Lymphography--still useful in the diagnosis of lymphangiomatosis

Diagnosis of Lymphangiomatosis: A Study Based on CT Lymphangiography

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.

Thoracic involvement in generalised lymphatic anomaly (or lymphangiomatosis)

Generalised lymphatic anomaly (GLA), also known as lymphangiomatosis, is a rare disease caused by congenital abnormalities of lymphatic development. It usually presents in childhood but can also be diagnosed in adults. GLA encompasses a wide spectrum of clinical manifestations ranging from single-organ involvement to generalised disease. Given the rarity of the disease, most of the information regarding it comes from case reports. To date, no clinical trials concerning treatment are available. This review focuses on thoracic GLA and summarises possible diagnostic and therapeutic approaches.

Possible diagnostic and therapeutic approaches to generalised lymphatic anomaly (lymphangiomatosis)http://ow.ly/4n4pgU

Sudden death of a 14-year-old girl with lymphangiomatosis

A 14-year-old girl presented with progressively worsening intermittent orthopnea. Imaging studies showed cardiomegaly, extensive pericardial effusion, and a mediastinal tumor. By pericardial drainage, approximately 8,000-mL fluid was collected over 10 days. Left thoracoscopic pericardial fenestration and mediastinal tumor biopsy were performed, revealing lymphangiomatosis. Chylous pleural effusion developed post-surgery. Although control was attempted, her condition worsened. Eight months later, she died of sudden cardiopulmonary arrest. Autopsy revealed systemic spread of the primary lesion from the hyperplastic lymph ducts to the parietal pleura and mediastinum confirming systemic lymphangiomatosis.

Thoracic lymphangiomatosis with massive chylothorax after a tumor biopsy and with disseminated intravenous coagulation--lymphoscintigraphy, an alternative minimally invasive imaging technique: report of a case

Thoracic lymphangiomatosis in childhood is a rare disorder that frequently has poor response to medical therapy as well as a poor prognosis. This disease is often misdiagnosed, and a definitive diagnosis is usually delayed because of the rarity and slow course of the disease. No previous reports have so far described the usefulness of lymphoscintigraphy in the diagnosis of lymphangiomatosis, although some authors have reported the efficacy of lymphoscintigraphy for evaluating chylothorax. A 6-year-old boy presented with a diffuse mediastinal mass and received an open mediastinal biopsy for a definitive diagnosis, which led to the occurrence of massive chylothorax postoperatively. A diagnosis of lymphangiomatosis was finally made based on the lymphoscintigraphic findings demonstrating an obstruction of the thoracic duct. This report describes a rare case of thoracic lymphangiomatosis diagnosed at autopsy, and suggests that the minimally invasive technique of lymphoscintigraphy should be employed to obtain a definitive diagnosis at an early stage.

Benign cystic lymphangioma presenting as a pelvic mass

We report a case of a 48-year-old woman with a complaint of chronic pelvic pain with a pelvic mass not related with uterus or adnexes. Preoperative ultrasonography or contrast enhanced computed tomography did not give accurate information on the origin of tumor. At laparotomy a cystic, retroperitoneal mass was totally resected without rupture. Final histopathological examination revealed that cystic spaces with abundant lymphocytes suggesting lymphangioma. No recurrence was detected in the follow up 6 months after total resection. As a result cystic lymphangioma should be considered as a rare cause of pelvic mass in women.

Expression of the vascular endothelial growth factor C receptor VEGFR-3 in lymphatic endothelium of the skin and in vascular tumors

It is difficult to identify lymph vessels in tissue sections by histochemical staining, and thus a specific marker for lymphatic endothelial cells would be more practical in histopathological diagnostics. Here we have applied a specific antigenic marker for lymphatic endothelial cells in the human skin, the vascular endothelial growth factor receptor-3 (VEGFR-3), and show that it identifies a distinct vessel population both in fetal and adult skin, which has properties of lymphatic vessels. The expression of VEGFR-3 was studied in normal human skin by in situ hybridization, iodinated ligand binding, and immunohistochemistry. A subset of developing vessels expressed the VEGFR-3 mRNA in fetal skin as shown by in situ hybridization and radioiodinated vascular endothelial growth factor (VEGF)-C bound selectively to a subset of vessels in adult skin that had morphological characteristics of lymphatic vessels. Monoclonal antibodies against the extracellular domain of VEGFR-3 stained specifically endothelial cells of dermal lymph vessels, in contrast to PAL-E antibodies, which stained only blood vessel endothelia. In addition, staining for VEGFR-3 was strongly positive in the endothelium of cutaneous lymphangiomatosis, but staining of endothelial cells in cutaneous hemangiomas was weaker. These results establish the utility of anti-VEGFR-3 antibodies in the identification of lymphovascular channels in the skin and in the differential diagnosis of skin lesions involving lymphatic or blood vascular endothelium.

Ongoing osteolysis in patients with lymphangioma

Severe osteolysis is a rare complication of lymphangioma. It can progress despite treatment and may be fatal. Four patients presented with massive osteolysis and serious related complications. Of these, two responded well to OK-432 therapy with arrest of the osteolysis. Complete recovery from life-threatening pleural effusion has been noted in one. Of the two nonresponders, one died of progressive osteolysis of the cervical and occipital bones, the other, despite therapy, still shows progressive osteolysis of the left leg from the femur to the phalanges. A boneless leg may be the outcome.

Multiple painful bone cysts in a young man

To confirm the diagnosis of diffuse cystic angiomatosis, it is necessary to biopsy the bone: the walls of the cysts react to immunological markers of the endothelium (antigens related to factor VIII and CD31). Alternatively, lymphography can avoid the necessity for biopsy. Evolution of the condition is variable and depends on the extent of visceral involvement, and usually the extent of soft tissue and visceral involvement dictates the morbidity and mortality. There is no specific treatment, though osseous lesions can regress spontaneously.