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Rose M, Ritter D, Gupta N, Tolusso L, Horn P, Wakefield E, Glass J. Healthcare provider recognition of pregnancy related risks and management considerations in patients with tuberous sclerosis complex. Orphanet J Rare Dis 2024; 19:4. [PMID: 38166979 PMCID: PMC10763101 DOI: 10.1186/s13023-023-03015-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Accepted: 12/20/2023] [Indexed: 01/05/2024] Open
Abstract
BACKGROUND Patients with tuberous sclerosis complex (TSC) face an increased risk of maternal health complications and worsening disease manifestations during pregnancy. There are no established consensus guidelines that address the management of pregnancy in patients with TSC and healthcare providers rely on their individual experiences and preferences to derive treatment decisions. We sought to obtain provider opinion of pregnancy related maternal complications in patients with TSC, and the common evaluation and management strategies used to address these issues. METHODS We conducted a cross-sectional survey of healthcare providers with diverse areas of expertise related to the multisystem nature of involvement in TSC. Descriptive analyses were used to analyze our three primary variables: (1) provider recognition of maternal risks/complications; (2) provider recommendations before and during pregnancy; and (3) provider/clinic protocols. RESULTS We received responses from 87 providers from 11 countries, with 40.7% (n = 35) seeing > 30 TSC patients yearly. The majority of providers (n = 70, 88.6%) deemed that a patient with TSC needed expert care beyond the standard of care for a typical pregnancy, with over 25% of providers reporting that they have seen lymphangioleiomyomatosis (LAM) exacerbation, seizures, and preterm labor in pregnant patients with TSC. Providers who managed patients treated with mTOR inhibitors (mTORi) also agreed that mTORi use should be stopped prior to pregnancy (n = 45, 68.2%) but there was uncertainty about when to stop the mTORi (one month 28.9%, two months 11.1%, three months 42.2%, and 6-12 months 2.2%). Additionally, there were mixed opinions on restarting mTORi in response to disease progression during pregnancy. When asked about provider or clinic specific protocols, 71.6% (n = 53) of providers stated that they do not have a clear protocol for management decisions for patients with TSC before or during pregnancy. CONCLUSION Healthcare providers recognize that patients with TSC are at an increased risk for maternal health complications during pregnancy. However, there are wide inter-individual variances in practice, especially pertaining to decisions regarding mTORi use. There is a critical need to better understand the implications of pregnancy for patients with TSC, and to draft consensus recommendations to guide management decisions.
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Affiliation(s)
- Meredith Rose
- Division of Human Genetics, Cincinnati Children's Hospital Medical Center, Cincinnati, USA.
- Medical Genetics Clinic, Mary Bridge Children's/MultiCare Health System, Tacoma, USA.
| | - David Ritter
- Division of Neurology, Cincinnati Children's Hospital Medical Center, Cincinnati, USA
- Department of Pediatrics, College of Medicine, University of Cincinnati, Cincinnati, USA
| | - Nishant Gupta
- Division of Pulmonary, Critical Care and Sleep Medicine, University of Cincinnati, Cincinnati, USA
- Medical Service, Veterans Affairs Medical Center, Cincinnati, OH, USA
| | - Leandra Tolusso
- Division of Human Genetics, Cincinnati Children's Hospital Medical Center, Cincinnati, USA
- Cincinnati Children's Fetal Care Center, Cincinnati, USA
| | - Paul Horn
- Division of Neurology, Cincinnati Children's Hospital Medical Center, Cincinnati, USA
- Department of Pediatrics, College of Medicine, University of Cincinnati, Cincinnati, USA
| | - Emily Wakefield
- Division of Human Genetics, Cincinnati Children's Hospital Medical Center, Cincinnati, USA
| | - Jennifer Glass
- Division of Human Genetics, Cincinnati Children's Hospital Medical Center, Cincinnati, USA
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Han Z, Xue X, Wang J, Lu D. Tuberous sclerosis complex associated lymphangioleiomyomatosis. QJM 2023; 116:873-874. [PMID: 37286375 PMCID: PMC10593382 DOI: 10.1093/qjmed/hcad125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2023] [Indexed: 06/09/2023] Open
Affiliation(s)
- Z Han
- Department of Gerontology, The First Affiliated Hospital of Shandong First Medical University and Shandong Provincial Qianfoshan Hospital, Jinan, China
| | - X Xue
- Department of Gerontology, The First Affiliated Hospital of Shandong First Medical University and Shandong Provincial Qianfoshan Hospital, Jinan, China
| | - J Wang
- Department of Gerontology, The First Affiliated Hospital of Shandong First Medical University and Shandong Provincial Qianfoshan Hospital, Jinan, China
| | - D Lu
- Department of Respiratory, The First Affiliated Hospital of Shandong First Medical University and Shandong Provincial Qianfoshan Hospital, Shandong Institute of Respiratory Diseases, Shandong Institute of Anesthesia and Respiratory Critical Medicine, Jinan, China
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Abramov R, Rufizen L, Gilshtein H. Resection of Extrapulmonary Lymphangiomyoma and Post-Operative Management Considerations. Vasc Endovascular Surg 2023; 57:756-759. [PMID: 36952511 DOI: 10.1177/15385744221144503] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/25/2023]
Abstract
Background: Lymphangiomyomatosis is a rare disease involving the lymph vessels, causing obstruction and cystic formation with an incidence of 3-8 per million women. The disease might be sporadic or inherited. Lymphangiomyomatosis mostly affects the pulmonary system, whereas extrapulmonary Lymphangiomyomatosis may present in various site, occasionally as a localized abdominal mass. The diagnostic process might entail surgical resection to obtain a specimen for pathology that may also help to achieve a long-term control of the disease. Methods: Herein, we present a case of a 45 years old female, who suffered from pulmonary symptoms, and during her workup an abdominal mass was found. The patient underwent exploratory laparotomy with resection of a left retroperitoneal bilobar mass. Results: Histopathological report revealed Lymphangiomyoma. She had a complication of a lymphatic leakage that required a second laparotomy with satisfactory clinical outcome. Conclusions: Surgeons should be aware of the pathological lymphatics and manage post-operative complications by a trial of conservative.
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Affiliation(s)
- Roi Abramov
- Department of General Surgery, Rambam Health Care Campus, Haifa, Israel
| | - Liel Rufizen
- Department of General Surgery, Rambam Health Care Campus, Haifa, Israel
| | - Hayim Gilshtein
- Department of General Surgery, Rambam Health Care Campus, Haifa, Israel
- Colorectal Unit, Rambam Health Care Campus, Haifa, Israel
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Munshi A, Hyslop AD, Kopras EJ, Gupta N. Spontaneous pneumothoraces during pregnancy in patients with lymphangioleiomyomatosis. Respir Investig 2023; 61:632-635. [PMID: 37451227 DOI: 10.1016/j.resinv.2023.06.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Revised: 05/04/2023] [Accepted: 06/15/2023] [Indexed: 07/18/2023]
Abstract
Patients with lymphangioleiomyomatosis (LAM) are prone to developing spontaneous pneumothoraces (SPs). We aimed to characterize the burden of SPs during pregnancy in LAM, using a web-based survey. Among the 50 respondents, 12 (24%) had never been pregnant and 38 (76%) were pregnant at least once, resulting in a total of 80 pregnancies. Respiratory symptoms during pregnancy led to the diagnosis of LAM in 34% of (13/38) patients, with SPs being the presenting manifestation in most of these patients (10/13, 77%). Eleven of the 38 pregnant patients (29%) experienced at least one SP during pregnancy. The majority of the SPs (∼60%) occurred during the second trimester. Our study provides valuable insights regarding the risk, burden, and timing of pregnancy-related SPs in patients with LAM that would be useful for the LAM community.
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Affiliation(s)
- Aamir Munshi
- Division of Pulmonary & Critical Care Medicine, University of Cincinnati, Cincinnati, OH, USA
| | - Alan D Hyslop
- Division of Pulmonary Medicine, Indiana University, Indianapolis, IN, USA
| | - Elizabeth J Kopras
- Division of Pulmonary & Critical Care Medicine, University of Cincinnati, Cincinnati, OH, USA
| | - Nishant Gupta
- Division of Pulmonary & Critical Care Medicine, University of Cincinnati, Cincinnati, OH, USA.
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Gupta N, Zhang B, Zhou Y, McCormack FX, Ingledue R, Robbins N, Kopras EJ, McMahan S, Singla A, Swigris J, Cole AG, Holz MK. Safety and Efficacy of Combined Resveratrol and Sirolimus in Lymphangioleiomyomatosis. Chest 2023; 163:1144-1155. [PMID: 36642366 PMCID: PMC10206511 DOI: 10.1016/j.chest.2023.01.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Revised: 12/16/2022] [Accepted: 01/04/2023] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND A critical need exists to develop remission-inducing therapies for lymphangioleiomyomatosis. RESEARCH QUESTION Is the addition of resveratrol safe and more efficacious than sirolimus alone in patients with lymphangioleiomyomatosis? STUDY DESIGN AND METHODS We conducted a phase 2, dose-escalating, open-label trial of resveratrol in patients with lymphangioleiomyomatosis receiving a stable regimen of sirolimus. Resveratrol was started at 250 mg/d and escalated every 8 weeks to maximum dose of 1,000 mg/d over 24 weeks. The primary outcome was ≥ 42% decline in serum vascular endothelial growth factor D (VEGF-D) levels on combined therapy compared with baseline VEGF-D levels on sirolimus. Secondary objectives included an assessment of the safety profile and the effect on lung function and health-related quality of life (HRQOL). Longitudinal change in outcome measures was assessed using linear mixed models. Adverse effects were tabulated using the National Cancer Institute's Common Terminology Criteria for Adverse Events version 4. RESULTS Twenty-five patients with lymphangioleiomyomatosis with a median age of 51 years were enrolled. Pulmonary function parameters at study inclusion were: FEV1: median absolute, 1.72 L; 64% predicted; FVC: median absolute, 2.99 L; 96% predicted; and diffusing capacity of the lungs for carbon monoxide: median absolute, 14.68 mL/mm Hg/min; 37% predicted. The median serum VEGF-D value at baseline was 617 pg/mL. Patients entered the study with a median sirolimus dose of 2 mg/d with median trough level of 6.3 ng/mL. Despite some GI side effects, the addition of resveratrol was well tolerated. Although the primary outcome was not met, a statistically significant reduction in serum VEGF-D levels and improvement in HRQOL during the study was found. INTERPRETATION The addition of resveratrol was safe and well tolerated in patients with lymphangioleiomyomatosis taking sirolimus and was associated with modest improvement in HRQOL. Larger controlled trials of this combination might be warranted to assess definitively the usefulness of resveratrol as an additive therapy in lymphangioleiomyomatosis. TRIAL REGISTRY ClinicalTrials.gov; No.: NCT03253913; URL: www. CLINICALTRIALS gov.
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Affiliation(s)
- Nishant Gupta
- Division of Pulmonary, Critical Care and Sleep Medicine, University of Cincinnati, Cincinnati, OH; Medical Service, Veterans Affairs Medical Center, Cincinnati, OH.
| | - Bin Zhang
- Department of Pediatrics, University of Cincinnati, Cincinnati, OH; Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | - Yuan Zhou
- Department of Mathematical Sciences, University of Cincinnati, Cincinnati, OH
| | - Francis X McCormack
- Division of Pulmonary, Critical Care and Sleep Medicine, University of Cincinnati, Cincinnati, OH; Medical Service, Veterans Affairs Medical Center, Cincinnati, OH
| | - Rebecca Ingledue
- Division of Pulmonary, Critical Care and Sleep Medicine, University of Cincinnati, Cincinnati, OH
| | - Nathan Robbins
- Department of Internal Medicine, University of Cincinnati, Cincinnati, OH
| | - Elizabeth J Kopras
- Division of Pulmonary, Critical Care and Sleep Medicine, University of Cincinnati, Cincinnati, OH
| | - Susan McMahan
- Division of Pulmonary, Critical Care and Sleep Medicine, University of Cincinnati, Cincinnati, OH
| | - Abhishek Singla
- Division of Pulmonary, Critical Care and Sleep Medicine, University of Cincinnati, Cincinnati, OH
| | - Jeffrey Swigris
- Division of Pulmonary, Critical Care and Sleep Medicine, National Jewish Health, Denver, CO
| | - Adam G Cole
- Division of Pulmonary and Critical Care Medicine, Lexington VA Medical Center, Lexington, KY; Department of Medicine, University of Kentucky College of Medicine, Lexington, KY
| | - Marina K Holz
- Department of Cell Biology and Anatomy, New York Medical College, New York, NY
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Esposito AJ, Imani J, Shrestha S, Bagwe S, Lamattina AM, Vivero M, Goldberg HJ, Rosas IO, Henske EP, El-Chemaly SY. Lymphangioleiomyomatosis: circulating levels of FGF23 and pulmonary diffusion. J Bras Pneumol 2023; 49:e20220356. [PMID: 37132737 PMCID: PMC10171272 DOI: 10.36416/1806-3756/e20220356] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2022] [Accepted: 02/19/2023] [Indexed: 04/05/2023] Open
Abstract
OBJECTIVE Lymphangioleiomyomatosis (LAM) is a rare, destructive disease of the lungs with a limited number of determinants of disease activity, which are a critical need for clinical trials. FGF23 has been implicated in several chronic pulmonary diseases. We aimed to determine the association between serum FGF23 levels and pulmonary function in a cohort of patients with LAM. METHODS This was a descriptive single-center study in which subjects with LAM and controls with unreported lung disease were recruited. Serum FGF23 levels were measured in all subjects. Clinical data, including pulmonary function testing, were retrospectively obtained from electronic medical records of LAM subjects. Associations between FGF23 levels and clinical features of LAM were explored via nonparametric hypothesis testing. RESULTS The sample comprised 37 subjects with LAM and 16 controls. FGF23 levels were higher in the LAM group than in the control group. In the LAM group, FGF23 levels above the optimal cutoff point distinguished 33% of the subjects who had nondiagnostic VEGF-D levels. Lower FGF23 levels were associated with impaired DLCO (p = 0.04), particularly for those with isolated diffusion impairment with no other spirometric abnormalities (p = 0.04). CONCLUSIONS Our results suggest that FGF23 is associated with pulmonary diffusion abnormalities in LAM patients and elicit novel mechanisms of LAM pathogenesis. FGF23 alone or in combination with other molecules needs to be validated as a biomarker of LAM activity in future clinical research.
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Affiliation(s)
- Anthony J Esposito
- . Department of Medicine, Division of Pulmonary and Critical Care Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston (MA) USA
- . Department of Medicine, Division of Pulmonary and Critical Care Medicine, Northwestern University, Feinberg School of Medicine, Chicago (IL) USA
| | - Jewel Imani
- . Department of Medicine, Division of Pulmonary and Critical Care Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston (MA) USA
| | - Shikshya Shrestha
- . Department of Medicine, Division of Pulmonary and Critical Care Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston (MA) USA
| | - Shefali Bagwe
- . Department of Medicine, Division of Pulmonary and Critical Care Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston (MA) USA
| | - Anthony M Lamattina
- . Department of Medicine, Division of Pulmonary and Critical Care Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston (MA) USA
| | - Marina Vivero
- . Department of Pathology, Brigham and Women’s Hospital, Harvard Medical School, Boston (MA) USA
| | - Hilary J Goldberg
- . Department of Medicine, Division of Pulmonary and Critical Care Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston (MA) USA
| | - Ivan O Rosas
- . Department of Medicine, Section of Pulmonary, Critical Care, and Sleep Medicine, Baylor College of Medicine, Houston (TX) USA
| | - Elizabeth P Henske
- . Department of Medicine, Division of Pulmonary and Critical Care Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston (MA) USA
| | - Souheil Y El-Chemaly
- . Department of Medicine, Division of Pulmonary and Critical Care Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston (MA) USA
- . Sanofi, Cambridge (MA) USA
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7
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Ye R, Liao Y, Luo L, Xiao X. Incidental lymphangioleiomyomatosis in pelvic lymph nodes associated with Malignant neoplasm of the ovary - two case reports. POL J PATHOL 2023; 74:148-150. [PMID: 37728475 DOI: 10.5114/pjp.2023.129181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/21/2023] Open
Affiliation(s)
- Rupei Ye
- Department of Pathology, The Affiliated Hospital of Southwest Medical University, Luzhou, China
| | - Yehui Liao
- Department of Orthopaedics, The Affiliated Hospital of Southwest Medical University, Luzhou, China
| | - Li Luo
- Department of Pathology, The Affiliated Hospital of Southwest Medical University, Luzhou, China
| | - Xiuli Xiao
- Department of Pathology, The Affiliated Hospital of Southwest Medical University, Luzhou, China
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8
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Koh JS, Oh S, Chung C. Pulmonary lymphangioleiomyomatosis and renal angiomyolipoma in a patient with systemic lupus erythematosus: A case report. Medicine (Baltimore) 2022; 101:e30554. [PMID: 36197220 PMCID: PMC9509188 DOI: 10.1097/md.0000000000030554] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND The co-incidence of systemic lupus erythematosus (SLE) and tuberous sclerosis with pulmonary lymphangioleiomyomatosis (LAM) and renal angiomyolipoma (AML) is rare. In such patients, the rupture of renal AML may result in fatal circumstances, but this may be preventable. METHODS A 22-year-old Asian woman with SLE was admitted to our hospital with severe left-flank pain. Imaging studies showed the bilateral rupture of multiple renal AMLs. RESULTS The patient underwent emergency selective transcatheter embolization (TE) of the left renal artery. After TE and massive hydration, the patient complained of dyspnea and postembolization syndrome with fever. The chest computed tomography (CT) revealed pulmonary LAM, pulmonary edema with bilateral pleural effusions, and pneumonic consolidation. After the emergency procedure, the patient was treated with intravenous administration of antibiotics, diuretics, and nonsteroidal anti-inflammatory drugs for 10 days. The patient recovered favorably and was discharged 20 days after the treatment. She was diagnosed with renal AML and pulmonary LAM along with facial angiofibromas as well as tuberous sclerosis complex (TSC), although she had no TSC1 or TSC2 gene mutations. CONCLUSION Although rare, SLE may coexist with TSC, along with LAM and AML, with a risk of AML rupture. The activation of the mTOR signaling pathway is shared between SLE and TSC. Thus, in patients with SLE, clinicians should consider imaging studies, such as kidney sonography and chest CT, to screen for possible manifestation of AML and LAM.
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Affiliation(s)
- Jeong Suk Koh
- Division of Pulmonology and Critical Care Medicine, Department of Internal Medicine, College of Medicine, Chungnam National University, Daejeon, 301-721, Republic of Korea
| | - Sina Oh
- College of Medicine, Chungnam National University, Daejeon 35015, Republic of Korea
| | - Chaeuk Chung
- Division of Pulmonology and Critical Care Medicine, Department of Internal Medicine, College of Medicine, Chungnam National University, Daejeon, 301-721, Republic of Korea
- Infection Control Convergence Research Center, Chungnam National University School of Medicine, Daejeon 35015, Republic of Korea
- * Correspondence: Chaeuk Chung, Division of Pulmonology, Department of Internal Medicine, Chungnam National University, 282, Munhwaro, Jung-gu, Daejeon 35015, Republic of Korea (e-mail: )
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Bhattacharya I, Ramasawmy R, Javed A, Lowery M, Henry J, Mancini C, Machado T, Jones A, Julien-Williams P, Lederman RJ, Balaban RS, Chen MY, Moss J, Campbell-Washburn AE. Assessment of Lung Structure and Regional Function Using 0.55 T MRI in Patients With Lymphangioleiomyomatosis. Invest Radiol 2022; 57:178-186. [PMID: 34652290 PMCID: PMC9926400 DOI: 10.1097/rli.0000000000000832] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Contemporary lower-field magnetic resonance imaging (MRI) may offer advantages for lung imaging by virtue of the improved field homogeneity. The aim of this study was to evaluate the utility of lower-field MRI for combined morphologic imaging and regional lung function assessment. We evaluate low-field MRI in patients with lymphangioleiomyomatosis (LAM), a rare lung disease associated with parenchymal cysts and respiratory failure. MATERIALS AND METHODS We performed lung imaging on a prototype low-field (0.55 T) MRI system in 65 patients with LAM. T2-weighted imaging was used for assessment of lung morphology and to derive cyst scores, the percent of lung parenchyma occupied by cysts. Regional lung function was assessed using oxygen-enhanced MRI with breath-held ultrashort echo time imaging and inhaled 100% oxygen as a T1-shortening MR contrast agent. Measurements of percent signal enhancement from oxygen inhalation and percentage of lung with low oxygen enhancement, indicating functional deficits, were correlated with global pulmonary function test measurements taken within 2 days. RESULTS We were able to image cystic abnormalities using T2-weighted MRI in this patient population and calculate cyst score with strong correlation to computed tomography measurements (R = 0.86, P < 0.0001). Oxygen-enhancement maps demonstrated regional deficits in lung function of patients with LAM. Heterogeneity of oxygen enhancement between cysts was observed within individual patients. The percent low-enhancement regions showed modest, but significant, correlation with FEV1 (R = -0.37, P = 0.007), FEV1/FVC (R = -0.33, P = 0.02), and cyst score (R = 0.40, P = 0.02). The measured arterial blood ΔT1 between normoxia and hyperoxia, used as a surrogate for dissolved oxygen in blood, correlated with DLCO (R = -0.28, P = 0.03). CONCLUSIONS Using high-performance 0.55 T MRI, we were able to perform simultaneous imaging of pulmonary structure and regional function in patients with LAM.
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Affiliation(s)
- Ipshita Bhattacharya
- Cardiovascular Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda MD, USA 20892
| | - Rajiv Ramasawmy
- Cardiovascular Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda MD, USA 20892
| | - Ahsan Javed
- Cardiovascular Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda MD, USA 20892
| | - Margaret Lowery
- Cardiovascular Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda MD, USA 20892
| | - Jennifer Henry
- Cardiovascular Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda MD, USA 20892
| | - Christine Mancini
- Cardiovascular Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda MD, USA 20892
| | - Tania Machado
- Pulmonary Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda MD, USA 20892
| | - Amanda Jones
- Pulmonary Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda MD, USA 20892
| | - Patricia Julien-Williams
- Pulmonary Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda MD, USA 20892
| | - Robert J Lederman
- Cardiovascular Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda MD, USA 20892
| | - Robert S Balaban
- Systems Biology Center, Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda MD, USA 20892
| | - Marcus Y Chen
- Cardiovascular Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda MD, USA 20892
| | - Joel Moss
- Pulmonary Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda MD, USA 20892
| | - Adrienne E Campbell-Washburn
- Cardiovascular Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda MD, USA 20892
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Kraaijvanger R, Seldenrijk K, Beijer E, Damen J, Wilson JL, Weichhart T, Grutters JC, Veltkamp M. Activation of Downstream mTORC1 Target Ribosomal Protein S6 Kinase (S6K) Can Be Found in a Subgroup of Dutch Patients with Granulomatous Pulmonary Disease. Cells 2021; 10:3545. [PMID: 34944053 PMCID: PMC8700352 DOI: 10.3390/cells10123545] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Revised: 12/07/2021] [Accepted: 12/10/2021] [Indexed: 11/16/2022] Open
Abstract
Mechanistic target of rapamycin complex 1 (mTORC1) has been linked to different diseases. The mTORC1 signaling pathway is suggested to play a role in the granuloma formation of sarcoidosis. Recent studies demonstrated conflicting data on mTORC1 activation in patients with sarcoidosis by measuring activation of its downstream target S6 kinase (S6K) with either 33% or 100% of patients. Therefore, the aim of our study was to reevaluate the percentage of S6K activation in sarcoidosis patients in a Dutch cohort. To investigate whether this activation is specific for sarcoid granulomas, we also included Dutch patients with other granulomatous diseases of the lung. The activation of the S6K signaling pathway was evaluated by immunohistochemical staining of its downstream effector phospho-S6 in tissue sections. Active S6K signaling was detected in 32 (43%) of the sarcoidosis patients. Twelve (31%) of the patients with another granulomatous disorder also showed activated S6K signaling, demonstrating that the mTORC1 pathway may be activated in a range for different granulomatous diseases (p = 0.628). Activation of S6K can only be found in a subgroup of patients with sarcoidosis, as well as in patients with other granulomatous pulmonary diseases, such as hypersensitivity pneumonitis or vasculitis. No association between different clinical phenotypes and S6K activation can be found in sarcoidosis.
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Affiliation(s)
- Raisa Kraaijvanger
- Interstitial Lung Diseases Centre of Excellence, Department of Pulmonology, St. Antonius Hospital, 3435 CM Nieuwegein, The Netherlands; (R.K.); (E.B.); (J.C.G.)
| | - Kees Seldenrijk
- Interstitial Lung Diseases Centre of Excellence, Pathology DNA, Department of Pathology, St. Antonius Hospital, 3435 CM Nieuwegein, The Netherlands;
| | - Els Beijer
- Interstitial Lung Diseases Centre of Excellence, Department of Pulmonology, St. Antonius Hospital, 3435 CM Nieuwegein, The Netherlands; (R.K.); (E.B.); (J.C.G.)
| | - Jan Damen
- Pathology DNA, Department of Pathology, Jeroen Bosch Hospital, 5223 GZ ’s-Hertogenbosch, The Netherlands;
| | - Jayne Louise Wilson
- Center for Pathobiochemistry and Genetics, Institute of Medical Genetics, Medical University of Vienna, 1090 Vienna, Austria; (J.L.W.); (T.W.)
| | - Thomas Weichhart
- Center for Pathobiochemistry and Genetics, Institute of Medical Genetics, Medical University of Vienna, 1090 Vienna, Austria; (J.L.W.); (T.W.)
| | - Jan C. Grutters
- Interstitial Lung Diseases Centre of Excellence, Department of Pulmonology, St. Antonius Hospital, 3435 CM Nieuwegein, The Netherlands; (R.K.); (E.B.); (J.C.G.)
- Division of Hearth and Lungs, University Medical Centre, 3584 CX Utrecht, The Netherlands
| | - Marcel Veltkamp
- Interstitial Lung Diseases Centre of Excellence, Department of Pulmonology, St. Antonius Hospital, 3435 CM Nieuwegein, The Netherlands; (R.K.); (E.B.); (J.C.G.)
- Division of Hearth and Lungs, University Medical Centre, 3584 CX Utrecht, The Netherlands
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Sathirareuangchai S, Shimizu D, Vierkoetter KR. Pulmonary Lymphangioleiomyomatosis: A Case Report and Literature Review. Hawaii J Health Soc Welf 2020; 79:224-229. [PMID: 32666056 PMCID: PMC7350511] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Pulmonary lymphangioleiomyomatosis (LAM) is a rare lung disease characterized by diffuse cystic changes caused by a destructive proliferation of smooth muscle-like cells or LAM cells. It is a part of the perivascular epithelioid cell family of tumors. LAM may be associated with the genetic disorder tuberous sclerosis complex or may occur sporadically. Individuals affected by LAM are typically females of child-bearing age who present with recurrent spontaneous pneumothorax. The microscopic findings can be subtle and careful examination is needed to identify the neoplastic cells of LAM. Immunohistochemical markers in cases of LAM demonstrate a characteristic co-expression of myogenic and melanocytic markers. We report a case of a 41-year-old woman who presented with multiple episodes of spontaneous pneumothorax and microscopic findings characteristic of LAM.
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Affiliation(s)
- Sakda Sathirareuangchai
- Department of Pathology, John A. Burns School of Medicine, University of Hawai‘i, Honolulu, HI (SS, DS, KRV)
| | - David Shimizu
- Department of Pathology, John A. Burns School of Medicine, University of Hawai‘i, Honolulu, HI (SS, DS, KRV)
- The Queen's Medical Center, Honolulu, HI (DS, KRV)
| | - Koah Robin Vierkoetter
- Department of Pathology, John A. Burns School of Medicine, University of Hawai‘i, Honolulu, HI (SS, DS, KRV)
- The Queen's Medical Center, Honolulu, HI (DS, KRV)
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Lamattina AM, Poli S, Kidambi P, Bagwe S, Courtwright A, Louis PH, Shrestha S, Stump B, Goldberg HJ, Thiele EA, Rosas I, Henske EP, El-Chemaly S. Serum endostatin levels are associated with diffusion capacity and with tuberous sclerosis- associated lymphangioleiomyomatosis. Orphanet J Rare Dis 2019; 14:72. [PMID: 30922357 PMCID: PMC6440133 DOI: 10.1186/s13023-019-1050-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2019] [Accepted: 03/19/2019] [Indexed: 11/24/2022] Open
Abstract
Endostatin is a naturally occurring collagen fragment with anti-angiogenic properties. We investigated the association between serum endostatin levels and DLCO in a cohort of patients with lymphangioleiomyomatosis (LAM). Associations of endostatin levels to clinical features of LAM were explored using logistic regression models. Endostatin levels were associated with DLCO and were higher in subjects with TSC-associated LAM compared to sporadic LAM. These data suggest that endostatin could be a predictive biomarker of decline in DLCO and that germline mutational inactivation of the TSC1 or TSC2 gene is associated with higher endostatin levels. These findings could offer novel insights into the pathogenesis of LAM.
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Affiliation(s)
- Anthony M. Lamattina
- Division of Pulmonary and Critical Care Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA 02115 USA
| | - Sergio Poli
- Division of Pulmonary and Critical Care Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA 02115 USA
| | - Pranav Kidambi
- Division of Pulmonary and Critical Care Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA 02115 USA
| | - Shefali Bagwe
- Division of Pulmonary and Critical Care Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA 02115 USA
| | - Andrew Courtwright
- Division of Pulmonary and Critical Care Medicine, Hospital of the University of Pennsylvania, Philadelphia, PA USA
| | - Pierce H. Louis
- Division of Pulmonary and Critical Care Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA 02115 USA
| | - Shikshya Shrestha
- Division of Pulmonary and Critical Care Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA 02115 USA
| | - Benjamin Stump
- Division of Pulmonary and Critical Care Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA 02115 USA
| | - Hilary J. Goldberg
- Division of Pulmonary and Critical Care Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA 02115 USA
| | - Elizabeth A. Thiele
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA USA
| | - Ivan Rosas
- Division of Pulmonary and Critical Care Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA 02115 USA
| | - Elizabeth P. Henske
- Division of Pulmonary and Critical Care Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA 02115 USA
| | - Souheil El-Chemaly
- Division of Pulmonary and Critical Care Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA 02115 USA
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Belliraj L, Ismaili A, Alaoui A, Harmouchi H, Lakranbi M, Serraj M, Ouadnouni Y, Smahi M. [Sporadic lymphangioleiomyomatosis: A rare cause of bilateral spontaneous pneumothorax in young woman]. Rev Pneumol Clin 2018; 74:497-501. [PMID: 30473222 DOI: 10.1016/j.pneumo.2018.10.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/27/2018] [Revised: 10/16/2018] [Accepted: 10/17/2018] [Indexed: 06/09/2023]
Abstract
Sporadic lymphangioleiomyomatosis is an orphan disease of the young woman. Its clinical manifestations are mainly respiratory, including spontaneous pneumothorax. The management is multidisciplinary. We report the case of a young patient with bilateral spontaneous pneumothorax revealing sporadic lymphangioleiomyomatosis.
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Affiliation(s)
- L Belliraj
- Département de chirurgie thoracique, CHU Hassan II, Fés, Maroc.
| | - A Ismaili
- Département de pneumologie, CHU Hassan II, Fés, Maroc
| | - A Alaoui
- Département de radiologie, CHU Hassan II, Fés, Maroc
| | - H Harmouchi
- Département de chirurgie thoracique, CHU Hassan II, Fés, Maroc
| | - M Lakranbi
- Département de chirurgie thoracique, CHU Hassan II, Fés, Maroc; Faculté de médecine et de pharmacie, université Sidi Mohamed Ben Abdallah, Fés, Maroc
| | - M Serraj
- Département de pneumologie, CHU Hassan II, Fés, Maroc; Faculté de médecine et de pharmacie, université Sidi Mohamed Ben Abdallah, Fés, Maroc
| | - Y Ouadnouni
- Département de chirurgie thoracique, CHU Hassan II, Fés, Maroc; Département de radiologie, CHU Hassan II, Fés, Maroc
| | - M Smahi
- Département de chirurgie thoracique, CHU Hassan II, Fés, Maroc; Faculté de médecine et de pharmacie, université Sidi Mohamed Ben Abdallah, Fés, Maroc
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14
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15
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Weinstock M, Vaidya A, El-Chemaly S, Godleski J, Henske E. The Verge of Collapse. N Engl J Med 2018; 378:e18. [PMID: 29590548 DOI: 10.1056/nejmimc1708586] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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16
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Namba M, Masuda T, Nakamura T, Horimasu Y, Miyamoto S, Nakashima T, Iwamoto H, Fujitaka K, Hamada H, Hattori N. Additional Octreotide Therapy to Sirolimus Achieved a Decrease in Sirolimus-refractory Chylous Effusion Complicated with Lymphangioleiomyomatosis. Intern Med 2017; 56:3327-3331. [PMID: 29021448 PMCID: PMC5790722 DOI: 10.2169/internalmedicine.8645-16] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Recently, sirolimus, an inhibitor of mammalian target of rapamycin, was reported to decrease chylous effusion in patients with lymphangioleimyomatosis (LAM). We herein report a case of a 34-year-old woman with LAM who developed refractory chylothorax and chylous ascites during sirolimus therapy. In this case, to reduce chylous effusion, we administered octreotide, which is often used to control postoperative chylous effusion, in addition to the sirolimus therapy. This combination therapy reduced the chylothorax and chylous ascites. For patients with LAM, octreotide therapy in addition to sirolimus may be effective for treating sirolimus-refractory chylous effusion.
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Affiliation(s)
- Masashi Namba
- Department of Respiratory Internal Medicine, Hiroshima University Hospital, Japan
| | - Takeshi Masuda
- Department of Respiratory Internal Medicine, Hiroshima University Hospital, Japan
| | - Takashi Nakamura
- Postgraduate Medical and Dental Training Center, Hiroshima University Hospital, Japan
| | - Yasushi Horimasu
- Department of Respiratory Internal Medicine, Hiroshima University Hospital, Japan
| | - Shintaro Miyamoto
- Department of Respiratory Internal Medicine, Hiroshima University Hospital, Japan
| | - Taku Nakashima
- Department of Respiratory Internal Medicine, Hiroshima University Hospital, Japan
| | - Hiroshi Iwamoto
- Department of Respiratory Internal Medicine, Hiroshima University Hospital, Japan
| | - Kazunori Fujitaka
- Department of Respiratory Internal Medicine, Hiroshima University Hospital, Japan
| | - Hironobu Hamada
- Department of Respiratory Internal Medicine, Hiroshima University Hospital, Japan
| | - Noboru Hattori
- Department of Respiratory Internal Medicine, Hiroshima University Hospital, Japan
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Nishino K, Yoshimi K, Shibuya T, Hayashi T, Mitani K, Kobayashi E, Ichikawa M, Asao T, Suzuki Y, Sato T, Shiota S, Kodama Y, Takahashi K, Seyama K. Protein-losing Enteropathy Caused by Intestinal or Colonic Lymphangiectasia Complicated by Sporadic Lymphangioleiomyomatosis: A Report of Two Cases. Intern Med 2017; 56:943-948. [PMID: 28420844 PMCID: PMC5465412 DOI: 10.2169/internalmedicine.56.7769] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
This report describes two patients with sporadic lymphangioleiomyomatosis complicated by protein-losing enteropathy (PLE). Imaging studies indicated retroperitoneal lymphangioleiomyomas and abnormalities of the adjacent digestive tract. Endoscopic mucosal biopsy revealed colonic lymphangiectasia in one patient; whereas the site in the other patient was intestinal. Treatment with sirolimus led to the complete resolution of PLE within several months; additionally, marked shrinkage was observed in the lymphangioleiomyomas of both cases. These findings suggest that colonic or intestinal lymphatic congestion due to neighboring lymphangioleiomyomas was the mechanism for the development of PLE. At the time of writing this report, the beneficial effect of sirolimus has lasted for more than 3 years.
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Affiliation(s)
- Koichi Nishino
- Division of Respiratory Medicine, Juntendo University Faculty of Medicine and Graduate School of Medicine, Japan
- The Study Group of Pneumothorax and Cystic Lung Diseases, Japan
| | - Kaku Yoshimi
- Division of Respiratory Medicine, Juntendo University Faculty of Medicine and Graduate School of Medicine, Japan
- The Study Group of Pneumothorax and Cystic Lung Diseases, Japan
| | - Tomoyoshi Shibuya
- Division of Gastroenterology, Juntendo University Faculty of Medicine and Graduate School of Medicine, Japan
| | - Takuo Hayashi
- Division of Human Pathology, Juntendo University Faculty of Medicine and Graduate School of Medicine, Japan
- The Study Group of Pneumothorax and Cystic Lung Diseases, Japan
| | - Keiko Mitani
- Division of Human Pathology, Juntendo University Faculty of Medicine and Graduate School of Medicine, Japan
- The Study Group of Pneumothorax and Cystic Lung Diseases, Japan
| | - Etsuko Kobayashi
- Division of Respiratory Medicine, Juntendo University Faculty of Medicine and Graduate School of Medicine, Japan
- The Study Group of Pneumothorax and Cystic Lung Diseases, Japan
| | - Masako Ichikawa
- Division of Respiratory Medicine, Juntendo University Faculty of Medicine and Graduate School of Medicine, Japan
| | - Tetsuhiko Asao
- Division of Respiratory Medicine, Juntendo University Faculty of Medicine and Graduate School of Medicine, Japan
| | - Yohei Suzuki
- Division of Respiratory Medicine, Juntendo University Faculty of Medicine and Graduate School of Medicine, Japan
| | - Tadashi Sato
- Division of Respiratory Medicine, Juntendo University Faculty of Medicine and Graduate School of Medicine, Japan
| | - Satomi Shiota
- Division of Respiratory Medicine, Juntendo University Faculty of Medicine and Graduate School of Medicine, Japan
| | - Yuzo Kodama
- Division of Respiratory Medicine, Juntendo University Faculty of Medicine and Graduate School of Medicine, Japan
| | - Kazuhisa Takahashi
- Division of Respiratory Medicine, Juntendo University Faculty of Medicine and Graduate School of Medicine, Japan
| | - Kuniaki Seyama
- Division of Respiratory Medicine, Juntendo University Faculty of Medicine and Graduate School of Medicine, Japan
- The Study Group of Pneumothorax and Cystic Lung Diseases, Japan
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Mou Y, Ye L, Wang J, Yee MS, Song YL, Zhu L, Jin ML. Diagnostic and Treatment Monitoring Potential of Serum Vascular Endothelial Growth Factor-D in Lymphangioleiomyomatosis. Lymphology 2016; 49:140-149. [PMID: 29906075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Lymphangioleiomyomatosis (LAM) is a rare multisystem disease occurring almost exclusively in premenopausal women and characterized by cystic lung destruction, abdominal tumors (renal angiomyolipomas (AML)), and involvement of the axial lymphatics (adenopathy, lymphangioleiomyomas). Serum vascular endothelial growth factor-D (VEGF-D), a lymphangiogenic factor, has been recently considered as a novel marker for LAM. Herein we report the diagnostic and differential diagnostic value of serum VEGF-D in LAM patients and evaluate the change of serum VEGF-D levels before and after treatment with sirolimus. The study group included 66 patients with LAM (47 definite LAM and 19 probable LAM based on European Respiratory Society guidelines), 14 patients with other polycystic lung diseases, and 20 healthy female controls. Serum VEGF-D levels were quantified by enzyme-linked immunoassay (ELISA). Serum VEGF-D levels were significantly increased in definite LAM patients compared with healthy controls (3890.3±373.3 pg/ml vs. 413.3±33.2 pg/ml, p<0.05). The optimal cutoff point for LAM diagnosis was 692.5 pg/ml with sensitivity of 97.9% and specificity of 100%. In probable LAM patients, serum VEGF-D levels were all greater than 692.5 pg/ml. Serum VEGF-D levels were significantly increased in definite LAM patients who had chylothorax compared with those without chylothorax (5153.9±598.3 pg/ml vs. 2869.8±372.8 pg/ml, p<0.05). But serum VEGF-D levels in LAM patients with/without pneumothorax, AML, and lymphangioleiomyomas were not significantly changed. Serum VEGF-D levels in definite LAM patients and patients with other cystic lung diseases were 3890.3±373.3 pg/ml and 412.6±27.5 pg/ml, respectively (p <0.05). We determined an optimal cutoff value of 688.5pg/ml, resulting in sensitivity of 97.9% and specificity of 100%. Following a median of 12-month treatment with sirolimus, serum VEGF-D levels decreased from 3135.0±909.4 pg/ml to 1731.8±621.2 pg/ml and symptoms improved. Our study found that serum VEGF-D levels were significantly higher in LAM patients compared with healthy controls and patients with other polycystic lung diseases and that the levels were further increased when complicated by chylothorax. Serum VEGF-D levels may be useful for diagnosis and differential diagnosis with high specificity and sensitivity as well as for following treatment response with sirolimus.
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Nuñez O, Román A, Johnson SR, Inoue Y, Hirose M, Casanova Á, de Garibay GR, Herranz C, Bueno-Moreno G, Boni J, Mateo F, Petit A, Climent F, Soler T, Vidal A, Sánchez-Mut JV, Esteller M, López JI, García N, Gumà A, Ortega R, Plà MJ, Campos M, Ansótegui E, Molina-Molina M, Valenzuela C, Ussetti P, Laporta R, Ancochea J, Xaubet A, Pollán M, Pujana MA. Study of breast cancer incidence in patients of lymphangioleiomyomatosis. Breast Cancer Res Treat 2016; 156:195-201. [PMID: 26951504 PMCID: PMC4788694 DOI: 10.1007/s10549-016-3737-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2016] [Accepted: 02/27/2016] [Indexed: 11/30/2022]
Abstract
Molecular evidence has linked the pathophysiology of lymphangioleiomyomatosis (LAM) to that of metastatic breast cancer. Following on this observation, we assessed the association between LAM and subsequent breast cancer. An epidemiological study was carried out using three LAM country cohorts, from Japan, Spain, and the United Kingdom. The number of incident breast cancer cases observed in these cohorts was compared with the number expected on the basis of the country-specific incidence rates for the period 2000–2014. Immunohistochemical studies and exome sequence analysis were performed in two and one tumors, respectively. All cohorts revealed breast cancer standardized incidence ratios (SIRs) ≥ 2.25. The combined analysis of all cases or restricted to pre-menopausal age groups revealed significantly higher incidence of breast cancer: SIR = 2.81, 95 % confidence interval (CI) = 1.32–5.57, P = 0.009; and SIR = 4.88, 95 % CI = 2.29–9.99, P = 0.0007, respectively. Immunohistochemical analyses showed positivity for known markers of lung metastatic potential. This study suggests the existence of increased breast cancer risk among LAM patients. Prospective studies may be warranted to corroborate this result, which may be particularly relevant for pre-menopausal women with LAM.
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Affiliation(s)
- Olivier Nuñez
- Cancer and Environmental Epidemiology Unit, National Center for Epidemiology, Carlos III Institute of Health, and Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), Sinesio Delgado 6, 28029, Madrid, Spain
| | - Antonio Román
- Lung Transplant Unit, Department of Pulmonology, Lymphangioleiomyomatosis Clinic, Vall d'Hebron University Hospital, 08035, Barcelona, Catalonia, Spain
| | - Simon R Johnson
- National Centre for Lymphangioleiomyomatosis, Nottingham University Hospitals NHS Trust, Nottingham, Nottinghamshire, UK Division of Respiratory Medicine and Respiratory Research Unit, University of Nottingham, Nottingham, NG7 2UH, UK
| | - Yoshikazu Inoue
- National Hospital Organization Kinki-Chuo Chest Medical Center, Sakai, 591-8555, Osaka, Japan
| | - Masaki Hirose
- National Hospital Organization Kinki-Chuo Chest Medical Center, Sakai, 591-8555, Osaka, Japan
| | - Álvaro Casanova
- Department of Pneumology, Henares Hospital, 28882, Madrid, Spain
| | - Gorka Ruiz de Garibay
- ProCURE, Breast Cancer and Systems Biology, Catalan Institute of Oncology (ICO), Bellvitge Institute for Biomedical Research (IDIBELL), Gran via 199, L'Hospitalet del Llobregat, 08908, Barcelona, Catalonia, Spain
| | - Carmen Herranz
- ProCURE, Breast Cancer and Systems Biology, Catalan Institute of Oncology (ICO), Bellvitge Institute for Biomedical Research (IDIBELL), Gran via 199, L'Hospitalet del Llobregat, 08908, Barcelona, Catalonia, Spain
| | - Gema Bueno-Moreno
- Department of Biochemistry, Autonomous University of Madrid (UAM), Biomedical Research Institute "Alberto Sols" (Spanish National Research Council (CSIC)-UAM), Hospital La Paz Institute for Health Research (IdiPAZ), 28029, Madrid, Spain
- MD Anderson International Foundation, 28033, Madrid, Spain
| | - Jacopo Boni
- ProCURE, Breast Cancer and Systems Biology, Catalan Institute of Oncology (ICO), Bellvitge Institute for Biomedical Research (IDIBELL), Gran via 199, L'Hospitalet del Llobregat, 08908, Barcelona, Catalonia, Spain
| | - Francesca Mateo
- ProCURE, Breast Cancer and Systems Biology, Catalan Institute of Oncology (ICO), Bellvitge Institute for Biomedical Research (IDIBELL), Gran via 199, L'Hospitalet del Llobregat, 08908, Barcelona, Catalonia, Spain
| | - Anna Petit
- Department of Pathology, University Hospital of Bellvitge, IDIBELL, L'Hospitalet del Llobregat, 08908, Barcelona, Catalonia, Spain
| | - Fina Climent
- Department of Pathology, University Hospital of Bellvitge, IDIBELL, L'Hospitalet del Llobregat, 08908, Barcelona, Catalonia, Spain
| | - Teresa Soler
- Department of Pathology, University Hospital of Bellvitge, IDIBELL, L'Hospitalet del Llobregat, 08908, Barcelona, Catalonia, Spain
| | - August Vidal
- Department of Pathology, University Hospital of Bellvitge, IDIBELL, L'Hospitalet del Llobregat, 08908, Barcelona, Catalonia, Spain
| | - José Vicente Sánchez-Mut
- Cancer Epigenetics and Biology Program, IDIBELL, L'Hospitalet del Llobregat, 08908, Barcelona, Catalonia, Spain
| | - Manel Esteller
- Cancer Epigenetics and Biology Program, IDIBELL, L'Hospitalet del Llobregat, 08908, Barcelona, Catalonia, Spain
- Department of Physiological Sciences II, School of Medicine, University of Barcelona, 08908, Barcelona, Catalonia, Spain
- Catalan Institution for Research and Advanced Studies (ICREA), 08010, Barcelona, Catalonia, Spain
| | - José Ignacio López
- Cruces University Hospital, BioCruces Research Institute, University of the Basque Country, 48903, Barakaldo, Spain
| | - Nadia García
- ProCURE, Breast Cancer and Systems Biology, Catalan Institute of Oncology (ICO), Bellvitge Institute for Biomedical Research (IDIBELL), Gran via 199, L'Hospitalet del Llobregat, 08908, Barcelona, Catalonia, Spain
| | - Anna Gumà
- Department of Radiology, University Hospital of Bellvitge, IDIBELL, L'Hospitalet del Llobregat, 08908, Barcelona, Catalonia, Spain
| | - Raúl Ortega
- Department of Radiology, University Hospital of Bellvitge, IDIBELL, L'Hospitalet del Llobregat, 08908, Barcelona, Catalonia, Spain
| | - María Jesús Plà
- Breast Cancer Functional Unit, Department of Gynecology, University Hospital of Bellvitge, ICO, IDIBELL, L'Hospitalet del Llobregat, 08908, Barcelona, Catalonia, Spain
| | - Miriam Campos
- Breast Cancer Functional Unit, Department of Medical Oncology, ICO, IDIBELL, L'Hospitalet del Llobregat, 08908, Barcelona, Catalonia, Spain
| | - Emilio Ansótegui
- Lung Transplant and Cystic Fibrosis Unit, Hospital Universitario y Politecnico La Fe, 46026, Valencia, Spain
| | - María Molina-Molina
- Department of Pneumology, University Hospital of Bellvitge, IDIBELL, L'Hospitalet del Llobregat, 08908, Barcelona, Catalonia, Spain
- Consortium for Biomedical Research in Respiratory Diseases (CIBERES), 28029, Madrid, Spain
| | - Claudia Valenzuela
- Department of Pneumology, Instituto de Investigación Sanitaria La Princesa, Hospital La Princesa, 28006, Madrid, Spain
| | - Piedad Ussetti
- Department of Pneumology, University Hospital Clínica Puerta del Hierro, 28222, Madrid, Spain
| | - Rosalía Laporta
- Department of Pneumology, University Hospital Clínica Puerta del Hierro, 28222, Madrid, Spain
| | - Julio Ancochea
- Department of Pneumology, Instituto de Investigación Sanitaria La Princesa, Hospital La Princesa, 28006, Madrid, Spain
| | - Antoni Xaubet
- Consortium for Biomedical Research in Respiratory Diseases (CIBERES), 28029, Madrid, Spain
- Department of Pneumology, Hospital Clinic of Barcelona, August Pi Suñer Biomedical Research Institute (IDIBAPS), 08036, Barcelona, Catalonia, Spain
| | - Marina Pollán
- Cancer and Environmental Epidemiology Unit, National Center for Epidemiology, Carlos III Institute of Health, and Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), Sinesio Delgado 6, 28029, Madrid, Spain.
| | - Miguel Angel Pujana
- ProCURE, Breast Cancer and Systems Biology, Catalan Institute of Oncology (ICO), Bellvitge Institute for Biomedical Research (IDIBELL), Gran via 199, L'Hospitalet del Llobregat, 08908, Barcelona, Catalonia, Spain.
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van Loenhout CJ, den Bakker MA, van Wijsenbeek MS, Hoek RAS, van Hal PTW. [A rare form of obstructive pulmonary disease]. Ned Tijdschr Geneeskd 2016; 160:D757. [PMID: 28074734] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
BACKGROUND Lymphangioleiomyomatosis (LAM) is characterised by progressive dyspnoea, spontaneous pneumothorax and cystic pulmonary destruction. The disease may show similarities with emphysema clinically, radiologically and on lung function tests. CASE DESCRIPTION A 44-year-old woman was referred for lung transplantation because of a 6-year history of dyspnoea and severe obstructive pulmonary function disorder with decreased diffusion capacity. Both her relatively young age and the fact that she had never smoked made us doubt the diagnosis 'COPD'. The pulmonary cysts seen on high-resolution CT (HRCT) suggested LAM. This was confirmed when we revised a pulmonary biopsy that had previously been performed. CONCLUSION CT investigation should be carried out in patients with severe obstructive pulmonary disease without a risk profile appropriate for COPD. Diffuse, homogenous cysts on CT scan can indicate LAM, particularly in women. Conflict of interest and financial support: none declared.
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Sebaaly J, Bowers L, Mazur J, Kotloff R, Olmsted BR, Kaplan A, Strange C. Rapid oral desensitization to sirolimus in a patient with lymphangioleiomyomatosis. J Allergy Clin Immunol Pract 2015; 4:352-3. [PMID: 26725158 DOI: 10.1016/j.jaip.2015.11.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/20/2015] [Revised: 11/04/2015] [Accepted: 11/09/2015] [Indexed: 11/15/2022]
Affiliation(s)
- Jamielynn Sebaaly
- Department of Pharmacy Services, Medical University of South Carolina, Charleston, SC
| | - Laura Bowers
- Eshelman School of Pharmacy, University of North Carolina at Asheville, Asheville, NC
| | - Joe Mazur
- Department of Pharmacy Services, Medical University of South Carolina, Charleston, SC
| | - Rob Kotloff
- Division of Pulmonary Medicine, Cleveland Clinic, Cleveland, Ohio
| | - Blake R Olmsted
- Department of Medicine, Medical University of South Carolina (MUSC), Charleston, SC
| | - Allen Kaplan
- Division of Pulmonary and Critical Care, Allergy and Sleep Medicine, MUSC, Charleston, SC
| | - Charlie Strange
- Division of Pulmonary and Critical Care, Allergy and Sleep Medicine, MUSC, Charleston, SC.
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Taveira-DaSilva AM, Jones AM, Julien-Williams P, Yao J, Stylianou M, Moss J. Severity and outcome of cystic lung disease in women with tuberous sclerosis complex. Eur Respir J 2015; 45:171-80. [PMID: 25537563 PMCID: PMC8356806 DOI: 10.1183/09031936.00088314] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
What are the clinical features, severity, and rate of progression of lung disease in women with tuberous sclerosis and lymphangioleiomyomatosis (LAM) and how do they differ from patients with sporadic LAM? Data from 94 tuberous sclerosis/LAM and 460 sporadic LAM women were compared. 40 tuberous sclerosis/LAM and 40 sporadic LAM patients were age- and lung function-matched, and changes in volume occupied by cysts (cyst score) and pulmonary function occurring over 6.5 years were evaluated. Tuberous sclerosis/LAM patients had better lung function than sporadic LAM patients, but no difference was observed from sporadic LAM patients in yearly rates of change in forced expiratory volume in 1 s (-1.9±2.7 versus -1.9±1.9% predicted; p=0.302), diffusing capacity of the lung for CO (-2.1±2.8 versus -1.9±2.7% predicted; p=0.282) or cyst scores (+1.0±1.3 versus +1.4±1.7%, p=0.213). However, the proportion of patients with abnormal lung function and higher rates of FEV1 decline was greater in sporadic LAM. Some young tuberous sclerosis/LAM patients (mean age 25.7±3 years) progressed rapidly from minimal to severe lung disease. Tuberous sclerosis/LAM patients may experience abrupt declines in lung function. Consequently, women with tuberous sclerosis found to have lung cysts should undergo periodic functional and radiological testing to follow disease progression and determine need for therapy.
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Affiliation(s)
- Angelo M Taveira-DaSilva
- Cardiovascular and Pulmonary Branch, National Institutes of Health Heart, Lung and Blood Institute, National Institutes of Health, Bethesda, MD, USA
| | - Amanda M Jones
- Cardiovascular and Pulmonary Branch, National Institutes of Health Heart, Lung and Blood Institute, National Institutes of Health, Bethesda, MD, USA
| | - Patricia Julien-Williams
- Cardiovascular and Pulmonary Branch, National Institutes of Health Heart, Lung and Blood Institute, National Institutes of Health, Bethesda, MD, USA
| | - Jianhua Yao
- Radiology and Imaging Sciences Department, National Institutes of Health, Bethesda, MD, USA
| | - Mario Stylianou
- Office of Biostatistics Research, National Institutes of Health Heart, Lung and Blood Institute, National Institutes of Health, Bethesda, MD, USA
| | - Joel Moss
- Cardiovascular and Pulmonary Branch, National Institutes of Health Heart, Lung and Blood Institute, National Institutes of Health, Bethesda, MD, USA
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23
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Affiliation(s)
| | | | - C-Y Tu
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, China Medical University Hospital and China Medical University, Taichung, TaiwanDivision of Pulmonary and Critical Care Medicine, Department of Internal Medicine, China Medical University Hospital and China Medical University, Taichung, Taiwan and Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Chu Shang Show Chwan Hospital, Nantou, TaiwanDivision of Pulmonary and Critical Care Medicine, Department of Internal Medicine, China Medical University Hospital and China Medical University, Taichung Taiwan
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24
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Karkera M. Daunting complications of one-lung ventilation: pneumothorax in a patient with lymphangioleiomyomatosis (LAM). J Clin Anesth 2014; 26:243. [PMID: 24793707 DOI: 10.1016/j.jclinane.2013.08.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2013] [Revised: 08/29/2013] [Accepted: 08/30/2013] [Indexed: 11/18/2022]
Affiliation(s)
- Megha Karkera
- Department of Anesthesiology, University of Arkansas for Medical Sciences, Little Rock, AR 72205, USA.
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25
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Affiliation(s)
- İrfan Yavaşoğlu
- Department of Haematology, Adnan Menderes University, School of Medicine, Turkey
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26
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Iablonskiĭ PK, Pichurov AA, Orzheshkovskiĭ OV, Petrun'kin AM, Goncharuk IV. [Features of spontaneous pneumothorax in female]. Vestn Khir Im I I Grek 2014; 173:89-95. [PMID: 25823322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
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27
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Bissler JJ, Kingswood JC, Radzikowska E, Zonnenberg BA, Frost M, Belousova E, Sauter M, Nonomura N, Brakemeier S, de Vries PJ, Whittemore VH, Chen D, Sahmoud T, Shah G, Lincy J, Lebwohl D, Budde K. Everolimus for angiomyolipoma associated with tuberous sclerosis complex or sporadic lymphangioleiomyomatosis (EXIST-2): a multicentre, randomised, double-blind, placebo-controlled trial. Lancet 2013; 381:817-24. [PMID: 23312829 DOI: 10.1016/s0140-6736(12)61767-x] [Citation(s) in RCA: 574] [Impact Index Per Article: 52.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND Angiomyolipomas are slow-growing tumours associated with constitutive activation of mammalian target of rapamycin (mTOR), and are common in patients with tuberous sclerosis complex and sporadic lymphangioleiomyomatosis. The insidious growth of these tumours predisposes patients to serious complications including retroperitoneal haemorrhage and impaired renal function. Everolimus, a rapamycin derivative, inhibits the mTOR pathway by acting on the mTOR complex 1. We compared the angiomyolipoma response rate on everolimus with placebo in patients with tuberous sclerosis or sporadic lymphanioleiomyomatosis-associated angiomyolipomata. METHODS In this double-blind, placebo-controlled, phase 3 trial, patients aged 18 years or older with at least one angiomyolipoma 3 cm or larger in its longest diameter (defined by radiological assessment) and a definite diagnosis of tuberous sclerosis or sporadic lymphangioleiomyomatosis were randomly assigned, in a 2:1 fashion with the use of an interactive web response system, to receive oral everolimus 10 mg per day or placebo. The primary efficacy endpoint was the proportion of patients with confirmed angiomyolipoma response of at least a 50% reduction in total volume of target angiomyolipomas relative to baseline. This study is registered with ClinicalTrials.gov number NCT00790400. RESULTS 118 patients (median age 31·0 years; IQR 18·0–61·0) from 24 centres in 11 countries were randomly assigned to receive everolimus (n=79) or placebo (n=39). At the data cutoff, double-blind treatment was ongoing for 98 patients; two main reasons for discontination were disease progression (nine placebo patients) followed by adverse events (two everolimus patients; four placebo patients). The angiomyolipoma response rate was 42% (33 of 79 [95% CI 31–53%]) for everolimus and 0% (0 of 39 [0–9%]) for placebo (response rate difference 42% [24–58%]; one-sided Cochran-Mantel-Haenszel test p<0·0001). The most common adverse events in the everolimus and placebo groups were stomatitis (48% [38 of 79], 8% [3 of 39], respectively), nasopharyngitis (24% [19 of 79] and 31% [12 of 39]), and acne-like skin lesions (22% [17 of 79] and 5% [2 of 39]). INTERPRETATION Everolimus reduced angiomyolipoma volume with an acceptable safety profile, suggesting it could be a potential treatment for angiomyolipomas associated with tuberous sclerosis. FUNDING Novartis Pharmaceuticals.
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Affiliation(s)
- John J Bissler
- Cincinnati Children’s Hospital Medical Center, Cincinnati, OH 45229-3039, USA.
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28
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Mydłowski T, Radzikowska E, Oniszh K, Szczepulska-Wójcik E, Jaguś P, Wiatr E. [Pneumocystosis in a patient with lymphangioleiomyomatosis]. Pneumonol Alergol Pol 2013; 81:61-67. [PMID: 23258473] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023] Open
Abstract
A 47-year-old, non-smoking woman was admitted to the National Tuberculosis and Lung Diseases Research Institute for diagnosis of progressive exertional dyspnoea and numerous small thin-walled, air-filled cysts equally distributed throughout both lungs revealed in HRCT (high resolution computed tomography) examination. Histological assessment of specimens obtained by open lung biopsy revealed proliferation of immature smooth muscle, showing the expression of the antigen HMB45. On this basis, diagnosis of lymphangioleiomyomatosis was established. The disease caused essential ventilation damage of the lungs (FEV1 1.34 L; 39.71% pred, VC 4.02 L; 94.96% pred, FEV1/ /VC 0.33-4 1.81% pred, DLCO 3.65 mmol/min/Kpa 38.35% pred).During the observation, despite the lack of immunological disorders, the patient developed Pneumocystis jiroveci pneumonia (PCP) that was treated with trimethoprimsulfamethoxazole. Lymphangioleiomyomatosis is a rare disease which results from a defect of TSC genes. The disease is not related to immunological defects or disorders. However, the considerable cystic destruction of the lungs can predispose the patient to opportunistic infections such as the one in the presented case.
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Affiliation(s)
- Tomasz Mydłowski
- II Oddział Chorób Płuc i Alergii Układu Oddechowego, Wojewódzki Zespół Zakładów Opieki Zdrowotnej, Centrum Leczenia Chorób Płuc i Rehabilitacji w Łodzi.
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29
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Richter MJ, Baumgartner R, Leuchte HH. [Chylothorax in an 87-year-old patient]. Internist (Berl) 2012; 54:105-9. [PMID: 23111591 DOI: 10.1007/s00108-012-3158-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
An 87-year-old woman presented with a left-sided pleural effusion. The milky aspirate fulfilled the criteria of a chylothorax. Thorax computed tomography (CT) showed characteristic multiple cysts and consequently the rare diagnosis of post-menopausal pulmonary lymphangioleiomyomatosis was made. In the diagnostic work-up of pleural effusion the determination of triglycerides should be considered to confirm the diagnosis of chylothorax. In the presence of a chylothorax the differential diagnosis of lymphangioleiomyomatosis should be included even in advanced age.
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Affiliation(s)
- M J Richter
- Abteilung für Pneumologie, Medizinische Klinik II, Krankenhaus Neuwittelsbach, München, Deutschland
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30
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Khajotia R, Raman S. Bilateral spontaneous persistent open pneumothorax with chylothorax. Can Fam Physician 2012; 58:757-760. [PMID: 22859639 PMCID: PMC3395515] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Affiliation(s)
- Rumi Khajotia
- International Medical University Clinical School, Department of Internal Medicine and Pulmonology, Jalan Rasah, Seremban, Negeri Sembilan 70300, Malaysia.
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31
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Duzhyĭ ID, Golubnychyĭ SO, Reshtanenko VA. [Lymphangioleiomyomatosis of lungs and spontaneous pneumochylothorax]. Lik Sprava 2012:112-116. [PMID: 23035610] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Lymphangioleiomyomatosis occupies a special place among rare systemic diseases of lungs, which are manifested by respiratory failure and the gradual development of pulmonary heart. Manifestations of the pleural cavity in the form of pneumothorax and pleural effusion syndrome are characteristic for the disease. In order to verify the process, the authors recommend a study of pleural punctate with Sudan-III for detection of lymph and a CT-scanning after removal of the contents of the pleural cavity. "Cell" pattern of lungs in combination with chylothorax confirm the diagnosis of lymphangioleiomyomatosis. In particularly complex cases, in their opinion, the lung and pleura biopsy is required.
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32
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Faehling M, Frohnmayer S, Leschke M, Trinajstic-Schulz B, Weber J, Liewald F. Successful pregnancy complicated by persistent pneumothorax in a patient with lymphangioleiomyomatosis (LAM) on sirolimus. Sarcoidosis Vasc Diffuse Lung Dis 2011; 28:153-155. [PMID: 22117507] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
We report a successful pregnancy in a patient with longstanding LAM on treatment with sirolimus. During temporary discontinuation fo sirolimus in early pregnancy, lung function declined but recovered after resumption of sirolimus. Pregnancy was complicated by a persistent pneumothorax which was treated surgically postnatally. The child has had a normal development despite exposure to low dose sirolimus intermittently during early embryonal and mid-fetal life.
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Affiliation(s)
- M Faehling
- Klinik für Kardiologie und Pneumologie, Klinikum Esslingen, Esslingen; 2Lungenfacharztpraxis, Esslingen.
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33
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Ishitobi F, Fukuma A, Shibata H, Nagai A. [Case of tuberous sclerosis complex with pulmonary lymphangioleiomyomatosis and angiomyolipomas of the liver and kidney]. Rinsho Byori 2011; 59:571-576. [PMID: 21815479] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
A 17-year-old woman, who complained of left abdominal pain, was diagnosed as left renal bleeding by ultrasonography at emergency room in Shimane University Hospital. Further ultrasonography revealed numberless round-shaped hyperechoic liver nodules (maximum 16 mm in a diameter) and dissemination of the same type of nodules in both kidneys, which was characterized as angiomyolipomas. The lesions were also detected by abdominal CT and MRI. In addition, the findings of tuberous calcification of the cerebral ventricles and parenchyma, facial angiofibromas and shagreen patches led to the diagnosis of tuberous sclerosis complex. Since two years later, she had recurrent attacks of spontaneous pneumothorax. The histopathological examination found out lymphangioleiomyomatosis from the biopsied lung tissues. Although she became pregnant, she selected a therapeutic abortion due to the high risk for renal failure which would be induced by pressure of the grown uterine. Abdominal ultrasonography was very useful for diagnosis in this case.
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Affiliation(s)
- Fuminori Ishitobi
- Central Clinical Laboratory, Shimane University Hospital, Izumo 693-8501, Japan.
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34
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Baldi BG, Pimenta SP, Kawassaki ADM, Bernardi FDC, Dolhnikoff M, Carvalho CRR. Pulmonary arterial involvement leading to alveolar hemorrhage in lymphangioleiomyomatosis. Clinics (Sao Paulo) 2011; 66:1301-3. [PMID: 21876992 PMCID: PMC3148482 DOI: 10.1590/s1807-59322011000700031] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Affiliation(s)
- Bruno Guedes Baldi
- Pulmonary Division, Heart Institute (InCor), University of Sao Paulo Medical School, Sao Paulo, Brazil.
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35
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Lewandowska K, Oniszh K, Augustynowicz-Kopeć E, Radwan-Röhrenschef P, Kuś J. [Bacteriologically confirmed pulmonary tuberculosis in a patient with lymphangioleiomyomatosis accompanying tuberous sclerosis syndrome]. Pneumonol Alergol Pol 2011; 79:309-314. [PMID: 21678282] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2023] Open
Abstract
Lymphangioleiomyomatosis (LAM) is a rare disease of unknown origin, that may be sporadic or develop in the course of tuberous sclerosis (TS). Patients do not present immune deficiency, but structural changes in the lung parenchyma (cysts) may encourage various infections, for example tuberculosis. Radiologic findings are often difficult to interpret, because of changes related to LAM itself. We present a young women with a history of TS and LAM, in whom protracting respiratory tract infection was finally diagnosed as tuberculosis. Initial diagnosis was based primarily on clinical signs and symptoms and treatment was started despite the negative result of the sputum microscopy for acid fast bacilli. In the course of treatment the diagnosis was supported by positive tuberculin skin test, interferon-gamma release assay and genetic test for M. tuberculosis in bronchoalveolar lavage fluid, and finally, positive sputum culture in liquid medium.
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36
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Noda M, Okada Y, Maeda S, Sado T, Sakurada A, Hoshikawa Y, Endo C, Kondo T. An experience with the modified total pleural covering technique in a patient with bilateral intractable pneumothorax secondary to lymphangioleiomyomatosis. Ann Thorac Cardiovasc Surg 2010; 16:439-441. [PMID: 21263428] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2009] [Accepted: 08/31/2009] [Indexed: 05/30/2023] Open
Abstract
We present a case of bilateral intractable pneumothorax associated with a modified form of lymphangioleiomyomatosis (LAM), successfully treated with a previously reported surgical procedure, the total pleural covering (TPC) technique, under video-assisted thoracic surgery. The patient was a 28-year-old woman with bilateral pneumothorax secondary to LAM who had undergone thoracoscopic surgery in another hospital. We performed bilateral TPC modified with a preceding coverage of air leak points with polyglycolic acid sheets for reinforcement. Although a minor air leak after the surgery necessitated a mild pleurodesis on the right side, the bilateral pneumothorax was well controlled, and no recurrence has been observed for 9 months. We believe that TPC is a safe and reliable procedure for the management of intractable pneumothorax secondary to LAM. It also has the potential to reduce risk of excessive bleeding in lung transplantation.
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Affiliation(s)
- Masafumi Noda
- Department of Thoracic Surgery, Institute of Development, Aging, and Cancer, Tohoku University, Sendai, Japan
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37
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Johnston CR, O'Donnell ME, Sayed Ahmed WA, Hunter A, Graham AN. Bilateral pneumothorax in pregnancy unmasking lymphangioleiomyomatosis. Ir J Med Sci 2010; 180:933-4. [PMID: 21076889 DOI: 10.1007/s11845-010-0628-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2010] [Accepted: 10/19/2010] [Indexed: 11/28/2022]
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38
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Kelly E, Mhurchu EN, Sukor S, McDonnell TJ, Tryfonopoulos D, Keane MP. Chemotherapy-associated recurrent pneumothoraces in lymphangioleiomyomatosis. Respir Care 2010; 55:1491-1494. [PMID: 20979677] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
Lymphangioleiomyomatosis is a rare cause of pneumothorax in women. We present the case of a 48-year-old woman with lymphangioleiomyomatosis, who had never had a pneumothorax prior to commencing chemotherapy for breast cancer. During chemotherapy she developed 3 pneumothoraces and 2 episodes of pneumomediastinum. We suggest that the pneumothoraces were caused by the chemotherapy. To our knowledge, this is the first reported case of chemotherapy triggering pneumothoraces in a woman with lymphangioleiomyomatosis.
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Affiliation(s)
- Emer Kelly
- Department of Medicine and Therapeutics, University College Dublin, St Vincent's University Hospital, Elm Park, Dublin 4, Ireland.
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39
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Terasaki Y, Yahiro K, Pacheco-Rodriguez G, Steagall WK, Stylianou MP, Evans JF, Walker AM, Moss J. Effects of prolactin on TSC2-null Eker rat cells and in pulmonary lymphangioleiomyomatosis. Am J Respir Crit Care Med 2010; 182:531-9. [PMID: 20413627 PMCID: PMC2937243 DOI: 10.1164/rccm.200911-1737oc] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
RATIONALE Lymphangioleiomyomatosis, a cystic lung disease of women, is characterized by proliferation of smooth muscle-like lymphangioleiomyomatosis cells, which possess mutations in the tuberous sclerosis complex genes, TSC1/TSC2. Growth factors involved in lymphangioleiomyomatosis cell proliferation are unknown. Prolactin, an important reproductive hormone in women, is known to promote cell proliferation and survival in other tissues. OBJECTIVES To determine the role of prolactin in signaling and proliferation in lymphangioleiomyomatosis. METHODS Prolactin levels in the sera of patients with lymphangioleiomyomatosis were correlated with clinical status. Components of prolactin signal transduction pathways were assessed in lymphangioleiomyomatosis lesions from human lung explants by real-time reverse transcription-polymerase chain reaction (RT-PCR) and immunohistochemistry. Prolactin effects on proliferation and signaling were quantified in tuberin-deficient and tuberin-expressing rat cells in vitro. MEASUREMENTS AND MAIN RESULTS Higher prolactin levels in the sera of patients with lymphangioleiomyomatosis were associated with a faster rate of decline in FEV(1) and an increased history of pneumothorax (P < 0.01). Higher levels of prolactin and prolactin receptor mRNA and immunoreactivity were found in lymphangioleiomyomatosis lesions when compared with vascular smooth muscle cells in the same region of tissue. This was accompanied by evidence of activation of signal transducer and activator of transcription-1 (STAT1), STAT3, p44/42, and p38 mitogen-activated protein kinase. Tsc2(-/-) Eker rat embryonic fibroblasts expressed more prolactin receptor than did Tsc2(+/+) cells, and responded to prolactin with increased proliferation and activation of the same signaling pathways seen in vivo. CONCLUSIONS Prolactin may be an important growth factor in the pathogenesis of lymphangioleiomyomatosis.
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Affiliation(s)
- Yasuhiro Terasaki
- Translational Medicine Branch, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD 20892-1590, USA
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40
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Takagi Y, Sato T, Morio Y, Kumasaka T, Mitani K, Miyamoto H, Iwakami SI, Kodama Y, Onuma E, Seyama K, Takahashi K. A pleuro-peritoneal communication through the diaphragm affected with lymphangioleiomyomatosis. Intern Med 2010; 49:439-45. [PMID: 20190480 DOI: 10.2169/internalmedicine.49.2714] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
A 30-year-old Japanese woman with lymphangioleiomyomatosis (LAM) developed a left chylothorax and chylous ascites. A pleuro-peritoneal communication was confirmed by a scintigram with (99)mTc-labeled macroaggregated-albumin injected into the peritoneal cavity. Video-assisted thoracic surgery revealed a protruding papillary lesion on the left diaphragm. Chyle was oozing into the pleural cavity through this lesion. Histopathological analyses demonstrated that the protrusion was a diaphragmatic LAM lesion and that LAM-associated lymphangiogenesis enabled communication between the pleural and peritoneal cavities through lymphatic vessels. This case demonstrated a new mechanism for chylous pleural effusion in LAM and illustrates the significance of LAM-associated lymphangiogenesis.
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Affiliation(s)
- Yumiko Takagi
- Department of Respiratory Medicine, Juntendo University School of Medicine, Tokyo
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41
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Silva O R, Puelma C F, Retamal P V, Rojas Sm P, Cruzat C C, Reyes G C. [Pulmonary lymphangioleiomyomatosis: report of one case]. Rev Med Chil 2009; 137:1474-1477. [PMID: 20098807] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
Lymphangioleiomyomatosis (LAM) is a rare interstitial lung disease, of unknown etiology, affecting almost exclusively women. Microscopically LAM consists of a diffuse proliferation of smooth muscle cells. LAM can occur without evidence of other diseases (sporadic LAM) or in conjunction with tuberous sclerosis complex (TSC). It presents with progressive breathlessness or with recurrent pneumothorax or chylothorax. We report a 33 year-old woman with a history of recurrent pneumothorax. Computed tomography (CT) scans showed numerous thin-walled cysts throughout the lungs, a characteristic finding in LAM. A pulmonary biopsy was compatible with the diagnosis and HMB-45 monoclonal antibodies were positive. Treatment with Sirolimus was started).
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Affiliation(s)
- Rafael Silva O
- Unidad de Enfermedades Respiratorias, Hospital Regional de Talca, Chile.
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42
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De Rosa N. Pulmonary lymphangioleiomyomatosis in tuberous sclerosis. A case report. Pathologica 2009; 101:186-189. [PMID: 20218060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2023] Open
Abstract
Pulmonary lymphangioleiomyomatosis (PLAM) is a rare disease that exclusively affects young women of reproductive age. It is characterized by widespread pulmonary proliferation of abnormal, "immature smooth muscle cells (lam cells) leading to cystic destruction of the lung parenchyma. Lam occurs frequently in the thoracic duct and in axial lymph nodes, mediastinal or retroperitoneal. It can occur either in association with tuberous sclerosis complex (TSC-LAM) or without TSC (sporadic LAM). A case of TSC-LAM is reported, and the histogenesis and the role of lymphangiogenesis in the progression of disease is discussed.
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Affiliation(s)
- N De Rosa
- U.O.C. di Anatomia Patologica, A.O.R.N. Monaldi, Naples, Italy.
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Cleary-Goldman J, Sanghvi AV, Nakhuda GS, Robinson JN. Conservative management of pulmonary lymphangioleiomyomatosis and tuberous sclerosis complicated by renal angiomyolipomas in pregnancy. J Matern Fetal Neonatal Med 2009; 15:132-4. [PMID: 15209123 DOI: 10.1080/14767050410001659879] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Both pulmonary lymphangioleiomyomatosis and tuberous sclerosis are rare diseases. The optimal management in pregnancy is unclear. A primigravida with pulmonary lymphangioleiomyomatosis and tuberous sclerosis complicated by worsening renal function secondary to angiomyolipomas was managed conservatively. Favorable maternal and neonatal outcomes were achieved. Pulmonary lymphangioleiomyomatosis is a consideration in tuberous sclerosis patients with respiratory symptoms. Tuberous sclerosis patients with pulmonary lymphangioleiomyomatosis require cautious and calculated expectant management in an effort to avoid adverse outcomes.
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Affiliation(s)
- J Cleary-Goldman
- Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, Columbia Presbyterian Medical Center, New York, New York, USA
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Mitani K, Kumasaka T, Takemura H, Hayashi T, Gunji Y, Kunogi M, Akiyoshi T, Takahashi K, Suda K, Seyama K. Cytologic, immunocytochemical and ultrastructural characterization of lymphangioleiomyomatosis cell clusters in chylous effusions of patients with lymphangioleiomyomatosis. Acta Cytol 2009; 53:402-9. [PMID: 19697724 DOI: 10.1159/000325340] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To establish the cytologic and immunocytochemical features of lymphangioleiomyomatosis (LAM) cell clusters (LCCs) and to clarify its diagnostic significance for LAM. STUDY DESIGN We evaluated 17 samples of LAM-associated chylous effisions from 13 patients with LAM. We performed Papanicolaou staining and immunocytochemistry for muscular antigens, melanoma-related antigens, female 'hormone receptors and markers for lymphatic endothelial cells (LECs). RESULTS The cytologic features of LCCs were a well-organized, globular cluster consisting of LAM cells enveloped by LECs. The LAM cells were observed to form a tightly cohesive core and had a moderate nuclear/cytoplasmic ratio. These are distinct characteristics from cancer cell clusters. Immunocytochemical examinations revealed the LAM cells to be positive for muscular antigens, melanoma-related antigens and progesterone receptor, but only 2 of 7 specimens were positive for estrogen receptor. The surface monolayer cells were confirmed to be immunopositive for various LEC markers. Ultrastructural study confirmed that LCCs were covered by LECs. CONCLUSION LCCs were detected in all LAM-associated chylous effusion samples. The cytologic and immunocytochemical examinations of chylous effusions are thus considered to have diagnostic significance for LAM that may therefore enable patients to avoid undergoing such invasive tests as lung biopsies.
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Affiliation(s)
- Keiko Mitani
- Department of Human Pathology, School of Medicine, Juntendo University, and Division of Clinical Laboratory, Juntendo University Hospital, Tokyo, Japan
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Mikkelsen CS, Mikkelsen DB, Madsen HD, Andersen PE, Ravn P, Bygum A. Lymphangioleiomyomatosis in a patient with tuberous sclerosis and dysregulated diabetes mellitus. Acta Derm Venereol 2009; 89:218-9. [PMID: 19326026 DOI: 10.2340/00015555-0621] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Takahashi K, Yano Y, Miyata Y, Terai T. [Anesthetic management of a patient with pulmonary tuberous sclerosis complicated with renal angiomyolipoma]. Masui 2009; 58:641-644. [PMID: 19462808] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
A 55-year-old woman underwent total hysterectomy. She suffered from tuberous sclerosis and was complicated with lymphangioleiomyomatosis and renal angiomyolipoma. There have been only a few reports of anesthetic management on patients with these three diseases. Anesthesia was maintained with combined spinal-epidural anesthesia. Patients with tuberous sclerosis should be examined precisely. This case was managed carefully to avoid pneumothorax and acute bleeding from renal angiomyolipoma. There was no postoperative anesthesia-related complications.
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Affiliation(s)
- Kayoko Takahashi
- Department of Anesthesiology, Osaka Rosai Hospital, Osaka 591-8025
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Higa F, Uchihara T, Haranaga S, Yara S, Tateyama M, Oshiro Y, Shiraishi M, Kumasaka T, Seyama K, Fujita J. Malignant epithelioid angiomyolipoma in the kidney and liver of a patient with pulmonary lymphangioleiomyomatosis: lack of response to sirolimus. Intern Med 2009; 48:1821-5. [PMID: 19834275 DOI: 10.2169/internalmedicine.48.2411] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
A 26-year-old woman with lymphangioleiomyomatosis (LAM) was hospitalized for the surgical excision of a giant abdominal tumor of right kidney origin. The pathological diagnosis of the tumor was conventional angiomyolipoma (AML). After 8 months, 2 liver tumors appeared and grew rapidly. The tumors were resected, and the pathological finding of these tumors was epithelioid AML. Thereafter, metastatic multiple lung tumors appeared, and there was local recurrence of the liver tumors. Sirolimus, an mTOR protein inhibitor, was used to treat epithelioid AML. However, the drug did not inhibit the rapid growth of the tumor at all. This finding suggests that sirolimus might not be effective against epithelioid AML, and in such cases, complete surgical resection should be the treatment of choice.
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Affiliation(s)
- Futoshi Higa
- Department of Medicine and Therapeutics, Prevention, Control of Infectious Diseases, School of Medicine, University of the Ryukyus, Okinawa.
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48
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Cho SY, Kim KH, Jeon WJ. Caesarean delivery under general anaesthesia for a woman with undiagnosed tuberous sclerosis complex and lymphangioleiomyomatosis. Anaesth Intensive Care 2009; 37:142-143. [PMID: 19157370] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
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49
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Kinoshita A, Odagi I, Aoki Y, Hirohama K, Ishiguro H, Nikami T, Tamaki S, Searashi Y, Sudou S, Hokari A, Ishikawa T, Negishi M, Nishino H, Tajiri H, Ikegami M. [Case of lymphangioleiomyomatosis associated with protein-losing gastroenteropathy]. Nihon Shokakibyo Gakkai Zasshi 2008; 105:1775-1780. [PMID: 19057163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
A 29-year-old woman was referred to our hospital for the intensive examination of leg edema and hypoproteinemia. CT scan of showed multiple thin-walled cysts in both lungs, suggesting lymphangioleiomyomatosis. CT scan of the abdomen, lymphoscintigraphy showed enlarged abdominal lymph nodes. Protein loss from the gastrointestinal tract was documented by measurement of the clearance of alpha-1 antitrypsin from the plasma using a 72 h stool collection and (99m)Tc human serum albumin scintigraphy. We thought that secondary lymphangiectasia with lymphangioleiomyomatosis caused protein-losing gastroenteropathy. Dietary therapy resulted in symptomatic improvement.
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Affiliation(s)
- Akiyoshi Kinoshita
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, The Jikei University School of Medicine
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Wataya-Kaneda M, Katayama I. Dissociate expression of tuberous sclerosis complex 1 product hamartin in a skin and pulmonary lesion of a tuberous sclerosis complex. Hum Pathol 2008; 40:430-4. [PMID: 18835623 DOI: 10.1016/j.humpath.2008.06.026] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2008] [Revised: 05/07/2008] [Accepted: 06/23/2008] [Indexed: 11/17/2022]
Abstract
Tuberous sclerosis complex is a multisystemic disorder characterized by systemic hamartomas. Tuberous sclerosis complex is caused by the mutation of tumor suppressor genes tuberous sclerosis complex 1 or tuberous sclerosis complex 2. Tuberous sclerosis complex tumorigenesis is not always accompanied by loss of heterozygosity. The incidence of loss of heterozygosity is varied among the organs in which hamartomas occur. We report a 25-year-old woman diagnosed with tuberous sclerosis complex with lymphangiomyomatosis. Expression of tuberin and hamartin was examined in lung and skin specimens. Her skin lesion (angiofibroma) expressed both hamartin and tuberin, but her pulmonary lesion did not express hamartin. This suggests that different mechanisms of tumorigenesis may occur in pulmonary and skin lesions.
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Affiliation(s)
- Mari Wataya-Kaneda
- Department of Dermatology, Osaka University Graduate School of Medicine, Suita-shi, Osaka 565-0871, Japan.
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