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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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2
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Abstract
BACKGROUND Filarial worms lodge anywhere, from body fluids to subcutaneous tissue, as various case reports prove. CASE A 21-year-old Nepali male presented with bilateral groin swellings. Imaging studies showed dilated retroperitoneal lymphatics forming a mass, suggestive of lymphangioma or lymphangioleiomyoma. Fine needle aspiration (FNA) of the retroperitoneal mass revealed microfilariae of Wuchereria bancrofti. CONCLUSION This is the first reported case of retroperitoneal filarial lymphangiectasia diagnosed on FNA, thus stressing the importance of FNA as a simple yet effective diagnostic tool.
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Affiliation(s)
- Issam Al Bozom
- Department of Surgical Pathology, Hamad Medical Corporation, Doha, Qatar
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3
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Saleh Gargari S, Hantoushzadae S, Mohamadi F, Jafar-Abadi M. Pregnancy complicated by lymphangioleiomyomatosis. Arch Iran Med 2009; 12:182-185. [PMID: 19249892] [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
Lymphangioleiomyomatosis, a multisystem disease characterized by cystic lung lesions can result in respiratory failure and is considered to be sex hormones related. No effective treatment for lymphangioleiomyomatosis is currently available. We report a 35-year-old patient in her second pregnancy. She also had experienced five episodes of spontaneous pneumothorax at the age of 30. Despite excessive estrogen production during pregnancy she had mild non-progressive exertional dyspnea without limitation of daily activities during pregnancy without deterioration of respiratory status.
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Affiliation(s)
- Soraya Saleh Gargari
- Feto-Maternal Unit, Mahdyeh Hospital, Shaheed Beheshti University of Medical Sciences, Tehran, Iran.
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4
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Bramer S, van Beek MWPM, Nieuwenhuijzen GAP, Daniëls-Gooszen AW, van den Borne BEEM, de Hingh IHJT. [Acute abdominal pain and fever in a young woman as the first symptoms of lymphangioleiomyomatosis]. Ned Tijdschr Geneeskd 2008; 152:33-37. [PMID: 18240760] [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: 05/25/2023]
Abstract
A previously healthy 28-year-old woman presented to the emergency clinic with acute severe abdominal pain and high fever. A diagnostic laparoscopy was performed, during which a large retroperitoneal tumour was found. A CT-scan of the abdomen and thorax confirmed the presence of a retroperitoneal mass but also revealed multiple renal angiomyolipomas and extensive cystic lesions in all lung fields. Based on these findings, the diagnosis lymphangioleiomyomatosis (LAM) was suspected, and later confirmed by histological examination of a biopsy specimen. The acute abdomen and fever appeared to have been caused by a Streptococcus agalactiae infection of the retroperitoneal lymphangiomyoma, which was treated with intravenous antibiotics. LAM is a very rare disease affecting mostly women of childbearing age and presenting almost exclusively with pulmonary symptoms. This is the first description of LAM presenting with an acute surgical abdomen and fever due to infection of a lymphangiomyoma.
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Affiliation(s)
- S Bramer
- Afd. Algemene Heelkunde, Catharina-ziekenhuis, Michelangelolaan 2, 5623 EJ Eindhoven
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5
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Abstract
Lymphangioleiomyomatosis is a rare disease that affects females of reproductive age. Microscopically, it is characterized by abnormal proliferation of immature smooth muscle-like cells that grow diffusely in the lung. Extrapulmonary manifestations in the mediastinum, peritoneum and pelvic lymph nodes are uncommon. We here describe a patient who initially presented with pulmonary lymphangioleiomyomatosis and subsequently developed a localized retroperitoneal mass. Pathologic examination showed that the mass was a lymphangioleiomyoma. The result of the immunohistochemical study was the same as that for the pulmonary lesion. It is therefore suggested that metastatic lymphangioleiomyoma should be included in the differential diagnosis in the patient with pulmonary lymphangioleiomyomatosis presenting with an extrapulmonary lesion.
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Affiliation(s)
- Hui-Chun Tai
- Department of Pathology, Changhua Christian Hospital, Changhua, Taiwan
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6
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Abstract
BACKGROUND Lymphangioleiomyomas are lymphatic masses that can be associated with lymphangioleiomyomatosis. They are usually associated with pulmonary involvement. CASE A 44-year-old premenopausal woman with breast cancer treated with adjuvant tamoxifen presented with abdominal distension. A thoraco-abdominopelvic enhanced computed tomography scan showed a 22 x 21 x 12 cm well-encapsulated, complex pelvic mass. An ovarian cystadenocarcinoma was suspected. Surgery revealed a retroperitoneal mass that was removed with uterus and both adnexae. Histological and immunohistochemical studies diagnosed a lymphangioleiomyoma. Estrogen and progesterone receptors were positive on smooth muscle cells and human melanoma black 45 was negative. CONCLUSION Isolated retroperitoneal lymphangioleiomyoma is rare and difficult to detect in the absence of pulmonary lymphangioleiomyomatosis. We speculate that tamoxifen treatment may play a role in the development of this benign tumor.
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Affiliation(s)
- David Atallah
- Department of Obstetrics and Gynecology, Hôtel Dieu de France, Beirut, Lebanon.
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7
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Słodkowska J, Patera J, Breborowicz J, Jarzemska A, Korzeniewska-Kosela M, Siemiatkowska K, Radzikowska E, Przybylski G, Kozłowski W. Extrapulmonary lymphangioleiomyomatosis presented as the asymptomatic retroperitoneal tumours--two cases report. POL J PATHOL 2006; 57:205-7. [PMID: 17285764] [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: 05/13/2023] Open
Abstract
Lymphangioleiomyomatosis [LAM] is a rare lung disease affecting women and characterized by abnormal smooth muscle cells (LAM cells) proliferation along lung and lymphatic channels. The frequent occurrence of extrapulmonary LAM [e-LAM] has been reported as abdomen pelvic lymph nodes involvement, angiomyolipomas, lymphangioleiomyomas or lymphangiomas in LAM patients. An extrapulmonary manifestation as the initial LAM presentation preceding pulmonary disorders and as asymptomatic extrapulmonary LAM lesions are unusual. We report two women presented with asymptomatic retroperitoneal cystic masses accidentally found on ultrasound examination. The tumours were surgically removed and diagnosed as: 1-malignant mesothelioma and 2-tymphangiomyoma. The microscopical sections were reviewed and re-diagnosed as e-LAM at advanced pulmonary LAM development. Mesotheliosis present in e-LAM morphology is unique and was misleading for malignancy diagnosis. The second case illustrates the hormone dependent growth of lymphangiomyoma and LAM development in young women. It is difficult to prove the presence of pulmonary LAM at the time of tumours excision but both cases demonstrate importance of appropriate LAM diagnosis and being aware of such diagnosis in cases presenting with extrapulmonary extension of the disease.
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Affiliation(s)
- Janina Słodkowska
- Department of Telepathology, National Institute of Tuberculosis and Lung Diseases, Warszawa.
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8
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Chen DC, Chen CH, Su HY, Yu CP, Yu MH. Retroperitoneal lymphangiomyomas presenting as a pelvic mass. Acta Obstet Gynecol Scand 2005; 84:917-20. [PMID: 16097988 DOI: 10.1111/j.0001-6349.2005.0414b.x] [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: 11/30/2022]
Affiliation(s)
- Da-Chung Chen
- Department of Obstetrics and Gynecology, Tri-Service General Hospital, National Defense Medical Center, #325 Section 2 Cheng-Kung Road, Nei-Hu, Taipei 114, Taiwan, ROC.
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9
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Affiliation(s)
- Edward W Cowen
- Dermatology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD 20892, USA.
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10
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Ammar Boukhris A, Sellami Kamoun N, Rammah S, Sassi S, Kilani T, Ben Miled M'rad K, Mathlouthi A, Ben Romdhane K, El Mezni F. [Comments on a case of generalized lymphangioleiomyomatosis starting in the mediastinum]. Rev Pneumol Clin 2001; 57:49-50. [PMID: 11373605] [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: 05/23/2023]
Affiliation(s)
- A Ammar Boukhris
- Service d'anatomie et de cytologie pathologiques, Hôpital Abderrahmane Mami Ariana, Tunis
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11
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Affiliation(s)
- M J Weinans
- Department of Obstetrics and Gynaecology, University Hospital Groningen, The Netherlands
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12
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Abstract
Lymphangiomas and lymphangiomyomas are benign abnormal collections of lymphatic vessels which form a cystic mass. The mediastinum is an uncommon location for these hamartomas in children, but may be life-threatening. We report herein the case of a 23-month-old boy who presented with stridor and a history of recurrent respiratory tract infections. Soon after his admission he suddenly developed respiratory failure and was found to have a multiloculated, cystic mediastinal mass which was initially thought to be a lymphangioma. The mass was extensively infiltrative, and histological examination showed prominent smooth muscle proliferation in the walls of the cysts, confirming a diagnosis of lymphangiomyoma. The terminology and relevant literature on the topic are reviewed following the presentation of this case.
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Affiliation(s)
- R Kataria
- Department of Pediatric Surgery, All India Institute of Medical Sciences, New Delhi
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13
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De Praeter G, Schoonjans R, Duyck P, Kunnen M. Retroperitoneal lymphangioleiomyomatosis. J Belge Radiol 1998; 81:237. [PMID: 9880962] [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: 02/09/2023]
Affiliation(s)
- G De Praeter
- Department of Radiology, University Hospital Ghent, Belgium
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14
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Abstract
Four cases with native pulmonary muscular proliferation (NPMP) are reported. The etiology of this rare condition is unknown. A hamartomatous process is discussed. In spite of its rarity the correct diagnosis of this condition is important. Both clinically and histologically in transbronchial biopsies, NPMP may be mistaken for pulmonary lymphangioleiomyomatosis (PLAM). Distinction of these 2 conditions is adamant, as PLAM has a poor prognosis, and, moreover may be associated with general disease, as with tuberous sclerosis. Whereas the typical distribution of more mature desmin positive muscle cells in a dense center core and more immature desmin negative radiating peripheral muscle cell proliferation with fascicular pattern in NPMP may be recognized in open lung biopsy, these differences may not become evident in small transbronchial biopsies. Immunohistochemical methods play an important role in the differential diagnosis--as with PLAM estrogen and progesterone receptors may be expressed and, most importantly, the reaction of the HMB45-antibody appears consistently positive in muscle cells of PLAM, while negative with NPMP. Thus, recognition of this clinically innocent disease is also possible in small tissue particles.
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Affiliation(s)
- W Wöckel
- Pathologisches Institut, Zentralkrankenhauses Gauting der LVA Oberbayern, Germany
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15
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Abstract
Lymphangiomyomatosis (LAM) is a benign tumor-like lesion of lymphatic vessels with unknown etiology. 80 cases of LAM are presently described. So far, it appears that only women in their reproductive years seem to be affected. Here, we describe the first LAM in an 11-months-old infant with a presumably local form of LAM. This leads us to consider the possibility that this tumor-like lesion may originate from a hamartomateous malformation. The diagnosis is based on pre-operative sonography and CT, as well as on histological and immunohistochemical examination of the tumor.
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Affiliation(s)
- J Fuchs
- Department of Pediatric Surgery, Hannover Medical School, Germany
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16
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Behr J, Haberl K, Blumenstein M. [37-year-old patient with progressive dyspnea after spontaneous pneumothorax]. Internist (Berl) 1997; 38:73-6. [PMID: 9119662] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Affiliation(s)
- J Behr
- Medizinische Klinik I, Klinikum Grosshadern, Ludwig-Maximilians-Universität München
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17
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Kantelhardt T, Hallfeldt K, Müller-Höcker J, Schweiberer L, Löhrs U. [Lymphangioleiomyomatosis--a rare disease of the lymphatic system]. Chirurg 1996; 67:653-7. [PMID: 8767100] [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: 02/02/2023]
Abstract
Lymphangioleiomyomatosis is a rare disease with proliferation of smooth muscle cells within the lymphatics, mediastinal and retroperitoneal lymph nodes and in the lungs. The clinical symptoms are increasing dyspnea, chylous effusion, intestinal obstruction and thoracic or abdominal pain. The authors report the case of a 42-year-old woman who primarily suffered from thoracic pain, dyspnea and chylous effusion. In further examinations we discovered a leftsided retroperitoneal tumor and a tumor in the mesentery. The diagnostic difficulties experienced are described and the necessity of explorative laparotomy for definite diagnosis is demonstrated. Furthermore, the article provides a review of the latest developments in pathology, diagnostics and therapy.
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Affiliation(s)
- T Kantelhardt
- Pathologisches Institut, Ludwig-Maximilians-Universität München
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18
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Barron Medrano M, Cabello Del Castillo J, Gracia Marzo A, Ponce de Leon Martinez L, Alcalde Manero M, Gonzalez Portal C, Escudero Nalda B, Pe-na Somovilla JL. [Lymphangioleiomyoma with retroperitoneal and thoracic involvement]. An Med Interna 1996; 13:75-8. [PMID: 8948817] [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: 02/03/2023]
Abstract
We report a new case of lymphangioleiomyoma in a 29 years old woman, with antecedents of recurrent spontaneous pneumothorax; she was diagnosed 2 years previously of retroperitoneal hemangiopericytoma, and she has admitted to the hospital because pneumothorax, chilotorax and honeycomb lung pattern, which induce to review the previous retroperitoneal biopsy and confirm to answer with lymphangioleiomyoma. The literature is reviewed.
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Affiliation(s)
- M Barron Medrano
- Sección de Neumología, Complejo Hospitalario San Millán-San Pedro, Logroño
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19
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Tsang WY, Chan JK. Primary leiomyomatosis of lymph node or nodal lymphangiomyoma? Histopathology 1993; 23:393-4. [PMID: 8300078] [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: 01/29/2023]
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20
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Anker N, Francis D, Viskum K. [2 cases of lymphangioleiomyomatosis treated by hormonal manipulation]. Ugeskr Laeger 1993; 155:2354-2356. [PMID: 8346582] [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: 05/22/2023]
Abstract
The course of disease in two women with bioptically verified lymphangioleiomyomatosis (LAM) is demonstrated. One was oestrogen- and progesterone-receptor negative, but responded promptly to hysterosalpingo-oophorectomy and has had no symptoms later. The other was receptor positive, but in spite of hysterosalpingo-oophorectomy and hormonal manipulation with tamoxifen and medroxyprogesterone, has had a complicated course of the disease with symptoms for ten years. LAM is a hormone dependent disease, but our knowledge is still incomplete. Hormonal manipulation should be tried in receptor positive as well as negative patients. Tamoxifen seems to have deleterious effects on the course of disease.
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Affiliation(s)
- N Anker
- Medicinsk afdeling, Roskilde Amts Sygehus
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21
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Johnson SF, Davey DD, Cibull ML, Schwartz RW, Strodel WE. Lymphangioleiomyomatosis. Am Surg 1993; 59:395-9. [PMID: 8323071] [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: 01/29/2023]
Abstract
Lymphangiomyomatosis (LAM) is a progressive disease afflicting women of childbearing age. LAM remains a rare disease, unfamiliar to many clinicians. It usually poses a diagnostic dilemma for the primary physician, possibly resulting in a delayed or missed diagnosis, unnecessary operative intervention, and inappropriate therapy. LAM is characterized microscopically by abnormal smooth muscle proliferation causing gradual obstruction of small airways, lymphatics, and vasculature. The proliferation eventually results in a characteristic clinical syndrome of progressive dyspnea, recurrent pneumothorax, chylous effusion, and hemoptysis. Despite a variety of treatment regimens developed since the first description of LAM, patient survival has not improved appreciably. Most patients die within 10 years of the time of diagnosis. This report presents a patient with LAM and a review of the literature.
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Affiliation(s)
- S F Johnson
- Department of Surgery, Chandler Medical Center, University of Kentucky, Lexington 40536-0084
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22
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Zahner J, Strauer BE. [CA-125--a tumor marker of lymphangioleiomyomatosis of diagnostic and prognostic importance?]. Geburtshilfe Frauenheilkd 1993; 53:492-4. [PMID: 8370492 DOI: 10.1055/s-2007-1022920] [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: 01/30/2023] Open
Abstract
Lymphangioleiomyomatosis is a rare tumour of the lymphatic system, affecting mostly women of childbearing age. Due to its rare occurrence, diagnosis is mostly made after thorough examination therefore time for an early treatment is lost. Diagnostically important are, on the one hand, the histological findings with smooth muscle cells invading the lymphatic system, and on the other hand thin-walled cysts in CT scanning of the lung. CA-125 seems to be a suitable screening parameter for LAM, which may be additionally of prognostic value. Sensitivity and specificity of CA-125 require further observation.
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Affiliation(s)
- J Zahner
- Medizinische Klinik, Heinrich-Heine-Universität Düsseldorf
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23
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Guillonneau B, Bouchot O, Buzelin F, Dupas B, Barrier JH, Buzelin JM. [Lymphangiomyomatosis: an exceptional cause of chyluria. Report of a case]. Prog Urol 1993; 3:484-9. [PMID: 8369828] [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: 01/30/2023]
Abstract
A rare case of lymphangiomatosis without pulmonary involvement is reported. The diagnosis was based on the presence of multifocal lesions and histological examination. Retroperitoneal lesions were responsible for chyluria, which was treated surgically. Chyluria is an exceptional complication of this disease, as only 3 such cases have been reported in the literature. The presence of cutaneous signs raises the question of the relations between lymphangiomatosis and Bourneville's tuberous sclerosis.
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Barranco Simó MJ, Ciscar Vilanova MA, Ibor Otamendi JL, Ferrando Marco J, Juan Samper G. [Pulmonary lymphangioleiomyomatosis. A disease which may have a benign progression]. An Med Interna 1993; 10:240-2. [PMID: 8518341] [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: 01/31/2023]
Abstract
Pulmonary lymphangioleiomyomatosis (PLLM) is characterized by a benign proliferation of the smooth muscle around lymphatics, venulas and bronchiolus. It is usually fatal within 1 to 9 years. We present a case which remained with scarce symptoms despite receiving no treatment after at least 9 years of evolution of the disease. We highlight the clinical manifestations of the disease and the relevance of pulmonary biopsia with thoracotomy in order to establish the diagnosis.
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25
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Kerr LA, Blute ML, Ryu JH, Swensen SJ, Malek RS. Renal angiomyolipoma in association with pulmonary lymphangioleiomyomatosis: forme fruste of tuberous sclerosis? Urology 1993; 41:440-4. [PMID: 8488612 DOI: 10.1016/0090-4295(93)90504-4] [Citation(s) in RCA: 47] [Impact Index Per Article: 1.5] [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: 01/31/2023]
Abstract
From 1976 to 1989, 27 patients with pulmonary lymphangioleiomyomatosis were seen at our institution. Twenty-five had no signs or symptoms of tuberous sclerosis; 21 of these had abdominal imaging or surgical exploration to make the diagnosis of renal angiomyolipoma in seven patients, all female. Three presented with symptoms secondary to renal disease, three with pulmonary manifestations, and one with both. Renal disease was bilateral in four patients; four patients underwent nephrectomy and two tumors were embolized. All patients experienced spontaneous pneumothoraces during the course of their disease. There was one respiratory death. It is our belief that any patient presenting with angiomyolipoma and a history of pulmonary problems should be evaluated for pulmonary lymphangioleiomyomatosis with a limited computed tomography scan of the chest at the time of abdominal imaging. The surgical treatment of angiomyolipoma when associated with lymphangioleiomyomatosis is predicated on the ability to adequately manage the complicating lung disease perioperatively.
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Affiliation(s)
- L A Kerr
- Department of Urology, Mayo Clinic, Rochester, Minnesota
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26
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Matthews TJ, Hornall D, Sheppard MN. Comparison of the use of antibodies to alpha smooth muscle actin and desmin in pulmonary lymphangioleiomyomatosis. J Clin Pathol 1993; 46:479-80. [PMID: 8320334 PMCID: PMC501266 DOI: 10.1136/jcp.46.5.479] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [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: 01/29/2023]
Abstract
To establish if antibodies to alpha smooth muscle actin (ASMA) are better than desmin as a tumour marker in pulmonary lymphangioleiomyomatosis both antisera were applied to five cases. ASMA strongly stained the muscle in all cases but desmin was negative. Five cases of cryptogenic fibrosing alveolitis showed that mature smooth muscle embedded in fibrous tissue surrounding cysts was positively stained with ASMA but the interstitial fibrous tissue was negative. ASMA is a consistent and better marker than desmin for the detection of immature smooth muscle in pulmonary lymphangioleiomyomatosis.
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Affiliation(s)
- T J Matthews
- Department of Histopathology, Royal Brompton National Heart and Lung Hospital, London
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27
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Saegusa M, Sakuramoto K, Hashimoto H, Uno S, Aramaki K, Johsen T. [Lymphangiomyomatosis involving the kidney: a case report]. Hinyokika Kiyo 1993; 39:249-52. [PMID: 8506796] [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: 01/31/2023]
Abstract
A 58-year-old female was admitted with a chief complaint of gross hematuria. A diagnosis of carcinoma of the left kidney with lymphnode metastasis was made on the basis of computerized tomography and angiography. Left nephrectomy and lymphnode dissection were performed. Histological examination revealed lymphangiomyoma, and the final clinical diagnosis was changed to lymphangiomyomatosis with pulmonary, retroperitoneal, and left renal lesions. Lymphangiomyomatosis with renal lesions is extremely rare, and differentiation from renal carcinoma is important, though difficult.
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Affiliation(s)
- M Saegusa
- Department of Urology, Hiroshima City Hospital
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28
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Chuang ML, Tsai YH, Pang LC. Early chylopneumothorax in a patient with pulmonary lymphangioleiomyomatosis. J Formos Med Assoc 1993; 92:278-82. [PMID: 8102284] [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: 01/28/2023] Open
Abstract
A 50-year-old woman was admitted with the complaint of cough and dyspnea on exertion for the previous two months. A radiograph of the chest showed a right-sided hydropneumothorax, which was proven to be a chylous effusion by lipoprotein electrophoresis and was very refractory to tetracycline-pleurodesis. The chylopneumothorax was cured by ligation of the thoracic duct and surgical pleurodesis. After an open lung biopsy, lymphangioleiomyomatosis (LAM) was diagnosed histopathologically with smooth muscle nodules scattered throughout the lungs, obstructing the small airways, venules and lymphatics. An immunohistochemistry study using the avidin biotin complex method with monoclonal antibodies for actin and desmin showed the small nodules to be of muscle origin. During the past two years, the patient has remained stable both in respiratory status and roentgenographically without hormonal manipulation or oophorectomy. We present this case to illustrate the heterogeneous nature of this condition. While our patient's initial presentation was acute and associated with chylothorax, her postoperative course has shown no progression despite withholding of hormonal therapy.
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Affiliation(s)
- M L Chuang
- Department of Internal Medicine, Chang Gung Memorial Hospital, Taoynan, Taiwan, R.O.C
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29
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King TE. Restrictive lung disease in pregnancy. Clin Chest Med 1992; 13:607-22. [PMID: 1478021] [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] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Restrictive ventilatory defects characterized by a reduction in lung volumes and an increase in the ratio of forced expiratory volume in 1 second to forced vital capacity occur when lung expansion is limited because of alterations in the lung parenchyma or because of abnormalities in the pleura, chest wall, or neuromuscular apparatus. Few studies have examined pregnant women with carefully defined restrictive lung disorders. The majority of pulmonary diseases have their onset after the childbearing years. When present, most do not alter fertility. Further, these disorders are only a relative contraindication to pregnancy because both the fetus and mother are able to survive without a high risk of increased morbidity or mortality. The clinical course of sarcoidosis is generally not altered by pregnancy. Factors indicative of a poor prognosis in sarcoidosis and pregnancy include parenchymal lesions on chest radiography, advanced roentgenologic staging, advanced maternal age, low inflammatory activity, requirement for drugs other than corticosteroids, and the presence of extrapulmonary sarcoidosis. Pregnancy seldom has a significant effect on the course of the connective tissue diseases. In PSS with significant renal involvement, pregnancy has the potential for poor fetal prognosis and the risk of maternal death due to a lethal progression of renal failure. Worsening of SLE is uncommon in pregnancy, and prophylactic therapy is generally not necessary. Most women with LAM are advised to avoid pregnancy or the use of estrogens because of the concern that it will lead to worsening of their disease. The incidence of kyphoscoliosis in pregnancy is relatively high. Premature birth rates are higher than that in the normal population. The risk of progression of the abnormal curve in a scoliotic patient appears low. However, women with unstable scolioses at the time of pregnancy can demonstrate progression of the curve with the pregnancy. Respiratory complications during pregnancy in patients with kyphoscoliosis have been reported but in general are not serious if appropriately managed. As a rule, patients with severe restrictive lung disease (i.e., vital capacity < 1 L) should be advised to avoid pregnancy or consider therapeutic abortion. If such a patient decides to continue the pregnancy she should be provided with optimal medical management of her underlying disease and should consider delivery by cesarean section.
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Affiliation(s)
- T E King
- Division of Pulmonary Sciences and Critical Care Medicine, University of Colorado Health Sciences Center, Denver
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30
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Bustamante Ruiz A, García San José I, Agüero Balbín R, Pascual Pablo E. [Lymphangioleiomyomatosis. Evolution of the same problem]. Med Clin (Barc) 1992; 99:356. [PMID: 1435010] [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: 12/27/2022]
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31
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Urban T, Kuttenn F, Gompel A, Marsac J, Lacronique J. Pulmonary lymphangiomyomatosis. Follow-up and long-term outcome with antiestrogen therapy; a report of eight cases. Chest 1992; 102:472-6. [PMID: 1643935 DOI: 10.1378/chest.102.2.472] [Citation(s) in RCA: 29] [Impact Index Per Article: 0.9] [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: 12/28/2022] Open
Abstract
Lymphangiomyomatosis is a rare disease which affects young women of childbearing age. Eight women with pulmonary LAM were treated with antiestrogen therapy and were monitored by blood estrogen measurements along with clinical hypoestrogenic symptoms. Treatment ranged from three to nine years. The response to therapy was evaluated by the clinical course, chest x-ray films, pulmonary function tests and overall long-term outcome. Three patients died of respiratory failure after three, five and nine years of treatment. Of the five patients remaining alive, respiratory function deteriorated in four cases, after a transient period of mild improvement lasting three years in two cases. The last patient appeared stable after three years of follow-up. Time course ranged from 4 to 17 years. However, without a control group, we cannot determine whether or not the apparent improvement of the natural time course was due to the hormonal treatment.
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Affiliation(s)
- T Urban
- Service de Pneumologie, Hopital Cochin, Paris, France
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32
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Case records of the Massachusetts General Hospital. Weekly clinicopathological exercises. Case 1-1992. A 34-year-old woman with dyspnea and multiple small cystic areas in the lungs. N Engl J Med 1992; 326:44-54. [PMID: 1445499 DOI: 10.1056/NEJM199201023260108] [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: 12/27/2022]
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33
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Díaz Pedreira JA, González-Carreró J, Cameselle Veloso R, Barros Tizón JC, Bandrés Gimeno R. [Pulmonary lymphangioleiomyomatosis. Presentation of a new case]. An Med Interna 1991; 8:614-6. [PMID: 1782317] [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: 12/28/2022]
Abstract
A 48-year-old woman hospitalized because of spontaneous pneumothorax. She suffered dyspnea since three years before. Diffuse reticulonodular interstitial pattern was observed in the radiography. The transbronchial biopsy suggested lymphangioleiomyomatosis, the diagnosis being supported by open pulmonary biopsy. Usefulness of transbronchial biopsy is discussed and several treatment modalities are described.
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34
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Abstract
When a 34-year-old woman had dyspnea and chylothorax 8 months postpartum, lymphangiomyomatosis was diagnosed by open-lung biopsy. Baseline laboratory studies to evaluate infertility had revealed normal hormonal levels. She was subsequently treated with various hormones to aid in conception and in sustaining pregnancy. Her condition has improved with progesterone therapy. This case raises concern about the possible adverse consequences of hormonal manipulation in treating infertility. The need for open-lung biopsy in patients with classic manifestations of LAM is also questioned, especially with the advent of high-resolution CT scanning, the nonspecificity of hormonal receptors with regard to response to therapy, and the possible need for subsequent lung transplantation.
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Affiliation(s)
- B P Burlew
- Department of Medicine, Louisiana State University School of Medicine, New Orleans
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35
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Poh SC, Wang YT. Lymphangioleiomyomatosis--treatment with progesterone. Singapore Med J 1991; 32:258-61. [PMID: 1776007] [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: 12/28/2022]
Abstract
Lymphangioleiomyomatosis is a rare devastating disease affecting women mostly of child-bearing age. It presents with spontaneous pneumothorax, chylous effusions, hemoptysis and progressive breathlessness. Most patients die from respiratory failure within 10 years. There are no controlled studies on the efficacy of various treatment regimens. We report our experience with progesterone therapy in three patients. Two failed to respond, one died about 11 years after presentation and another after 5 1/2 years. The third patient has survived 11 years after onset of disease.
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Affiliation(s)
- S C Poh
- Department of Medicine III, Tan Tock Seng Hospital, Singapore
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36
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Morera J, Munné A. [Diffuse infiltrative pulmonary disease and pleural effusion in a 31-year-old woman]. Med Clin (Barc) 1991; 97:228-34. [PMID: 1943282] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Affiliation(s)
- J Morera
- Jefe del Servicio de Neumología, Hospital Germans Trias i Pujol, Badalona
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37
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Stollewerk D, Lehmer G, Sudermann TH, Kersten W. [A rare interstitial lung disease]. Pneumologie 1991; 45:582-8. [PMID: 1946256] [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: 12/29/2022]
Abstract
Pulmonary lymphangioleiomyomatosis (p.l.) is a rare disease of unknown etiology, and restricted to fertile women. It is characterized by a nodular proliferation of smooth muscle cells in the peribronchial, perivascular and perilymphatic lung tissue, accompanied by cystic dilations of the alveoles, rupture of the alveolar wall, lymphangiectasis, and septal collagen fiber deposition. Radiological-alterations range from enhanced interstitial shadowing to honey comb lung. Common clinical symptoms are progressive dyspnea, pneumothorax, chylous pleural effusion and hemoptysis. Here we present the case of a 43 years old woman, undergoing nephrectomy because of hamartoma of the left kidney, with recurrent pneumothorax and progressive dyspnea, verifying the diagnosis of p.l. by open lung biopsy. Pathogenesis of the disease, differential diagnosis and possible therapeutic approaches are discussed.
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Affiliation(s)
- D Stollewerk
- Abteilung für Lungen-und Bronchialheilkunde-Allergologie-Krhs. Bethanien Moers
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38
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Bjørnland K, Rode L, Jørstad SO. Acute abdominal pain as presenting symptom in lymphangiomyomatosis. Case report. Eur J Surg 1991; 157:367-8. [PMID: 1678654] [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: 12/28/2022]
Abstract
A case of lymphangiomyomatosis presenting with acute abdominal pain is described. Laparotomy revealed a multiloculated cystic mass on the posterior abdominal wall with typical histological pattern. In the ensuing 3 years the respiratory manifestations of this rare disorder have slowly progressed. Possible causal factors and management are discussed.
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Affiliation(s)
- K Bjørnland
- Department of Surgery, Sarpsborg Hospital, Norway
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39
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Ju JJ, Lu CC, Perng RP. [Tuberous sclerosis associated with pulmonary lymphangioleiomyomatosis]. Zhonghua Yi Xue Za Zhi (Taipei) 1991; 47:65-70. [PMID: 1848466] [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: 12/29/2022]
Abstract
Lymphangioleiomyomatosis (LAM) is a rare disease of women of childbearing age in which there is hyperplasia of atypical smooth muscle along lymphatics in the lung, thorax, and abdomen. Since Lautenbacher's first description in 1918, less than 100 cases of Bourneville's tuberous sclerosis (BTS) with involvement of the lungs have been reported. Their clinical, radiologic and pathologic manifestations are so strikingly similar to those of pulmonary lymphangioleiomyomatosis (PLM) that some authors have considered PLM to be a form fruste of BTS. We present a case of PLM with clinical pictures of dermatologic stigmata and kidney angiomyolipoma of tuberous sclerosis but free of neurologic symptoms. After the development of a recurring spontaneous pneumothorax, she had a downhill course and progressive pulmonary functional defect.
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Affiliation(s)
- J J Ju
- Department of Chest Medicine, Veterans General Hospital, Taipei
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40
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Naegeli CD, Cordasco EM, Meden G, O'Donnell JK, MacIntyre WJ, Dishner W. Lymphangiomyomatosis--newer concepts in pathogenesis and management--case reports. Angiology 1990; 41:957-63. [PMID: 2244700 DOI: 10.1177/000331979004101110] [Citation(s) in RCA: 2] [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] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Lymphangiomyomatosis was first reported more than forty years ago. Although its incidence is rare, its occurrence is being increasingly recognized and has been the subject of a growing number of cases reports in recent years. This study adds 2 more cases to the file. Both cases involved young women with the characteristic symptoms of dyspnea, cough, abdominal discomfort and swelling, chest pain, and hemoptysis, with abundant formation of refractory chylous, serous ascites. Although the progression of the disease differed in each case, pulmonary function was affected in a similar way by the presence of obstructive and restrictive defects and a decrease in diffusing capacity. Underlying abnormalities were dilated lymphatics, thickened lymphatic walls, and muscular proliferation of leiomyomatous origin, leading to bronchial restriction. The authors point to the subtlety required in arriving at a differentiated diagnosis of lymphangiomyomatosis lymphangioleiomyomatosis and the difference between the two conditions. They also make particular recommendations in respect to the importance of preliminary hormone receptor tests and to the wisdom to be exercised in ligating a main lymphatic duct in the chest to control the formation of ascites. Pneumothorax, a frequent manifestation of lymphangiomyomatosis, is found to be the result of chronic air trapping due to a combination of narrowing of conducting airways and disruption of normal lung parenchyma.
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Affiliation(s)
- C D Naegeli
- Medical Research Laboratory, London, England
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41
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Affiliation(s)
- J R Taylor
- Division of Pulmonary and Critical Care Medicine, Stanford University Medical School, Calif 94305
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42
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43
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Franchi M, Falaschi F, Calderazzi A, Napoli S, Marchetti G, Testi C. [Diagnostic reflections on lung lymphangioleiomyomatosis]. Radiol Med 1990; 80:29-35. [PMID: 2217940] [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: 12/30/2022]
Abstract
Two cases of histologically proven pulmonary lymphangiomyomatosis were studied by means of an adequate combination of the current imaging modalities. After an anatomical survey of the secondary pulmonary lobule, the authors discuss the pathologic appearance, the pathogenetic factors (mainly hormones), and the diagnostic problems concerning this pathologic condition. Finally, the authors emphasize the decisive role of high-resolution CT (HRCT) in the evaluation of pulmonary lymphangioleiomyomatosis.
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Affiliation(s)
- M Franchi
- Istituto di Radiologia, Università, Pisa
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44
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Jóźwiak S. Severe pulmonary hypertension with diffuse smooth muscle proliferation of the lungs. Chest 1990; 98:250. [PMID: 2361402 DOI: 10.1378/chest.98.1.250b] [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] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
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45
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Abstract
In this report, we describe a case of lymphangiomatosis that mimicked lymphangioleiomyomatosis in a 20-year-old woman. Lung biopsy specimens showed proliferation of anastomosing lymphatic channels in the visceral pleura and dilated peribronchiolar and septal lymphatic channels. During 8 years of follow-up, this process behaved like lymphangioleiomyomatosis with reticulonodular infiltrates and worsening obstructive and restrictive changes evident on pulmonary function tests.
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Affiliation(s)
- D W Swank
- Department of Laboratory Medicine, University of North Dakota, Minot
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46
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Sakano T, Hamasaki T, Kawaguchi Y, Tanaka Y, Ueda K, Hiramoto T. Pulmonary lymphangiomyomatosis in childhood? Marked smooth muscle cell proliferation of the lung in a preadolescent girl with repeated pneumothorax and progressive dyspnea. Hiroshima J Med Sci 1989; 38:147-9. [PMID: 2584060] [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: 01/01/2023]
Abstract
A 13-year-old girl with repeated spontaneous pneumothorax and progressive dyspnea is described. The biopsy specimen of the lung showed marked proliferation of smooth muscle cells in the thickened bullous wall and alveolar septa, which was similar to the findings of the pulmonary lymphangiomyomatosis. Pulmonary lymphangiomyomatosis is one of the diseases which should be considered when children have progressive dyspnea, chylous effusions and repeated spontaneous pneumothorax.
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47
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Affiliation(s)
- J E Jacobs
- Department of Radiology, Hartford Hospital, CT 06106
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48
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Templeton PA, McLoud TC, Müller NL, Shepard JA, Moore EH. Pulmonary lymphangioleiomyomatosis: CT and pathologic findings. J Comput Assist Tomogr 1989; 13:54-7. [PMID: 2910948] [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: 01/03/2023]
Abstract
We present two cases that illustrate the appearance of pulmonary lymphangioleiomyomatosis on high resolution CT. Both patients had numerous thin-walled cystic airspaces of varying sizes distributed diffusely throughout the lungs. Most of the lung parenchyma surrounding the cystic spaces was normal. This pattern correlated closely with the surgical and pathologic findings and is distinct from other diffuse lung diseases.
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Affiliation(s)
- P A Templeton
- Department of Radiology, Massachusetts General Hospital, Boston, MA 02114
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49
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Case records of the Massachusetts General Hospital. Weekly clinicopathological exercises. Case 24-1988. A 32-year-old woman with recurrent pneumothorax. N Engl J Med 1988; 318:1601-10. [PMID: 3374529 DOI: 10.1056/NEJM198806163182408] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [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: 01/05/2023]
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50
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Abstract
Cystic disease of the lung should be considered in the differential diagnosis of any patient presenting with respiratory symptoms. The most important aids available to the thoracic surgeon for the evaluation of cystic disease are history, physical examination, and chest radiograph. Confirmation of diagnosis often requires computed tomography, pulmonary and thoracic aortic angiography, and upper gastrointestinal barium series.
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Affiliation(s)
- F M Shamji
- Division of Cardiothoracic Surgery, Ottawa Civic Hospital, University of Ottawa, Ontario, Canada
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