1
|
Alqutub A, Baamir NJ, Mofti Z, Zawawi F, Al-Khatib T. Sclerotherapy vs. surgical excision for lymphatic malformations of the head and neck: a systematic review and meta-analysis. Eur Arch Otorhinolaryngol 2024:10.1007/s00405-024-08793-9. [PMID: 38951201 DOI: 10.1007/s00405-024-08793-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2024] [Accepted: 06/16/2024] [Indexed: 07/03/2024]
Abstract
OBJECTIVES Lymphatic malformations (LMs) are abnormal lymphatic vessels with cystic characteristics, categorized as macrocystic, microcystic, or a combination of both. They represent the second most common vascular malformations, and their management involves multidisciplinary approaches based on clinical assessments and imaging studies. LMs manifest as a challenge to medical professionals in the head and neck, posing functional and aesthetic concerns. Our systematic review aims to compare the efficacy of sclerotherapy and surgery for LMs, identifying optimal treatment modalities for each scenario. METHODS We searched four electronic databases for related studies. Data were extracted from the included studies. We calculated the pooled rate ratios with 95% confidence intervals (CIs). The I2 test was used to detect heterogeneity. The inclusion of the studies required the following prerequisites: 1- Studies focusing on any lymphatic malformations in the head and neck, whether microcystic, macrocystic, or a mix of both; 2- Studies performed on more than ten patients; 3- All interventions used as surgery, sclerotherapy, or both. RESULTS We included 58 studies in our systematic review, of which 45 were eligible for the meta-analysis. For macrocystic LMs, sodium tetradecyl sulfate (STS) mixed with ethanol and excision achieved the highest complete response rates at (92.9%) and (92.5%), respectively. Surgical excision showed the lowest poor response rate. Polidocanol microfoam had the highest poor response rate (11.1%). In microcystic LMs, combining sclerotherapy with excision showed the highest complete response rate (70.3%) and the lowest poor response rate (1.3%). Picibanil had the lowest complete response rate (9.1%) and the highest rate of poor response (61.4%). In mixed LMs, surgical excision had the highest complete response rate (70.3%). CONCLUSION Both surgical excision and STS combined with ethanol are highly effective for treating macrocystic LMs, achieving similar complete response rates. The combination of sclerotherapy and surgical excision demonstrated the best outcomes in microcystic LMs. Surgical excision demonstrates superior efficacy over sclerotherapy for mixed LMs. These findings suggest that excision is generally more effective in achieving complete and excellent responses across all LM subtypes. Further high-quality studies are necessary to standardize and optimize treatment protocols.
Collapse
Affiliation(s)
- Abdulsalam Alqutub
- Department of Otolaryngology-Head and Neck Surgery, King Abdulaziz University, Jeddah, Saudi Arabia.
| | - Noor J Baamir
- Department of Otolaryngology-Head and Neck Surgery, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Zainab Mofti
- Department of Family and Community Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Faisal Zawawi
- Department of Otolaryngology-Head and Neck Surgery, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Talal Al-Khatib
- Department of Otolaryngology-Head and Neck Surgery, King Abdulaziz University, Jeddah, Saudi Arabia
| |
Collapse
|
2
|
Woodis KM, Garlisi Torales LD, Wolf A, Britt A, Sheppard SE. Updates in Genetic Testing for Head and Neck Vascular Anomalies. Oral Maxillofac Surg Clin North Am 2024; 36:1-17. [PMID: 37867039 PMCID: PMC11092895 DOI: 10.1016/j.coms.2023.09.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2023]
Abstract
Vascular anomalies include benign or malignant tumors or benign malformations of the arteries, veins, capillaries, or lymphatic vasculature. The genetic etiology of the lesion is essential to define the lesion and can help navigate choice of therapy. . In the United States, about 1.2% of the population has a vascular anomaly, which may be underestimating the true prevalence as genetic testing for these conditions continues to evolve.
Collapse
Affiliation(s)
- Kristina M Woodis
- Unit on Vascular Malformations, Division of Intramural Research, Eunice Kennedy Shriver National Institute for Child Health and Human Development, 10 Center Drive, MSC 1103, Bethesda, MD 20892-1103, USA
| | - Luciana Daniela Garlisi Torales
- Unit on Vascular Malformations, Division of Intramural Research, Eunice Kennedy Shriver National Institute for Child Health and Human Development, 10 Center Drive, MSC 1103, Bethesda, MD 20892-1103, USA
| | - Alejandro Wolf
- Department of Pathology and ARUP Laboratories, University of Utah, 2000 Circle of Hope, Room 3100, Salt Lake City, UT 84112, USA
| | - Allison Britt
- Comprehensive Vascular Anomalies Program, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Sarah E Sheppard
- Unit on Vascular Malformations, Division of Intramural Research, Eunice Kennedy Shriver National Institute for Child Health and Human Development, 10 Center Drive, MSC 1103, Bethesda, MD 20892-1103, USA.
| |
Collapse
|
3
|
Teng JM, Hammill A, Martini J, Treat J. Sirolimus in the Treatment of Microcystic Lymphatic Malformations: A Systematic Review. Lymphat Res Biol 2022; 21:101-110. [PMID: 35852876 DOI: 10.1089/lrb.2021.0103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background: Genetic alterations in lymphatic development can lead to microcystic lymphatic malformations (micro LMs). LMs can have both microcystic and macrocytic components or be exclusively one or the other. LMs can result in serious, sometimes life-threatening, sequelae. Absent consensus guidelines, treatment has been largely empiric. Recent advances in our understanding of the pathogenesis of micro LMs have provided a foundation for novel therapeutic approaches. This review examines clinical data over the last 10 years on the role of sirolimus, an inhibitor of the PI3K/AKT/mTOR signaling pathway implicated in micro LM development, in the treatment of micro LM. Methods and Results: Systematic review of published clinical studies from January 1, 2011, to July 15, 2021, using the PubMed, Google Scholar, and Cochrane Reviews databases, and utilizing delimiters to focus specifically on sirolimus in the treatment of micro LM. A total of 16 studies were identified (13 case studies or case reviews; 3 prospective) that included 52 subjects treated with topical (n = 15) or oral (n = 37) sirolimus for micro LM. Clinically meaningful, long-term improvement (up to 3 years) was noted in 92% (46/50), mostly previously treated subjects. Sirolimus yielded improvements in key manifestations such as lymphatic leakage, bleeding, vesicle bulk, pain, and skin discoloration. Some subjects experienced a rapid onset of effect (within 2 weeks). No unexpected adverse events were seen. Conclusion: Sirolimus appears to be an effective and safe option in the management of cutaneous and complex micro LM. However, prospective, controlled trials are clearly needed to accurately elucidate the benefits and risks of sirolimus in the management of micro LM. ClinicalTrials.gov Identifier: NCT05050149.
Collapse
Affiliation(s)
- Joyce M.C. Teng
- Department of Dermatology, School of Medicine, Stanford University, Palo Alto, California, USA
| | | | | | - James Treat
- Children's Hospital of Pennsylvania, Philadelphia, Pennsylvania, USA
| |
Collapse
|
4
|
Rootman DB, Diniz SB, Cohen LM. Clinical Assessment and Lesion-Specific Management of Orbital Vascular Malformations. J Neurol Surg B Skull Base 2021; 82:116-128. [PMID: 33777625 DOI: 10.1055/s-0040-1722702] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Abstract
The systematic classification of vascular disease as proposed and refined by the International Society for the Study of Vascular Anomalies (ISSVA) divides vascular pathology first into tumors and malformations. Malformations are described as simple and complex, where simple malformations contain a single vascular system and complex malformations comprised of multiple vascular systems. Arteriovenous malformations are considered in terms of inflow characteristics which are primarily responsible for the key management challenges. Management utilizing endovascular embolization and/or surgical resection is often employed; however, recurrence can occur, particularly in diffuse cases. There may be an increasing role for systemic antiangiogenic therapy in such cases. Lymphaticovenous malformations are divided into the principle components on the lymphatic and venous sides for clarity of discussion. Lymphatic malformations are described morphologically as macrocystic and microcystic, and physiologically in terms of the processes responsible for growth. In both cases, surgical options are challenging and local therapeutics intended to close large luminal spaces in the case of macrocystic and to slow biological signaling for growth in microcystic. Venous malformations are described physiologically in terms of flow and distensibility, as volume plays a critical role in the limited space of the orbital cavity. Combined embolic-surgical approaches can be effective for management. More complicated, combined lesions can be managed by dividing the lesion into principal components and treating each appropriately.
Collapse
Affiliation(s)
- Daniel B Rootman
- Division of Orbital and Ophthalmic Plastic Surgery, Doheny and Stein Eye Institutes, University of California, Los Angeles, United States
| | - Stefania B Diniz
- Division of Orbital and Ophthalmic Plastic Surgery, Doheny and Stein Eye Institutes, University of California, Los Angeles, United States
| | - Liza M Cohen
- Division of Orbital and Ophthalmic Plastic Surgery, Doheny and Stein Eye Institutes, University of California, Los Angeles, United States
| |
Collapse
|
5
|
Zenner K, Cheng CV, Jensen DM, Timms AE, Shivaram G, Bly R, Ganti S, Whitlock KB, Dobyns WB, Perkins J, Bennett JT. Genotype correlates with clinical severity in PIK3CA-associated lymphatic malformations. JCI Insight 2019; 4:129884. [PMID: 31536475 DOI: 10.1172/jci.insight.129884] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2019] [Accepted: 09/12/2019] [Indexed: 12/19/2022] Open
Abstract
Lymphatic malformations (LMs) are congenital, nonneoplastic vascular malformations associated with postzygotic activating PIK3CA mutations. The mutation spectrum within LMs is narrow, with the majority having 1 of 3 hotspot mutations. Despite this relative genetic homogeneity, clinical presentations differ dramatically. We used molecular inversion probes and droplet digital polymerase chain reaction to perform deep, targeted sequencing of PIK3CA in 271 affected and unaffected tissue samples from 81 individuals with isolated LMs and retrospectively collected clinical data. Pathogenic PIK3CA mutations were identified in affected LM tissue in 64 individuals (79%) with isolated LMs, with variant allele fractions (VAFs) ranging from 0.1% to 13%. Initial analyses revealed no correlation between VAF and phenotype variables. Recognizing that different mutations activate PI3K to varying degrees, we developed a metric, the genotype-adjusted VAF (GVAF), to account for differences in mutation strength, and found significantly higher GVAFs in LMs with more severe clinical characteristics including orofacial location or microcystic structure. In addition to providing insight into LM pathogenesis, we believe GVAF may have broad applicability for genotype-phenotype analyses in mosaic disorders.
Collapse
Affiliation(s)
- Kaitlyn Zenner
- Center for Integrative Brain Research, Seattle Children's Research Institute, Seattle, Washington, USA.,Division of Pediatric Otolaryngology, Department of Head and Neck Surgery, University of Washington, Seattle, Washington, USA
| | - Chi Vicky Cheng
- Center for Integrative Brain Research, Seattle Children's Research Institute, Seattle, Washington, USA
| | - Dana M Jensen
- Center For Developmental Biology and Regenerative Medicine, Seattle Children's Research Institute, Seattle, Washington, USA
| | - Andrew E Timms
- Center For Developmental Biology and Regenerative Medicine, Seattle Children's Research Institute, Seattle, Washington, USA
| | | | - Randall Bly
- Division of Pediatric Otolaryngology, Department of Head and Neck Surgery, University of Washington, Seattle, Washington, USA
| | - Sheila Ganti
- Center for Clinical and Translational Research, Seattle Children's Research Institute, Seattle, Washington, USA
| | - Kathryn B Whitlock
- Center for Clinical and Translational Research, Seattle Children's Research Institute, Seattle, Washington, USA
| | - William B Dobyns
- Center for Integrative Brain Research, Seattle Children's Research Institute, Seattle, Washington, USA.,Department of Pediatrics, Division Genetic Medicine, University of Washington, Seattle, Washington, USA
| | - Jonathan Perkins
- Division of Pediatric Otolaryngology, Department of Head and Neck Surgery, University of Washington, Seattle, Washington, USA
| | - James T Bennett
- Center For Developmental Biology and Regenerative Medicine, Seattle Children's Research Institute, Seattle, Washington, USA.,Department of Pediatrics, Division Genetic Medicine, University of Washington, Seattle, Washington, USA
| |
Collapse
|
6
|
Kaipainen A, Chen E, Chang L, Zhao B, Shin H, Stahl A, Fishman SJ, Mulliken JB, Folkman J, Huang S, Fannon M. Characterization of lymphatic malformations using primary cells and tissue transcriptomes. Scand J Immunol 2019; 90:e12800. [DOI: 10.1111/sji.12800] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2019] [Revised: 06/10/2019] [Accepted: 06/22/2019] [Indexed: 01/25/2023]
Affiliation(s)
- Arja Kaipainen
- Vascular Biology Program, Department of Surgery Harvard Medical School, Boston Children's Hospital Boston MA USA
| | - Emy Chen
- Vascular Biology Program, Department of Surgery Harvard Medical School, Boston Children's Hospital Boston MA USA
| | - Lynn Chang
- Vascular Biology Program, Department of Surgery Harvard Medical School, Boston Children's Hospital Boston MA USA
| | - Bing Zhao
- Department of Ophthalmology and Visual Sciences University of Kentucky Lexington KY USA
| | - Hainsworth Shin
- Department of Biomedical Engineering University of Kentucky Lexington KY USA
| | - Andreas Stahl
- Vascular Biology Program, Department of Surgery Harvard Medical School, Boston Children's Hospital Boston MA USA
| | - Steven J. Fishman
- Department of Surgery Harvard Medical School, Boston Children's Hospital Boston MA USA
| | - John B. Mulliken
- Department of Plastic and Oral Surgery, Department of Surgery Harvard Medical School, Boston Children's Hospital Boston MA USA
| | - Judah Folkman
- Vascular Biology Program, Department of Surgery Harvard Medical School, Boston Children's Hospital Boston MA USA
| | - Sui Huang
- Vascular Biology Program, Department of Surgery Harvard Medical School, Boston Children's Hospital Boston MA USA
| | - Michael Fannon
- Vascular Biology Program, Department of Surgery Harvard Medical School, Boston Children's Hospital Boston MA USA
- Department of Ophthalmology and Visual Sciences University of Kentucky Lexington KY USA
| |
Collapse
|
7
|
Gomez-Acevedo H, Dornhoffer JR, Stone A, Dai Y, Richter GT. Gene Expression Differences in Pediatric Lymphatic Malformations: Size Really Matters. Lymphat Res Biol 2019; 16:347-352. [PMID: 30130159 DOI: 10.1089/lrb.2017.0064] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
Lymphatic malformations (LMs) are congenital vascular anomalies characterized by dilated and cystic lymphatic channels. They are subdivided into macrocystic and microcystic lesions based upon the predominant size of the cysts involved. However, significant differences in clinical characteristics, treatment outcomes, and prognosis between macrocytic and microcytic disease suggest variation in underlying biologic and genetic influences. Indirect differential expression analysis revealed that 426 genes are significantly different (p < 0.01) in a small sample of LM subtypes. Functional analyses on the differentially expressed gene sets showed that microcystic LM gene expression favors a prooncogenic profile with upregulation of MYC target genes and cell cycle proteins, whereas macrocystic expression demonstrates hypoxic events that lead to angiogenesis and cell proliferation. Therefore, microcystic and macrocystic LMs, although histologically and physiologically similar, may occur under the influence of vastly different biological pathways and mechanisms of action.
Collapse
Affiliation(s)
- Horacio Gomez-Acevedo
- 1 Department of Biomedical Informatics, University of Arkansas for Medical Sciences , Little Rock, Arkansas
| | - James R Dornhoffer
- 2 Department of Otolaryngology Head and Neck Surgery, The Medical University of South Carolina , Charleston, South Carolina
| | - Annjanette Stone
- 3 Department of Pathology, University of Arkansas for Medical Sciences , Little Rock, Arkansas.,4 Central Arkansas Veterans Healthcare System , Little Rock, Arkansas
| | - Yuemeng Dai
- 5 Mesquite Rehabilitation Institute , Mesquite, Texas
| | - Gresham T Richter
- 6 Department Otolaryngology, University of Arkansas for Medical Sciences , Little Rock, Arkansas.,7 Arkansas Children's Hospital , Little Rock, Arkansas
| |
Collapse
|
8
|
Noia G, Maltese PE, Zampino G, D'Errico M, Cammalleri V, Convertini P, Marceddu G, Mueller M, Guerri G, Bertelli M. Cystic Hygroma: A Preliminary Genetic Study and a Short Review from the Literature. Lymphat Res Biol 2018; 17:30-39. [PMID: 30475086 DOI: 10.1089/lrb.2017.0084] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND The objective of this study is to examine the hypothesis that cystic hygroma (CH) with normal karyotype can manifest as a Mendelian inherited trait, and that a genetic similitude with hereditary lymphedema exists. To reach this goal, we investigated the prevalence of genetic variants in angiogenesis and lymphangiogenesis genes in a cohort of euploid fetuses with CH that almost resolved before delivery. A short review of cases from literature is also reported. METHODS AND RESULTS Five fetuses were screened using a next-generation sequencing approach by targeting 33 genes known to be associated with vascular and lymphatic malformations. The genetic evaluation revealed two novel variants in KDR and KRIT1 genes. CONCLUSION A review of the literature to date revealed that an association exists between CH and hereditary lymphedema and, similar to lymphedema, CH can be inherited in autosomal recessive and autosomal dominant manner, with the latter most likely associated with a better prognosis. About KDR and KRIT1 genes, no other similar associations are reported in the literature and caution is needed in their interpretation. In conclusion, we thought that a genetic test for the outcome of familial CH could be of enormous prognostic value.
Collapse
Affiliation(s)
- Giuseppe Noia
- 1 Hospice Perinatale Centro per le Cure Palliative prenatali Santa Madre Teresa di Calcutta, Policlinico A. Gemelli-Centro Studi per la Tutela della Madre e del Concepito-Università Cattolica del Sacro Cuore-Roma, Roma, Italy
| | | | - Giuseppe Zampino
- 3 Centro Malattie Rare e Difetti Congeniti, Polo Scienza della Salute della Donna e del Bambino, Fondazione Policlinico Universitario A. Gemelli, Roma, Italy
| | - Marco D'Errico
- 4 Divisione di Ostetricia e Ginecologia, Ospedale "Cristo Re," Roma, Italy
| | - Vittoria Cammalleri
- 1 Hospice Perinatale Centro per le Cure Palliative prenatali Santa Madre Teresa di Calcutta, Policlinico A. Gemelli-Centro Studi per la Tutela della Madre e del Concepito-Università Cattolica del Sacro Cuore-Roma, Roma, Italy
| | | | | | | | | | - Matteo Bertelli
- 2 Magi's Lab, Rovereto, Italy.,5 Magi Euregio, Bolzano, Italy
| |
Collapse
|
9
|
Lokmic Z. Utilizing lymphatic cell markers to visualize human lymphatic abnormalities. JOURNAL OF BIOPHOTONICS 2018; 11:e201700117. [PMID: 28869350 DOI: 10.1002/jbio.201700117] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/11/2017] [Revised: 08/31/2017] [Accepted: 08/31/2017] [Indexed: 06/07/2023]
Abstract
In vivo visualization of the human lymphatic system is limited by the mode of delivery of tracing agents, depth of field and size of the area examined, and specificity of the cell markers used to distinguish lymphatic endothelium from the blood vessels and the surrounding tissues. These limitations are particularly problematic when imaging human lymphatic abnormalities. First, limited understanding of the lymphatic disease aetiology exists with respect to genetic causes and phenotypic presentations. Second, the ability of a tracer to reach the entire lymphatic network within the diseased tissue is suboptimal. Third, what is known about the expression of lymphatic endothelial cell (LEC) markers, such as podoplanin, lymphatic vessel endothelial hyaluronan receptor, Drosophila melanogaster homeobox gene prospero-1 and vascular endothelial growth factor receptor-3 in rodent lymphatic vessels and healthy human LECs may not necessarily apply in human lymphatic disease settings. The aim of this review is to highlight challenges in visualizing lymphatic vessels in human lymphatic abnormalities with respect to distribution patterns of the cellular markers currently employed to visualize abnormal human lymphatic vessels in experimental settings. Allowing for these limitations within new diagnostic visualization technologies is likely to improve our ability to image human lymphatic diseases.
Collapse
Affiliation(s)
- Zerina Lokmic
- Department of General Medicine, The Royal Children's Hospital, Melbourne, Victoria, Australia
- School of Health Sciences, The University of Melbourne, Melbourne, Victoria, Australia
| |
Collapse
|
10
|
Perkins JA. New Frontiers in Our Understanding of Lymphatic Malformations of the Head and Neck: Natural History and Basic Research. Otolaryngol Clin North Am 2018; 51:147-158. [PMID: 29217059 DOI: 10.1016/j.otc.2017.09.002] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
The future of head and neck lymphatic malformation (HNLM) evaluation and treatment is changing because of 2 decades of clinical research and recent basic science investigation. Basic science investigation using cellular biology and molecular genetics has revealed the genetic cause of some HNLMs, which has created the possibility of medical treatment specific to HNLM. This article summarizes the clinical and basic science research that will likely influence the future of HNLM assessment and treatment.
Collapse
Affiliation(s)
- Jonathan A Perkins
- Otolaryngology/Head and Neck Surgery, University of Washington School of Medicine, 1959 Pacific Avenue NE, Box 366515, Seattle, WA 98195, USA; Vascular Anomalies Program, Seattle Children's Hospital, 4800 Sand Point Way Northeast, Seattle, WA 98105, USA.
| |
Collapse
|
11
|
Spontaneous Regression of Lymphangiomas in a Single Center Over 34 Years. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2017; 5:e1501. [PMID: 29062665 PMCID: PMC5640371 DOI: 10.1097/gox.0000000000001501] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2017] [Accepted: 07/26/2017] [Indexed: 11/26/2022]
Abstract
Background: A lymphangioma, also called a lymphatic malformation, is a congenital condition that frequently occurs in young children. It is classified into 3 groups depending on the size of the cysts (macrocystic, microcystic, and mixed). Spontaneous regression occurs in some cases; however, the characteristics of patients who show regression have not been studied previously. Furthermore, the types and the timing of the initial treatment are still controversial. Therefore, we statistically analyzed the occurrence of short-term spontaneous regression, patient age at original occurrence, cyst types, cyst sizes, and cyst locations in patients diagnosed with peripheral localized lymphangiomas in a single children center over 34 years. Methods: We retrospectively collected the data of 153 patients and reviewed the medical charts. Results: Spontaneous regression occurred only in macrocystic or mixed type; regression was most frequent in patients who, at the time of onset, were more than 2 years old. Conclusions: We concluded that elderly patients with macrocystic or mixed type lymphangioma may have to wait for treatment for over 3 months from the initial onset. Conversely, microcystic type could not be expected to show regression in a short period, and prompt initiation of the treatments may be required. The difference of the regression or not may depend on the characteristics of the lymph flow.
Collapse
|
12
|
O TMJ, Lou MS, Ma Y. Zinc effect on human lymphatic malformation cells in vitro. Int J Pediatr Otorhinolaryngol 2016; 80:33-8. [PMID: 26746609 DOI: 10.1016/j.ijporl.2015.11.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2015] [Revised: 11/04/2015] [Accepted: 11/09/2015] [Indexed: 11/18/2022]
Abstract
OBJECTIVES Lymphatic malformations (LM) are clinically characterized by episodes of inflammatory episodes. Often, an upper respiratory illness or trauma will lead to painful swelling in the distribution of the LM. Zinc is an element involved in numerous aspects of cellular metabolism and is a common dietary supplement and cold remedy. We surmise that zinc may act as a therapeutic anti-inflammatory agent for lymphatic malformations and their cellular components. We investigate the apparent cytotoxic effect of zinc ion on lymphatic malformation cells in vitro. METHODS Fresh surgical lymphatic malformation specimens from 10 patients were collected and processed in a laboratory. Tissues were processed and lymphatic malformation cells were isolated and grown. Immunohistochemistry and cell morphology were used to confirm LM cells. HUVEC cells were used as controls. Zinc chloride solution was added to the cells and its effect observed. RESULTS LM cells were isolated from five of the 10 specimens. Of these, the cells of only one specimen were able to be amplified to confluence. Five specimens were contaminated. Immunohistochemical staining (CD31, D2-40, and LYVE-1) and cell morphology of our specimens were consistent with lymphatic malformation while HUVEC control cells were negative. Zinc has a cytotoxic effect on BEL isolates in vitro with no obvious effect on cell morphology or growth rate of the control HUVEC cells. When compared with the published toxic zinc concentration for most cell types in the literature (100μM total zinc in vitro), our result indicates that LM cells may have a lower tolerance to zinc (10μM total zinc in vitro). CONCLUSION Zinc has an apparent morphological effect on lymphatic malformation cells in vitro. Compared with other cell types, LM cells have a lower tolerance to zinc. While this result looks very promising for future therapeutic use of zinc in acute lymphangitis, further studies are necessary, such as finding the IC50 of zinc for lymphatic malformation in vitro and also in vivo.
Collapse
Affiliation(s)
- Teresa Min-Jung O
- Vascular Birthmark Institute of New York, Department of Otolaryngology-Head and Neck Surgery, Manhattan Eye, Ear, and Throat and Lenox Hill Hospitals, 210 East 64th Street, 7th Floor, New York, NY 10065, USA.
| | - Man Si Lou
- Touro College of Osteopathic Medicine, 230 West 125th Street, New York, NY 10027, USA; Stony Brook University Medical Center, Department of Pathology, Basic Sciences Tower, Level 9, Stony Brook Medicine, Stony Brook, NY 11794-8691, USA.
| | - Yupo Ma
- Stony Brook University Medical Center, Department of Pathology, Basic Sciences Tower, Level 9, Stony Brook Medicine, Stony Brook, NY 11794-8691, USA.
| |
Collapse
|
13
|
Lokmic Z, Ng ES, Burton M, Stanley EG, Penington AJ, Elefanty AG. Isolation of human lymphatic endothelial cells by multi-parameter fluorescence-activated cell sorting. J Vis Exp 2015:e52691. [PMID: 25992474 DOI: 10.3791/52691] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Lymphatic system disorders such as primary lymphedema, lymphatic malformations and lymphatic tumors are rare conditions that cause significant morbidity but little is known about their biology. Isolating highly pure human lymphatic endothelial cells (LECs) from diseased and healthy tissue would facilitate studies of the lymphatic endothelium at genetic, molecular and cellular levels. It is anticipated that these investigations may reveal targets for new therapies that may change the clinical management of these conditions. A protocol describing the isolation of human foreskin LECs and lymphatic malformation lymphatic endothelial cells (LM LECs) is presented. To obtain a single cell suspension tissue was minced and enzymatically treated using dispase II and collagenase II. The resulting single cell suspension was then labelled with antibodies to cluster of differentiation (CD) markers CD34, CD31, Vascular Endothelial Growth Factor-3 (VEGFR-3) and PODOPLANIN. Stained viable cells were sorted on a fluorescently activated cell sorter (FACS) to separate the CD34(Low)CD31(Pos)VEGFR-3(Pos)PODOPLANIN(Pos) LM LEC population from other endothelial and non-endothelial cells. The sorted LM LECs were cultured and expanded on fibronectin-coated flasks for further experimental use.
Collapse
Affiliation(s)
- Zerina Lokmic
- Murdoch Childrens Research Institute, The Royal Childrens Hospital; Department of Paediatrics, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne;
| | - Elizabeth S Ng
- Murdoch Childrens Research Institute, The Royal Childrens Hospital; Department of Anatomy and Developmental Biology, Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton
| | - Matthew Burton
- Murdoch Childrens Research Institute, The Royal Childrens Hospital
| | - Edouard G Stanley
- Murdoch Childrens Research Institute, The Royal Childrens Hospital; Department of Paediatrics, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne; Department of Anatomy and Developmental Biology, Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton
| | - Anthony J Penington
- Murdoch Childrens Research Institute, The Royal Childrens Hospital; Department of Paediatrics, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne
| | - Andrew G Elefanty
- Murdoch Childrens Research Institute, The Royal Childrens Hospital; Department of Paediatrics, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne; Department of Anatomy and Developmental Biology, Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton
| |
Collapse
|
14
|
|
15
|
Rockson SG. Laboratory models for the investigation of lymphangiomatosis. Microvasc Res 2014; 96:64-7. [DOI: 10.1016/j.mvr.2014.08.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2014] [Revised: 08/17/2014] [Accepted: 08/21/2014] [Indexed: 10/24/2022]
|
16
|
Soares-Medina AR, López-Gutiérrez JC, Fernández-Pineda I, Vivas G. Association Between Lymphatic Malformations of the Mediastinum and Congenital Venous Ectasia: Is It Just Coincidental? Lymphat Res Biol 2014; 14:30-4. [PMID: 25144764 DOI: 10.1089/lrb.2013.0049] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
The association between lymphatic malformations and congenital venous ectasia is extremely rare, and the relative rarity of both entities makes it difficult to determine the relationship between the two. Here we present four new cases and review the current literature. We hypothesize that there might be a strong association between mediastinal lymphatic malformations and segmental phlebectasia; furthermore, there is a molecular background that may justify the association between these two entities.
Collapse
Affiliation(s)
- A R Soares-Medina
- 1 Vascular Anomalies Center. Department of Pediatric Surgery, La Paz Children's Hospital , Madrid, Spain .,2 Department of Pediatric Surgery, Virgen del Rocío Children's Hospital , Seville, Spain
| | - J C López-Gutiérrez
- 1 Vascular Anomalies Center. Department of Pediatric Surgery, La Paz Children's Hospital , Madrid, Spain
| | - I Fernández-Pineda
- 2 Department of Pediatric Surgery, Virgen del Rocío Children's Hospital , Seville, Spain
| | - G Vivas
- 1 Vascular Anomalies Center. Department of Pediatric Surgery, La Paz Children's Hospital , Madrid, Spain .,2 Department of Pediatric Surgery, Virgen del Rocío Children's Hospital , Seville, Spain
| |
Collapse
|
17
|
Xu Y, Xu D, Chen Z. Giant lymphatic malformations of the mediastinum in children: report of three cases. Clin Imaging 2012; 36:606-8. [PMID: 22920372 DOI: 10.1016/j.clinimag.2011.11.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2011] [Accepted: 11/14/2011] [Indexed: 11/27/2022]
Abstract
Lymphatic malformations are vascular malformations and consist of masses of abnormal lymphatic channels. They are uncommon in the mediastinum. We report three cases of giant mediastinum lymphatic malformations in children. One case developed two episodes of cardiopulmonary arrests, and the other two were first diagnosed and treated as pneumonia. They all recovered well after surgery. The diagnosis is rather important in lymphatic malformations. A delay in diagnosis of mediastinum lymphatic malformation increases the risk of death and prolonged clinical course. Thus, mediastinum lymphatic malformations should be kept in mind as a differential diagnosis of pneumonia and mass in the neck.
Collapse
Affiliation(s)
- Yingchun Xu
- Department of Pulmonology, Children's Hospital, Zhejiang University School of Medicine, Hangzhou 310003, Zhejiang Province, China
| | | | | |
Collapse
|
18
|
Bruder E, Alaggio R, Kozakewich HPW, Jundt G, Dehner LP, Coffin CM. Vascular and perivascular lesions of skin and soft tissues in children and adolescents. Pediatr Dev Pathol 2012; 15:26-61. [PMID: 22420724 DOI: 10.2350/11-11-1119-pb.1] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Vascular anomalies in children and adolescents are the most common soft tissue lesions and include reactive, malformative, and neoplastic tumefactions, with a full spectrum of benign, intermediate, and malignant neoplasms. These lesions are diagnostically challenging because of morphologic complexity and recent changes in classification systems, some of which are based on clinical features and others on pathologic findings. In recent decades, there have been significant advances in clinical diagnosis, development of new therapies, and a better understanding of the genetic aspects of vascular biology and syndromes that include unusual vascular proliferations. Most vascular lesions in children and adolescents are benign, although the intermediate locally aggressive and intermediate rarely metastasizing neoplasms are important to distinguish from benign and malignant mimics. Morphologic recognition of a vasoproliferative lesion is straightforward in most instances, and conventional morphology remains the cornerstone for a specific diagnosis. However, pathologic examination is enhanced by adjunctive techniques, especially immunohistochemistry to characterize the type of vessels involved. Multifocality may cause some uncertainty regarding the assignment of "benign" or "malignant." However, increased interest in vascular anomalies, clinical expertise, and imaging technology have contributed greatly to our understanding of these disorders to the extent that in most vascular malformations and in many tumors, a diagnosis is made clinically and biopsy is not required for diagnosis. The importance of close collaboration between the clinical team and the pathologist cannot be overemphasized. For some lesions, a diagnosis is not possible from evaluation of histopathology alone, and in a subset of these, a specific diagnosis may not be possible even after all assembled data have been reviewed. In such instances, a consensus diagnosis in conjunction with clinical colleagues guides therapy. The purpose of this review is to delineate the clinicopathologic features of vascular lesions in children and adolescents with an emphasis on their unique aspects, use of diagnostic adjuncts, and differential diagnosis.
Collapse
Affiliation(s)
- Elisabeth Bruder
- Institute for Pathology, Hospital of the University of Basel, Basel, Switzerland
| | | | | | | | | | | |
Collapse
|
19
|
Netto ACDM, Oliveira MBD, Bernardes VF, Gomes CC, Gomez RS. Wilms tumor 1 protein is not expressed in oral lymphangiomas. Braz Dent J 2012; 23:707-10. [DOI: 10.1590/s0103-64402012000600014] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2012] [Accepted: 12/05/2012] [Indexed: 03/03/2023] Open
Abstract
Lymphangiomas are benign hamartomatous lesions of lymphatic vessels. Wilms Tumor 1 (WT1) is a transcription factor that is activated in some human neoplasias. WT1 protein expression is observed in endothelial cells during angiogenesis and is a useful marker to distinguish between vascular proliferations and vascular malformations. The purpose of the present study is to report a case series of oral lymphangiomas together with an immunohistochemical investigation of WT1. Seventeen cases of oral lymphangioma were retrieved and reviewed. Immunohistochemical analysis of WT1 protein was performed and pyogenic granuloma samples were used as positive controls. The male/female ratio was 1.125 and most of the lesions occurred in young subjects. While pyogenic granuloma showed positive staining for WT1, the endothelial cells lining the thin-walled dilated lymphatic vessels of lymphangiomas were negative for this protein. The findings strengthen the idea that oral lymphangioma is a vascular malformation characterized by lymphatic dilatation without significant endothelial proliferation.
Collapse
|
20
|
Sun Y, Jia J, Zhang W, Liu B, Zhang Z, Zhao Y. A Reproducible In-vivo Model of Lymphatic Malformation in Rats. J Comp Pathol 2011; 145:390-8. [DOI: 10.1016/j.jcpa.2011.02.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2010] [Revised: 01/01/2011] [Accepted: 02/01/2011] [Indexed: 10/18/2022]
|
21
|
Dai Y, Hou F, Saad A, Fan CY, Buckmiller LM, Suen JY, Richter GT. Preliminary investigation of human lymphatic malformations in vitro. Laryngoscope 2011; 121:2435-42. [DOI: 10.1002/lary.22187] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
|
22
|
Kirsh AL, Cushing SL, Chen EY, Schwartz SM, Perkins JA. Tertiary lymphoid organs in lymphatic malformations. Lymphat Res Biol 2011; 9:85-92. [PMID: 21688977 DOI: 10.1089/lrb.2010.0018] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Examine lymphatic malformation lymphoid aggregates for the expression of tertiary lymphoid organ markers. Determine how lymphoid aggregate density relates to lymphatic malformation clinical features. METHODS AND RESULTS Retrospective cohort study. Tissue and clinical data were reviewed from 29 patients in the Vascular Anomaly Database who represented the spectrum of head and neck lymphatic malformations and had >5 years of follow-up. Archived formalin-fixed, paraffin-embedded lymphatic malformation tissue was immunohistochemically stained with antibodies for tertiary lymphoid organ markers, which included follicular and mature myeloid dendritic cells, high endothelial venules, segregated B and T-cells, lymphatic endothelial cells, and lymphoid homing chemokines (CXCL13, CCL21). Lymphoid aggregate density (count/mm(2)) was quantified by 2 independent, blinded reviewers. Lymphoid aggregate density and lymphatic malformation clinical features were characterized using analysis of variance. Larger lymphatic malformation tissue lymphoid aggregates stained consistently for tertiary lymphoid organ markers. In oral cavity and neck specimens from the same patients (n = 9), there were more tertiary lymphoid organ in oral cavity than in neck specimens (p = 0.0235). In lymphatic malformation neck tissue, de Serres stage 4 lymphatic malformations displayed the highest tertiary lymphoid organ density. No significant association was seen between tertiary lymphoid organ density and other clinical features. CONCLUSION This study demonstrates that some lymphoid aggregates within lymphatic malformations represent tertiary lymphoid organs. There was an association between tertiary lymphoid organ density and lymphatic malformation location. Further study is required to define the role of lymphoid neogenesis and tertiary lymphoid organ formation in lymphatic malformation pathogenesis.
Collapse
Affiliation(s)
- Andrew L Kirsh
- Division of Pediatric Otolaryngology, Seattle Children's Hospital, Washington, USA
| | | | | | | | | |
Collapse
|
23
|
Perkins JA, Manning SC, Tempero RM, Cunningham MJ, Edmonds JL, Hoffer FA, Egbert MA. Lymphatic malformations: Current cellular and clinical investigations. Otolaryngol Head Neck Surg 2010; 142:789-94. [DOI: 10.1016/j.otohns.2010.02.025] [Citation(s) in RCA: 64] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2009] [Revised: 02/18/2010] [Accepted: 02/18/2010] [Indexed: 10/19/2022]
Abstract
Objective: Summarize current knowledge of lymphatic malformation development, biology, and clinical outcome measures. Methods: Panel presentation of lymphatic malformation biology and measurement of head and neck malformation treatment outcomes. Results: Characterization of lymphatic malformation endothelial and stromal cells may lead to biologically based treatment. Traditionally, lymphatic malformation treatment outcomes have been measured according to reduction of malformation size. Currently, methods to measure functional outcomes following lymphatic malformation treatment are lacking. This is particularly apparent when the malformation directly involves the upper aerodigestive tract. Conclusions: The etiology and pathogenesis of head and neck lymphatic malformations are poorly understood, but understanding is improving through ongoing investigation. Reduction of lymphatic malformation size is generally possible, but further work is necessary to optimize methods for measuring therapeutic outcomes in problematic areas.
Collapse
Affiliation(s)
- Jonathan A. Perkins
- Division of Pediatric Otolaryngology–Head and Neck Surgery, Seattle Children's Hospital, Seattle, WA
- Department of Otolaryngology–Head and Neck Surgery, University of Washington, Seattle, WA
| | - Scott C. Manning
- Division of Pediatric Otolaryngology–Head and Neck Surgery, Seattle Children's Hospital, Seattle, WA
- Department of Otolaryngology–Head and Neck Surgery, University of Washington, Seattle, WA
| | | | - Michael J. Cunningham
- Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, and Department of Otology and Laryngology, Harvard Medical School, Boston, MA
| | - Joseph L. Edmonds
- Children's ENT of Houston, Houston, TX
- Department of Otolaryngology and Division of Plastic Surgery, Baylor College of Medicine, Houston, TX
- Department of Otolaryngology, Weill Cornell College of Medicine, New York, NY
- Department of Otolaryngology, University of Texas School of Medicine, Houston, TX
| | - Fredric A. Hoffer
- Department of Radiology, Seattle Children's Hospital, University of Washington, Seattle WA
| | - Mark A. Egbert
- Department of Oral and Maxillofacial Surgery, Dental Medicine, Seattle Children's Hospital, University of Washington, Seattle WA
| |
Collapse
|