Lymphangiosarcoma (Stewart-Treves syndrome) in postmastectomy patients

Paraspinous hemolymphangioma associated with adolescent scoliosis

Lymphangiomas are a group of benign malformations of the lymphatic system, and hemolymphangioma (or hemangiolymphangioma) is a rare congenital malformation of the lymphatic system with vascular involvement. These benign malformations are most commonly diagnosed at an early age, and may be present as a part of an associated syndrome. In this case report, we describe the first case of adolescent scoliosis associated with a large, paraspinous hemolymphangioma. A 15-year-old girl with an incidental finding of a paraspinous hemolymphangioma is presented along with her history, physical exam, radiographic findings, and operative course. The possible pathogenesis, treatment approach, and clinical dilemmas are also discussed. Given the well-known relationship between tumors and scoliosis, a benign paraspinous vascular and lymphatic tumor may be responsible for the presence of scoliosis in a small number of patients.

Lymphangiosarcoma with systemic metastases in a Japanese domestic cat

A 4-year-2-month-old female Japanese domestic cat was diagnosed with lymphangiosarcoma through tissue biopsy of an amputated leg. Two months later, the cat was euthanized, and postmortem findings revealed edema, and bruising at the caudal region of the trunk, pulmonary hemorrhage, pulmonary nodules and mediastinal lymphadenopathy. Microscopically, neoplastic tissues were observed in the dermis and subcutis of the trunk, lung, mediastinal lymph nodes, diaphragm, omentum and mesentery. The tumor cells were spindle to polygonal-shaped with nuclear pleomorphism aligning along pre-existing collagen bundles and forming irregular vascular channels in which the erythrocytes were rarely observed. These cells were immunopositive for vimentin, von Willebrand factor and CD31. Based on the histopathological and immunohistochemical features, the neoplasia was diagnosed as lymphangiosarcoma with systemic metastases.

A novel approach to treatment of lymphangiosarcoma in a boxer dog

A five-year-old female boxer presented with a swelling in the area of the caudal mammary gland. The mass was surgically excised and histopathological examination revealed a poorly demarcated lesion, extending into mammary tissue and infiltrating the sinuses of adjacent lymph nodes. The diagnosis was lymphangiosarcoma. Full blood work, thoracic radiographs, abdominal and scar ultrasound were unremarkable, apart from possible inflammatory reactions in the latter and reactive/metastatic changes in inguinal lymph nodes. Doxorubicin treatment resulted in a 6-month recurrence free interval. At relapse, the dog was treated with metronomic chemotherapy using chlorambucil and meloxicam, which failed to adequately control the disease. Toceranib phosphate was introduced and resulted in almost complete regression of the mass, leaving just a skin plaque. To the authors' knowledge this is the first report describing the use of two novel therapeutic approaches to treat canine lymphangiosarcoma that resulted in a higher than previously described survival time.

Diagnosis and therapy in children with lymphoedema

Introduction

Lymphoedema (LE) is a disorder characterized by persistent swelling caused by impaired lymphatic drainage because of various aetiologies, including lymphatic injury and congenital functional or anatomical defects.

Objective

Literature review and expert opinion about diagnosis and treatment of LE in children.

Results

LE is rare in children, with a prevalence of about 1.15/100,000 persons, 20 years old. The management of LE in children differs considerably from adults in terms of origin, co-morbidity and therapeutic approach. The objective of this presentation is to discuss practical issues related to clinically relevant information on the diagnosis, aetiology, work-up and treatment of LE in children. In contrast to adults, who usually experience secondary LE because of acquired lymphatic failure, most cases in children have a primary origin. The diagnosis can be made mainly on the basis of careful personal and family history, and physical examination. LE in children can be part of a syndrome if there are other concomitant phenotypic abnormalities and if a genetic defect is recognizable. Treatment of LE is mostly conservative utilizing decongestive LE therapy including compression therapy, directed exercises, massage and skincare. In the neonate, initial observation alone may be sufficient, as delayed lymphatic development and maturation can result in spontaneous improvement. The role of parents is crucial in providing the necessary input.

Conclusion

We present a review emphasizing a practical approach to treating a child with LE according to current publications and our own experience.

Lymphangiosarcoma in two cats

Lymphangiosarcoma is a malignant neoplasm of the lymphatic endothelium that is rare in cats. This report describes two cases of feline lymphangiosarcoma that originated in the distal limb, causing intractable lymphoedema and serosanguineous discharge with ecchymoses in local and distant sites. In association with the neoplasia, one cat had cortical bone lysis of multiple metacarpal bones of the affected limb and the other had severe immune-mediated haemolytic anaemia (IMHA). The disease in both cases affected young cats and progressed rapidly. Persistent distal limb lymphoedema with serosanguineous discharge is suggestive of lymphangiosarcoma especially when local or distal ecchymoses are evident.

Extensive cutaneous metastatic breast carcinoma of the hand and upper extremity: a case report

Cutaneous metastatic breast carcinoma involving the hand is extremely rare. We report a case of a 39-year-old woman with a history of recurrent invasive ductal adenocarcinoma of the breast who had a right modified radical mastectomy, chemotherapy, and radiation therapy before presenting to our institution with extensive cutaneous metastasis to the upper limb including the hand. The presentation, pathogenesis, incidence, prognosis, management, and differential diagnosis of cutaneous metastatic breast carcinoma to the hand and upper limb are discussed.

Malignant tumors of the hand and wrist

Malignant tumors in the hand and wrist compose a wide variety of lesions involving skin, soft tissues, and bone. Although these lesions are found elsewhere in the body, many have unique characteristics at this anatomic location. Skin tumors predominate; the most common are squamous cell carcinomas, followed in frequency by basal cell carcinomas and malignant melanomas. Other soft-tissue malignancies are less common but may present more difficult diagnostic problems. They often appear as painless masses that sometimes have been present for months or even years and deceptively appear to be benign. A missed or delayed diagnosis of these tumors can have devastating consequences. Bone malignancies involve both primary lesions, of which chondrosarcomas are the most common, and metastatic lesions. Regardless of cell type, treatment of malignant tumors in the hand and wrist requires special considerations because of the important function of these structures. Orthopaedic surgeons should be familiar with the spectrum of these tumors, the work-up necessary to arrive at a precise diagnosis, and the treatment that will achieve the most favorable outcome.

Malignant vascular tumors: clinical presentation, surgical therapy, and long-term prognosis

BACKGROUND

The aim of this study was to analyze the presentation of, surgery for, and prognosis of malignant vascular tumors (MVTs).

METHODS

This was an observational single-center study. Patients who underwent operation for MVTs between 1988 and 2004 were included. Data were gathered prospectively in a computerized registry.

RESULTS

Of 568 adult patients with soft tissue malignancies, 43 (7.6%) were treated for MVTs. Twenty-four men and 19 women (median age, 55.3 years) were referred for 30 primary tumors and 13 recurrences. Symptoms were observed in 90.7% of the cases (swelling [37.2%], pain [34.9%], extrusion [11.6%], hemorrhage [7%], weight loss [4.7%], loss of energy [4.7%], impaired function [4.7%], and others [30.2%]). Tumors were located in the extremities (n = 16), trunk (n = 3), abdomen (n = 15), retroperitoneum (n = 7), and thyroid gland (n = 2). Twenty-two (51.2%) angiosarcomas, nine (20.9%) malignant hemangiopericytomas, eight (18.6%) malignant epithelioid hemangioendotheliomas, and four (9.3%) lymphangiosarcomas were seen. The median overall survival after surgery was 21.4 months, with 2-, 5-, and 10-year overall survival rates of 41.5%, 38.3%, and 18.8%, respectively. MVTs of the extremities and trunk and localized disease indicated a better prognosis than abdominal or retroperitoneal MVTs (univariate and multivariate analyses: P = .0122 and P = .0287) and metastasized stages (univariate and multivariate analyses: P = .0187 and P = .0287).

CONCLUSIONS

A considerable number of patients with soft tissue malignancies undergo surgery for MVT. Various symptoms and a multilocular occurrence are typical. The course of MVTs is aggressive. Tumor site and stage are important prognostic factors. Surgery is potentially curative, especially for localized disease of the extremities and trunk.

Cutaneous lymphangiosarcoma in a young dog: clinical, anatomopathological and lectinhistochemical description

Lymphangiosarcoma is a rare tumour in domestic animals arising from lymphatic endothelial cells. Occasionally, microscopic differentiation with haemangiosarcoma may be difficult. The aim of the present study was to describe a lymphangiosarcoma in a 1-year-old female Doberman Pinscher dog and to characterize its lectinhistochemical binding pattern as compared with that of haemangiosarcoma. The dog was presented because of a cutaneous painful swelling located in the left axilla. Histological diagnosis confirmed lymphangiosarcoma. The dog was killed. Necropsy revealed mediastinal lymph nodes' involvement. Twenty lectins were tested in tissue sections of this case as well as in four haemangiosarcomas from other dogs. Staining intensity was issued upon optical density determinations. Percentage of lectinhistochemical staining area was also conducted. RCA-I showed the most intense and wide distributed labelling pattern for lymphangiosarcoma. PHA-E was the counterpart for haemangiosarcoma. Should similar results be obtained in further studies, such differences could aid in the differential diagnosis between lymphangiosarcoma and haemangiosarcoma when histological pictures were not conclusive.