Lethal outcomes in Klippel-Trenaunay syndrome

Splenic Lymphatic Malformation With Papillary Endothelial Proliferation: A Rare Histologic Variant or a Unique Entity?

Lymphatic malformations (LMs) are congenital anomalies of the lymphatic system due to abnormalities that occur during the development of the lymphovascular system. Also known as lymphangiomas, they are usually multifocal, affect multiple organ systems, and are seen in a variety of developmental or overgrowth syndromes. Splenic lymphangiomas are uncommon and usually occur in the context of multiorgan lymphangiomatosis. Within the spleen, 7 prior cases have been reported of LMs with unusual papillary endothelial proliferations (PEPs), which can mimic more aggressive splenic lymphovascular tumors. It is not currently known if splenic LM-PEP represents a unique entity, or is simply an unusual, site-specific, morphologic variant of LM. To address this question, we conducted a retrospective, single-institutional review of this rare entity and systematically evaluated its clinical, histologic, radiologic, electron microscopical, and molecular features. In all 3 splenic LM-PEPs, the clinical course was benign, imaging demonstrated subcapsular lesions with characteristic "spoke-and-wheel" appearance, histology showed distinctive PEPs within lymphatic microcysts, immunohistochemistry confirmed a lymphatic endothelial phenotype and electron microscopy demonstrated lesional endothelial cells, rich in mitochondria and intermediate filaments with prominent cytoplasmic lumina and vacuoles and lacking Weibel-Palade granules. Occasional lymphothelial cells were situated within the cytoplasm of another lesional cell, appearing to be engulfed. Next-generation sequencing identified a PIK3CA mutation in 1 patient, while in 2 others no molecular alterations were identified. We conclude with a summary of all prior published cases and discuss key diagnostic elements that distinguish this benign entity from its more aggressive mimickers.

Case Report: Life-Threatening Post-operative Hemorrhage in Klippel-Trenaunay Syndrome Associated With Hypofibrinogenemia

Klippel–Trenaunay Syndrome (KTS) is a rare congenital disorder, characterized by venous and lymphatic malformations of the skin, soft tissue, and bone, causing limb hypertrophy. Although, a ruptured hemorrhagic corpus luteum is a rare condition in women of reproductive age, it can result in lethal outcomes. Here, we have described a patient with KTS and hypofibrinogenemia who went through recurrent lethal postoperative bleeding due to a ruptured hemorrhagic corpus luteum. This case suggested that conservative therapy might be the first choice and effective therapy for the patients with KTS, who suffered from bleeding complications of surgical therapy.

Genitourinary involvement in pediatric patients with Klippel-Trenaunay Syndrome

BACKGROUND

Klippel-Trenaunay Syndrome (KTS) is a genetic vascular malformation disorder which induces a variety of phenotypic expression in patients which differ in terms of severity/location. While previous studies have documented genitourinary (GU) complications in adult KTS patients, documentation of the scope and incidence of GU involvement in the pediatric population with imaging findings is currently limited. This study represents the largest KTS genitourinary review to date.

OBJECTIVE

To assess the incidence, scope, clinical findings and imaging characteristics of GU pathology in pediatric KTS patients.

MATERIALS/METHODS

Using a retrospective data analysis design, the charts and imaging studies of pediatric KTS patients were reviewed. All patients received care at a specialized vascular clinic within a multicenter tertiary care system. Variables studied included age, age at KTS diagnosis, gender, urologic involvement, and age of urologic complication.

RESULTS

58 patients were identified. 33 were male and 25 were female. 10 patients had GU findings. Three of these patients had multifocal GU involvement (greater than 1 finding). Urologic manifestations were diverse with 9 distinct diagnoses involving 6 unique organs. Renal, vesical and scrotal pathologies were most common. Hematuria was the most common presenting symptom in 30% (3/10). Previously unreported findings (labial swelling, renal lymphatic cysts) were identified. The average age of KTS diagnosis was 4.9 years. The average age of documented GU complication and involvement was 7.6 years.

CONCLUSION

Significant GU complications due to KTS can occur in the pediatric population. Early clinical and imaging characterization of these conditions is important for management, family education and early intervention strategies.

Cancer Risk in Klippel-Trenaunay Syndrome

Background: Klippel-Trenaunay syndrome (KTS) is an overgrowth syndrome defined by capillary/venous/lymphatic malformations (CVLM) with soft tissue and/or bone hypertrophy. Whether KTS predisposes to cancer is not clear. Methods and Results: We surveyed members of the K-T Support Group (KTSG) and reviewed PubMed for "Klippel Trenaunay Syndrome" or "CVLM" and "cancer." Individuals with cancer were reviewed for confirmation of KTS, tumor type, location, and age at presentation. Of 223 KTSG respondents, 24 (10.8%) reported 26 malignancies or benign brain tumors (diagnosed from 6 months to 68 years of age, median 41 years), including 3 who were younger than 18 years (2 with Wilms tumor). Nine of twenty-six cancers were basal cell carcinomas (4% of respondents). From 475 articles, we identified 11 cancers or brain tumors in 10 individuals with KTS. Four of these were in children (Wilms tumor n = 2; rhabdomyosarcoma n = 1; serous borderline tumor n = 1). Tumors in adults included basal cell carcinoma (n = 1), squamous cell carcinoma of skin (n = 2), and angiosarcoma, Hodgkin disease, glioblastoma, malignant hemangiopericytoma in one patient each. Ulceration or lymphedema associated with VLM or capillary malformations were associated with some basal cell or squamous cell carcinomas and angiosarcomas. Conclusions: The risk of embryonal cancer other than Wilms tumor in children with KTS does not appear to be higher than in the general population. Wilms tumor incidence is under 5%, and routine surveillance is not indicated. In adults, particular attention should be paid to skin in the area of malformations. These conclusions may not apply to all overgrowth syndromes with vascular malformations.

Lymphedema in Klippel-Trenaunay Syndrome: Is It Possible to Normalize?

The aim of this study is to report the results of intensive therapy of lymphedema associated with Klippel-Trenaunay syndrome. A 24-year-old female patient reported that her family had observed edema in her right leg and port wine stains from birth. For ten years, they consulted with different specialists in the region but the prognosis did not change and no specific treatment was found. In 2014, at the age of 24, with massive lymphedema, a leg ulcer, and recurrent infections, she started treatment at the Clínica Godoy in São José do Rio Preto. She was evaluated by clinical history, physical examination, water displacement volumetry, and bioimpedance. Intensive therapy (8 hours daily) was proposed using Manual Lymphatic Therapy (Godoy & Godoy), Cervical Stimulation Therapy, Mechanical Lymphatic Therapy, a grosgrain stocking adjusted several times a day, and the use of Unna boot in the region of the ulcer. The volume of edema was reduced by about 44% within the first week with further reductions in the following weeks and healing of the ulcer. Subsequently, it was possible to control and maintain the reduction in swelling with less intense treatment. It is possible to reduce and maintain the treatment results of lymphedema associated with Klippel-Trenaunay syndrome.

An unusual presentation of pediatric osteoblastoma in a patient with Klippel-Trenaunay-Weber syndrome: case report

Osteoblastoma is an uncommon primary bone tumor that usually presents as a painful lesion in a long bone or in the spine. Osteoblastoma has been reported only twice in the literature in conjunction with systemic fibromatosis. The authors report the case of an 8-year-old girl with suspected Klippel-Trenaunay-Weber syndrome, a rare syndrome of systemic fibromatosis, who presented with a painless thoracic rib lesion that was found to be an osteoblastoma.