently no successful treatment of the disease. Castration as a means of early therapy has been associated with a stable respiratory picture in our patient. Peritoneal-jugular shunt can benefit women with significant ascities.

Leiomyosarcoma of the pulmonary artery. A light and electronmicroscopical study

A 25-year-old man with chest pain and shortness of breath was found to have a primary sarcoma of the pumonary artery. On light- and electronmicroscopy and immunofluorescence microscopy the lesion was found to be composed of cells of smooth muscle origin. It was diagnosed as leiomyosarcoma. The cross and microscopic features of the tumor are described and the morphologic characteristics of previously reported vascular sarcomas are briefly reviewed.

Pulmonary lymphangiomyomatosis

Pulmonary lymphangiomyomatosis is a rare but distinct clinical and pathological entity. It is characterized by hamartomatous proliferation of smooth muscle around the lymphatic vessels of the lung, mediastinum, and retroperitoneum. It occurs only in menstruating women and girls and is manifested by spontaneous pneumothorax and chylous pleural or abdominal effusion. As it progresses, the lungs become increasingly involved with subsequent pulmonary insufficiency and recurrent infection. Eventually death results. This entity has not been reported previously in the surgical literature even though the thoracic surgeon is called on to both establish the diagnosis and aid in palliation. The hypothesis that the disease is estrogen dependent is reviewed and the desirability of estrogen ablation in patients with positive estrogen receptors is suggested.

Lymphangiomyomatosis syndrome with hyperparathyroidism: a case report

A 48-year-old woman presented with the classical clinicopathological features of the lymphangiomyomatosis syndrome. After a three year stable period, there was the onset of a rapidly progressive downhill course unresponsive to dietary, bronchodilator and corticosteroid therapy. Pathological findings were characterized by widespread pulmonary, thoracic duct and lymph node involvement. There was a mediastinal lymphangiomyoma growing within the distal thoracic duct, and a similar lesion within the left kidney which could clinically mimic an angiomyolipoma. Comments are also made on the finding of a parathyroid adenoma. The physiopathology and possible resemblance to "formes frustes" of tuberous sclerosis are discussed.

Lymphangiomyoma of the Thoracic Duct with Previously Undescribed Epithelial Tubules

A case of mediastinal lymphangiomyoma with tubules covered with epithelium is reported. The epithelium of these tubules is morphologically identical to that of the bronchi. It is the first time that epithelial, presumably pulmonary, elements have been described in an extrapulmonary lymphangiomyoma. It is concluded that the present case of a mediastinal lymphangiomyoma suggests a hamartomatous malformation. Whether this applies in general to lymphangiomyomatosis still remains a matter of discussion.

Lymphangiomyoma

A case report is presented of the incidental finding of a lymphangiomyoma in a 50-year-old woman who underwent total hysterectomy for squamous cell carcinoma of the cervix. The condition seems to occur only in women after puberty and so far, has been mainly reported in association with chylothorax or chylous ascites. There is no evidence of any clinical complication more than 2 years after removal of the lesion. The lesion is most likely a hamartoma although the term lymphangiomyoma is acceptable. The term lymphangiomyomatosis is best reserved for the fully developed clinico-pathological syndrome.

Pulmonary lymphangiomyomatosis: three new cases studied with electron microscopy

Three cases of pulmonary lymphangiomyomatosis are described, with emphasis on the ultrastructural changes. The clinicopathologic features corresponded to those previously described. Each patient was a female in the reproductive years; breathlessness and recurrent pneumothoraces were the predominant clinical features. Histologically, the lungs showed a focal interstitial infiltrate of short, spindle-shaped mononuclear cells compatible with primitive smooth muscle, which was associated with irregular emphysema and hemosiderosis. Electron microscopy confirmed the smooth muscle nature of the pulmonary infiltrate and showed the presence of cells intermediate between smooth muscle and fibroblasts. Abnormalities were also noted in the pulmonary connective tissue that are possibly related to the fragility of the lung in this condition.

Lymphangiomyomatosis: morphogenetic study and ultrastructural confirmation of the histogenesis of the lung lesion

A 34-year old woman underwent a surgical intervention as a result of a retroperitoneal tumor. This tumor was excised and the pathological diagnosis was lymphangiomyoma. Two months later she developed a spontaneous right pneumothorax with a chylous pleural effusion. Roentgenograms showed that the lungs had developed a honeycomb pattern. She was treated surgically and at the same time a biopsy was performed. Sixteen months later she deveoped a left pneumothorax which necessitated additional surgery, and a further biopsy was taken. She died of respiratory insufficiency 2 years after the clinical onset of the symptoms. The pathologic material was studied by both electron and light microscopy in serial sections. The electron-microscopic study proved the muscular nature of this condition. The light microscopic study of the serial sections showed that the lung lesion was due to the proliferation of the muscle cells associated with the lymphatics surrounding the acini.

Angiosarcoma of the skin. A clinicopathologic and fine structural study

A study of ten cutaneous angiosarcomas is presented. These tumors characteristically involve the scalp or face of elderly individuals, where they present as bluish or violaceous plaques and nodules. They have a marked tendency for local spread in surface and depth, and a third of them eventually give rise to distant metastases, particularly to cervical lymph nodes and lung. Microscopically, angiomatous areas of freely anastomosing channels lined by atypical endothelial cells are seen alternating with Kaposi-like spindle cell areas and undifferentiated foci. By electron microscopy, the tumor cells are seen to have all the features of endothelial cells, including pinocytotic vesicles, tubulated bodies, and in one case closed fenestrations. They also exhibit a cytoplasmic specialization here interpreted as the intracellular formation of a vascular lumen. Pericytes and cells resembling smooth muscle cells are also present. In the differential diagnosis this entity has to be distinguished from other clinical types of angiosarcoma of the skin and from a number of benign and malignant conditions. It is suggested that surgery be used for solitary, well circumscribed tumors and radiation therapy for tumors that either are multicentric or have ill defined margins.

The lungs in lymphangiomyomatosis and in tuberous sclerosis

Two cases of pulmonary lymphangiomyomatosis (PL) are described and 33 other cases from the literature are reviewed. These are compared with one case of tuberous sclerosis with pulmonary involvement (PTS) and 32 other cases from the literature. There are no differences in lung function between these two conditions, both of which show airways obstruction associated with diffuse radiological lung changes. There are, however, both clinical and radiological differences and also differences in the distribution of the lesions and the histological location of the excessive smooth muscle; these indicate that PL and PTS are probably different entities and not polar forms of one condition. Finally, the strictly female incidence of PL suggests a sex-linked disorder, and it is postulated that this may be related to congenital pulmonary lymphangiectases.

Retroperitoneal cystic lymphangioma

A case of a large retroperitoneal tumor in a previously asymptomatic twenty-two-year-old white female is presented. A review of the literature confirms the rarity of this tumor. Its histologic and embryologic derivation as well as its subtle and bizarre method of presentation are discussed. The cause of such lesions is debatable, but primary cure can be accomplished by meticulous excision of the lesion or marsupialization. This seldom seen neoplasm must enter into the differential diagnosis of all retroperitoneal masses.

Lymphangiomyomatosis: report of a case with ureteral involvement and chyluria

A 54-year-old woman, presenting with chyluria and progressive dyspnea, is reported. Necropsy revealed co-existent lymphangiomyomatosis and pneumoconiosis in the lungs. Retroperitoneal lymphangiomyomas surrounded the distal ureters, and cystoscopy revealed pyelolymphatic backflow into renal lymphatic sinuses. The finding of chyluria with atypical smooth muscle hyperplasia within the ureters is extremely rare. Previously reported cases of lymphangiomyomatosis are discussed and compared with our own. Electron micrographs of involved lymph nodes are presented and the findings briefly evaluated.