Chylous cyst-venous shunt for the management of central conducting lymphatic anomaly

We present the case of a 45-year-old man who had presented with ubiquitous chylous reflux that manifested as a bilateral inguinal chylous cutaneous fistula and a voluminous right cervical chylous cyst. He had difficulty breathing owing to compression of the airway. Anastomosis of the chylous cyst wall with the external jugular vein was performed using a valvular vein segment to prevent blood reflux. Postoperatively, anticoagulant therapy was initiated. We found this derivative surgical procedure to be an effective and minimally invasive technique for complex lymphatic anomalies.

Topical Tacrolimus 0.1% for treatment of cutaneous microcystic lymphatic malformations

Microcystic lymphatic malformations as described in the international literature form a subgroup of low-flow congenital vascular malformations (VM) resulting from irregular embryological development. Microcystic lesions normally manifest as an accumulation of lymph- and blood-filled vesicles that, when externalized, cause skin maceration with consequent pain and potential infection resulting in the impairment of the patient's quality of life. There is no consensus on a standardized algorithm nor clear guidelines for successful treatment of this type of lymphatic malformation, and treatment options employed often result in ambivalent and transient outcomes with a high rate of recurrence. The topical formulation of tacrolimus is a well-known FDAapproved anti-T cell agent that was recently identified as a potent activator of ALK1, which is involved in several processes and functions including angiogenesis. We investigated if topical administration of tacrolimus may be an effective therapy for directly targeting cutaneous microcystic lymphatic malformations as a complement to systemic treatment. The study enrolled four patients with cutaneous microcystic lymphatic malformations: three male (ages: 13,15,18) and one female (age: 30). Two of the patients presented lesions on their backs, one patient on the left hand and one on the left lower limb. All four patients received treatment with topical tacrolimus 0.1% twice a day for 10 weeks on a previously selected area for application. Weekly clinical follow-ups were conducted along with close physician-patient contact. All patients displayed a satisfactory response after treatment. Lymphorrhea and bleeding were stopped in all cases and the esthetic aspect of lesions improved in two patients. To date, all patients presented no clinically significant changes to the size or extension of the lesion. Topical tacrolimus treatment is a promising and reasonable option for microcystic lymphatic malformations. Our results encourage further exploration in larger populations with the consideration that it is a safe and effective alternative or complementary therapy to systemic treatment.

In Memoriam Prof. Prof. h.c. Dr. med. Michael Földi, January 10, 1920 - October 20, 2018 "Father of Lymphology"

In Memoriam: With deep sadness the world of Lymphology learned of the death of Prof. Prof. h.c. Dr. med. Michael Földi, a ground breaking pioneer of modern Lymphology. Words alone will never fully describe or capture the breadth and depth of Michael's contribution to our lymphatic knowledge and the legacy he has left for us all.

A salvage surgical solution for recurrent lymphangioma of the prepuce

Treatment of lymphangioma circumscriptum of the prepuce is often technically demanding. Many different medical and surgical approaches have been described over the years, none of which has proved completely successful. We describe a case in which skin deficiency was a problem after prior multiple excisions of lymphangiomatous tissue. We decided to bury the degloved shaft in the scrotum. After 6 months the penis was raised and reconstructed using scrotal skin; this achieved satisfactory skin coverage. In such cases piliferous follicles can easily be dealt with at a later stage by cosmetic treatment. We believe this technical approach may be a valid alternative to conventional procedures (i.e. grafts and flaps) especially when extensive resection makes skin coverage particularly difficult.

Lipoblastoma-lipoblastomatosis associated with unilateral limb hypertrophy: a case report in a newborn

Lipoblastoma is a benign mesenchymal tumor of embryonic adipose tissue, uncommon in infancy. Multicentricity, absence of a capsule and histopathology best defines a lipoblastoma. Synonyms for this lesion are embryonic lipoma, fetal lipoma, lipoblastic tumor, and congenital lipomatoid tumor. Lipoblastoma is more common in males (approximately 80%), is usually located in the subcutaneous soft tissue (benign lipoblastoma) or in the deep interstitium (benign lipoblastomatosis), or sometimes in all corporeal segments. Primary treatment is complete excision. Relapse is between 14-25%, many of which are more "mature," and difficult to differentiate from lipoma. The differential diagnosis includes liposarcoma, which is rare under ten years. Radical excision in children is recommended with relapses, especially with lipoblastomatosis. Chromosomal markers help discriminate between liposarcoma and lipoblastoma.

Klippel-Trenaunay-Servelle Syndrome in Pediatrics

The aim of this report is to explain the historical differences between Klippel-Trenaunay (KT), Klippel-Trenaunay-Weber (KTW), and Klippel-Trenaunay-Servelle (KTS) syndromes. Furthermore, an attempt will be made to describe the different causes, symptoms, and consequences of the pathology, largely as a consequence of venous hypertension. The significance of these syndromes within the pediatric population is highlighted.

Lymphatic dysplasia in paediatrics. A new classification

A classification of dysplasias of the lymphatic system is proposed on the basis of the anatomical structures involved: lymph vessel-angiodysplasia, lymphadeno(nodal)-dysplasia and the summary of both lymphangio-adeno(nodal)dysplasias. The suggested terminology is: LAD I (Lymphangiodysplasias), LAD II (Lymphadeno(nodal)dysplasia) and LAAD (lymphadeno(nodal)-dysplasia). With this classification we may coherently group the malformations we already know, relate them to the big syndromes and to all the other angiodysplasias and also create the reference background for another chapter of lymphology: primary or idiopathic lymphedema.