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Liang Y, Tian R, Wang J, Shan Y, Gao H, Xie C, Li J, Xu M, Gu S. Gorham-Stout disease successfully treated with sirolimus (rapamycin): a case report and review of the literature. BMC Musculoskelet Disord 2020; 21:577. [PMID: 32843029 PMCID: PMC7446191 DOI: 10.1186/s12891-020-03540-7] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2020] [Accepted: 07/27/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Gorham-Stout disease (GSD) is a rare disease characterized by bone lesions and osteolysis. Therapy usually involves surgical resection. Sirolimus (Rapamycin) is used in some patients with GSD but the efficacy and safety of Sirolimus remains unclear. We propose that Sirolimus may be a novel therapeutic for GSD and present a case and review of literature that supports this. CASE PRESENTATION We presented a 1-year-old boy with GSD involving osteolysis of the right humerus with fracture of the left femur complicated by an effusion in the right pleural cavity. X-rays showed osteolysis in the right clavicle. A large pleural effusion was observed on the right-side, and the left lung was significantly compressed. X-rays also showed a fracture of the left femur. A femoral biopsy was performed that showed necrotic tissue in the cortical bone and a large number of irregularly shaped capillaries that proliferated within the necrotic tissue. Dilated lymphatic vessels were seen adjacent to the cortex, with fibrous tissue hyperplasia. We prescribed sirolimus, which is an oral mTOR inhibitor, for two consecutive years. The boy recovered well without other progressive bone lesions and participates in normal daily activities. His growth and development are the same as that of his peers. DISCUSSION AND CONCLUSION Gorham-Stout disease is a rare and enigmatic disease characterized by the presentation of an intraosseous lymphatic anomaly (LM), which results in progressive bone resorption. Based on this case report and a literature review, we conclude that sirolimus may be an effective alternative medication for GSD.
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Affiliation(s)
- Yu Liang
- Department of Surgery, Shanghai Children's Medical Center, Shanghai Jiaotong University School of Medicine, Dongfang Road No.1678, Pudong District, Shanghai, 200127, China
| | - Ruicheng Tian
- Department of Surgery, Shanghai Children's Medical Center, Shanghai Jiaotong University School of Medicine, Dongfang Road No.1678, Pudong District, Shanghai, 200127, China
| | - Jing Wang
- Department of Surgery, Shanghai Children's Medical Center, Shanghai Jiaotong University School of Medicine, Dongfang Road No.1678, Pudong District, Shanghai, 200127, China
| | - Yuhua Shan
- Department of Surgery, Shanghai Children's Medical Center, Shanghai Jiaotong University School of Medicine, Dongfang Road No.1678, Pudong District, Shanghai, 200127, China
| | - Hongxiang Gao
- Department of Surgery, Shanghai Children's Medical Center, Shanghai Jiaotong University School of Medicine, Dongfang Road No.1678, Pudong District, Shanghai, 200127, China
| | - Chenjie Xie
- Department of Surgery, Shanghai Children's Medical Center, Shanghai Jiaotong University School of Medicine, Dongfang Road No.1678, Pudong District, Shanghai, 200127, China
| | - Jingjing Li
- Department of Surgery, Shanghai Children's Medical Center, Shanghai Jiaotong University School of Medicine, Dongfang Road No.1678, Pudong District, Shanghai, 200127, China
| | - Min Xu
- Department of Surgery, Shanghai Children's Medical Center, Shanghai Jiaotong University School of Medicine, Dongfang Road No.1678, Pudong District, Shanghai, 200127, China.
| | - Song Gu
- Department of Surgery, Shanghai Children's Medical Center, Shanghai Jiaotong University School of Medicine, Dongfang Road No.1678, Pudong District, Shanghai, 200127, China.
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Jin D, Sun X, Shen W, Zhao Q, Wang R. Diagnosis of Lymphangiomatosis: A Study Based on CT Lymphangiography. Acad Radiol 2020; 27:219-226. [PMID: 31076330 DOI: 10.1016/j.acra.2019.03.024] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2018] [Revised: 03/28/2019] [Accepted: 03/28/2019] [Indexed: 11/15/2022]
Abstract
RATIONALE AND OBJECTIVES Lymphangiomatosis is a rare disease characterized by the widespread presence of lymphangiomas in any part of the body. In previous studies, lymphatic vessel abnormalities in lymphangiomatosis have only rarely been mentioned. The objective of this paper is to discuss the imaging features of lymphangiomatosis, including cystic lesions and lymphatic abnormalities, on computed tomography lymphangiography (CTL). MATERIALS AND METHODS All 34 patients who were diagnosed with lymphangiomatosis underwent direct lymphangiography followed by CTL. The CTL images were independently analyzed by two experienced radiologists. The CTL image analyses included assessment of the features of cystic lesions and lymphatic vessel abnormalities. RESULTS (i) CTL revealed several cystic lesions ranging in size from 3 mm to 14 cm; the lesions were located in the neck and shoulders (61.8%), mediastinum (52.9%), retroperitoneum (70.6%), and pelvis and perineum (64.7%). (ii) Approximately 29.4% of patients showed abnormal contrast medium accumulation in cystic masses. (iii) Approximately 67.6% of patients showed lymphatic reflux. (iv) Dilated lymphatic vessels were distributed in the mediastinum (38.2%), retroperitoneum (50.0%), pelvis and lower limbs (47.1%). (v) Finally, 8.8% of patients had perineal lymphatic fistulae, and 2.9% of patients had chyluria. CONCLUSION Lymphangiomatosis is a type of systemic lymphatic abnormality that is accompanied by multiple cystic lesions. The therapeutic measures for lymphangiomatosis are determined by the size of the cystic lesions. Furthermore, the prognosis of lymphangiomatosis is affected by lymphatic abnormalities.
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Affiliation(s)
- Dan Jin
- Department of Radiology, Beijing Shijitan Hospital, Peking University Ninth School of Clinical Medicine, Capital Medical University, No. 10 Tieyi St, Haidian District, Beijing 100038, PR China
| | - Xiaoli Sun
- Department of Radiology, Beijing Shijitan Hospital, Peking University Ninth School of Clinical Medicine, Capital Medical University, No. 10 Tieyi St, Haidian District, Beijing 100038, PR China
| | - Wenbin Shen
- Department of Lymph Surgery, Beijing Shijitan Hospital, Peking University Ninth School of Clinical Medicine, Capital Medical University, Beijing, PR China
| | - Qingqing Zhao
- Department of Radiology, Beijing Shijitan Hospital, Peking University Ninth School of Clinical Medicine, Capital Medical University, No. 10 Tieyi St, Haidian District, Beijing 100038, PR China
| | - Rengui Wang
- Department of Radiology, Beijing Shijitan Hospital, Peking University Ninth School of Clinical Medicine, Capital Medical University, No. 10 Tieyi St, Haidian District, Beijing 100038, PR China.
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Chen C, Chu SY, Lin C, Liu KH, Cheng MH. Intra-abdominal chylovenous bypass treats retroperitoneal lymphangiomatosis. J Surg Oncol 2019; 121:75-84. [PMID: 31273800 DOI: 10.1002/jso.25514] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2019] [Accepted: 05/04/2019] [Indexed: 11/08/2022]
Abstract
BACKGROUND Retroperitoneal lymphangiomatosis (RL) is a rare form of primary lymphedema featuring aberrant retroperitoneal lymphatic proliferation. It causes recurrent cellulitis, repeated interventions, and poor life quality. This study aimed to investigate proper diagnositc criteria and surgical outcomes for RL with extremity lymphedema. METHODS Between 2012 and 2018, 44 primary lower-extremity lymphedema cases received lymphoscintigraphy, magnetic resonance imaging, and single-photon electron computed tomography to detect RL. RL patients underwent vascularized lymph node transfers (VLNT) for extremity lymphedema and intra-abdominal side-to-end chylovenous bypasses (CVB) for chylous ascites. Complications, CVB patency, and quality of life were evaluated postoperatively. RESULTS Six RL patients (mean age of 30.3 years) had chylous ascites with five had lower-extremity lymphedema. All CVBs remained patent, though one required re-anastomosis, giving a 100% patency rate. Four unilateral and one bilateral extremity lymphedema underwent six VLNTs with 100% flap survival. Patients reported improved quality of life (P = 0.023), decreased cellulitis incidence (P = 0.041), and improved mean lymphedema circumference (P = 0.043). All patients resumed a normal diet and activity. CONCLUSIONS Evaluating primary lower-extremity lymphedema patients with MRI and SPECT could reveal a 13.6% prevalence of RL and guide treatment of refractory extremity lymphedema. Intra-abdominal CVB with VLNT effectively treated RL with chylous ascites and extremity lymphedema.
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Affiliation(s)
- Courtney Chen
- UC San Diego School of Medicine, San Diego, California
| | - Sung-Yu Chu
- Department of Medical Imaging and Intervention, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Chieh Lin
- Department of Nuclear Medicine, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Ken-Hao Liu
- Department of General Surgery, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Ming-Huei Cheng
- Division of Reconstructive Microsurgery, Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Taoyuan, Taiwan.,Center for Tissue Engineering, Chang Gung Memorial Hospital, Taoyuan, Taiwan.,Department of Plastic Surgery, University of Michigan, Ann Arbor, Michigan
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Rasmussen JC, Fife CE, Sevick-Muraca EM. Near-Infrared Fluorescence Lymphatic Imaging in Lymphangiomatosis. Lymphat Res Biol 2015; 13:195-201. [PMID: 26287470 DOI: 10.1089/lrb.2015.0013] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND Lymphangiomatosis is a rare disorder of the lymphatic system that can impact the dermis, soft tissue, bone, and viscera and can be characterized by lymphangiomas, swelling, and chylous discharge. Whether disordered lymphangiogenesis in lymphangiomatosis affects the function and anatomy of the entire systemic lymphatic circulation or is localized to specific sites is not fully known. METHODS AND RESULTS A 35-year-old Caucasian female diagnosed with whole-body lymphangiomatosis at 2 months of age and who continues to present with progressive disease was imaged with near-infrared fluorescence lymphatic imaging. While the peripheral lymphatics in the extremities appeared largely normal compared to prior studies, we observed tortuous lymphatic vessels, fluorescence drainage from the peripheral lymphatics into lymphangiomas, and extensive dermal lymphatics in the left thigh and inguinal regions where the subject had previously had surgical assaults, potentially indicating defective systemic lymphangiogenesis. CONCLUSIONS Further research into anatomical and functional lymphatic changes associated with the progression and treatment of lymphangiomatosis could aid in understanding the pathophysiology of the disease as well as point to treatment strategies.
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Affiliation(s)
- John C Rasmussen
- 1 The University of Texas Health Science Center at Houston , Houston, Texas
| | - Caroline E Fife
- 2 St. Lukes Hospital , The Woodlands, The Woodlands, Texas.,3 Formerly with Memorial Herman Hospital , Houston, Texas, and The University of Texas Health Science Center at Houston, Houston, Texas
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Rockson SG. Laboratory models for the investigation of lymphangiomatosis. Microvasc Res 2014; 96:64-7. [DOI: 10.1016/j.mvr.2014.08.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2014] [Revised: 08/17/2014] [Accepted: 08/21/2014] [Indexed: 10/24/2022]
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Lin RY, Zou H, Chen TZ, Wu W, Wang JH, Chen XL, Han QX. Abdominal lymphangiomatosis in a 38-year-old female: Case report and literature review. World J Gastroenterol 2014; 20:8320-8324. [PMID: 25009412 PMCID: PMC4081712 DOI: 10.3748/wjg.v20.i25.8320] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2013] [Revised: 02/09/2014] [Accepted: 04/09/2014] [Indexed: 02/06/2023] Open
Abstract
Lymphangioma is an uncommon benign tumor that develops in the lymphatic system. Abdominal lymphangiomatosis is extremely rare in adult patients, and the clinical symptoms of this condition are complicated and atypical. We report a case of abdominal lymphangiomatosis in a 38-year-old female who presented with intestinal bleeding and protein-losing enteropathy, as well as lesions in the lung and bones. A computed tomography scan revealed multiple small cystic lesions without enhancement. Histological examination revealed microscopic cysts were submucosal, with walls composed of thin fibrous tissue, and D2-40 stained highlight the lining of the lymphatic channels by immunohistochemical method. We make a comparison with the cases reported before, and also discuss the diagnose of diffuse pulmonary lymphangiomatosis and Gorham’s disease.
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