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You H, Kim G, Lew H. A novel classification of senile dermatochalasis: insights from clinical and histological analysis. Graefes Arch Clin Exp Ophthalmol 2024:10.1007/s00417-024-06430-z. [PMID: 38446201 DOI: 10.1007/s00417-024-06430-z] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Revised: 02/17/2024] [Accepted: 02/27/2024] [Indexed: 03/07/2024] Open
Abstract
PURPOSE Dermatochalasis is a common disorder of the elderly, often requiring upper blepharoplasty. Although it is mainly accepted as a process of aging, its clinical and histological findings vary among patients. The aim of this study was to classify types of dermatochalasis based on their clinical and histological findings. METHODS This retrospective study included patients with dermatochalasis who had undergone senile blepharoplasty at a single center. Clinical parameters such as margin-to-reflex distance 1 (MRD1), eyelid contour, visual field, and pre-existing medical conditions were assessed. Histological analysis was conducted of eyelid tissues stained with hematoxylin and eosin (H&E) and D2-40 to evaluate dermal edema, inflammation, lymphatic changes, and stromal depth. RESULTS This study included 67 eyes of 35 patients. The mean age of the patients was 69.0 ± 8.3 years, and the average MRD1 was 1.8 ± 1.3 mm. In correlation analysis, two distinct types of dermatochalasis based on the histological findings were identified: lymphangiectasia-dominant and stromal edema-dominant types. The difference between nasal and temporal side MRD1(NT-MRD1) showed the area under the ROC curve of 0.718 of for distinguishing the two histological types of dermatochalasis was 0.718. CONCLUSION Our novel classification of senile dermatochalasis based on morphological and histological analysis provides insights into the underlying pathology and may help to predict surgical outcomes and complications.
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Affiliation(s)
- Heejeong You
- Department of Ophthalmology, CHA Bundang Medical Center, CHA University College of Medicine, Seongnam, Republic of Korea
| | - Gwangil Kim
- Department of Pathology, CHA Bundang Medical Center, CHA University College of Medicine, Seongnam, Republic of Korea
| | - Helen Lew
- Department of Ophthalmology, CHA Bundang Medical Center, CHA University College of Medicine, Seongnam, Republic of Korea.
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2
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Awal S, Regmi PR, Awal L. Misty mesentery, ascites, and bowel wall thickening in a child: Diagnostic clue for intestinal lymphangiectasia. Radiol Case Rep 2023; 18:4032-4035. [PMID: 37680662 PMCID: PMC10480635 DOI: 10.1016/j.radcr.2023.08.034] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Accepted: 08/04/2023] [Indexed: 09/09/2023] Open
Abstract
Primary intestinal lymphangiectasia (PIL) is a rare congenital disorder characterized by lymphatic system obstruction, resulting in the leakage of lymph into the bowel lumen. We present the case of a 6-year-old boy with recurrent diarrhea and weight loss. On examination, bilateral pitting edema in the lower limbs was observed. Laboratory investigations revealed hypoalbuminemia and lymphopenia. Contrast-enhanced CT of the abdomen showed thickening of the jejunum, echogenic fat islands, and enlarged lymph nodes in the mesentery. The diagnosis was confirmed by endoscopic biopsy. The patient was managed with a high-protein diet and replacement of the long-chain triglycerides with medium-chain triglycerides. Gradual improvement in symptoms was observed with regular follow-up. PIL is a protein-losing enteropathy that causes hypoproteinemia, hypolymphopenia, and hypoglobulinemia. PIL usually presents with peripheral edema, weight loss, abdominal pain, and chronic diarrhea. Diagnosis is based on characteristic endoscopic and histopathologic findings. Management involves a multidisciplinary approach, including nutritional modifications, medical therapy, and, in rare cases, surgical resection. PIL remains a challenging diagnosis due to its nonspecific clinical presentation. Clinicians should maintain awareness of this disorder for prompt identification and management.
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Affiliation(s)
- Shila Awal
- Suryabinayak Municipal Hospital, Bhaktapur, Nepal
| | - Pradeep Raj Regmi
- Department of Radiology, Tribhuvan University Teaching Hospital, Kathmandu, Nepal
| | - Lila Awal
- Rangpur Medical College, Rangpur, Bangladesh
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3
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Ospino R, Brookmeyer C. Development of unilateral renal peripelvic lymphangiectasia after renal vein thrombosis. Radiol Case Rep 2023; 18:3690-3694. [PMID: 37601119 PMCID: PMC10432910 DOI: 10.1016/j.radcr.2023.07.075] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2023] [Revised: 07/23/2023] [Accepted: 07/29/2023] [Indexed: 08/22/2023] Open
Abstract
Renal peripelvic lymphangiectasia is a rare entity that can mimic hydronephrosis on routine contrast-enhanced computer tomography (CT). While it may remain asymptomatic, symptomatic cases can exhibit refractory hypertension (HTN) and recurrent abdominal pain. Diagnostic challenges stem from its nonspecific symptoms and imaging characteristics, which can overlap with other renal disorders. Thereby, adequate protocolling of CT or magnetic resonance (MR) imaging is important for accurate diagnosis. In this report, we present a case of renal lymphangiectasia that developed in a medically complex patient following renal vein thrombosis.
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Affiliation(s)
- Rafael Ospino
- Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Claire Brookmeyer
- Russell H. Morgan Department of Radiology, Johns Hopkins School of Medicine, 601 N Caroline St, Baltimore, MD, 21287, USA
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4
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Alhazmi W, Qurban A, Alrashidi E. Case report of generalized lymphatic dysplasia with PIEZO1 mutation and review of the literature. Respir Med Case Rep 2023; 44:101872. [PMID: 37274623 PMCID: PMC10238584 DOI: 10.1016/j.rmcr.2023.101872] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Accepted: 05/11/2023] [Indexed: 06/06/2023] Open
Abstract
Background The newborn malformation of primary lymphatic dysplasia (PLD), developed primarily due to PIEZO1 gene autosomal recessive mutation, is known to hinder with the lymphatic system action, causing chyle or lymph effusion into the peritoneal cavity or pleura. Case presentation A 4-years-old male subject presented with a recurrent chylothorax and bilateral lower limb edema that started at age of 6 months. Lymphoscintigraphy showed lymphangiectasia with chylothorax. The whole exome sequence consisted of Pathogenic variants in PIEZO1 gene associated with lymphatic malformation type 6 (LMPHM6). Conclusion This is the first reported pediatric case of PIEZO1 gene mutation in Saudi Arabia. This case highlighted the wide differential diagnosis of recurrent chylothorax and lower limb edema, as well as the relative literature on the molecular foundation, clinical scale, pathophysiology, and lymphatic malformation treatment. patients can be improved via application of standardized chylothorax and lymphedema therapies. Overall, awareness of the diseases related to the thoracic lymphatic circulation should be observed as its prognosis may highly promote better approaches for its management.
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Affiliation(s)
- Wedad Alhazmi
- Department of Pediatric, Maternity and Children Hospital in Makkah, Saudi Arabia
| | - Afnan Qurban
- Department of Pediatric, Maternity and Children Hospital in Makkah, Saudi Arabia
| | - Essa Alrashidi
- Department of Pediatric, King Saud Medical City in Riyadh, Saudi Arabia
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5
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Safaei F, Sadeghi A, Ketabi Moghadam P, Taheri P. Small Bowel Lymphangiectasia Leading to Massive Gastrointestinal Bleeding: A Case Report. Middle East J Dig Dis 2023; 15:60-62. [PMID: 37547165 PMCID: PMC10404075 DOI: 10.34172/mejdd.2023.322] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Accepted: 12/06/2022] [Indexed: 08/08/2023] Open
Abstract
Lymphangiomas are benign lymphatic system abnormalities that can appear anywhere on the skin and mucous membranes. Lymphangiomas are caused by congenital or acquired lymphatic system disorders. In the congenital form, although the cause is unknown it is said that it is formed by the incorrect attachment of lymphatic channels to the main lymphatic drainage duct before the age of 5 years. lymphangiectasia as a subgroup of lymphangioma occurs seldom in the small bowel, especially in adults. If that happens, protein-losing enteropathy will be the most common presenting sign. In the present study, we introduce a case of a 40-year-old man without a history of any congenital or acquired diseases who was admitted to the emergency room due to long-lasting obscure overt gastrointestinal (GI) bleeding. Normal upper and lower GI endoscopies were suggestive of GI bleeding originating from the small intestine. Despite receiving iron supplements, he continued to have melena and remained anemic. Further evaluation of the small intestine by deep enteroscopy revealed multiple white spots histologically consistent with dilated lymphatics. Intestinal lymphangiectasia was eventually introduced to be the final diagnosis of the patient.
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Affiliation(s)
- Farahnaz Safaei
- Gastroenterology and Liver Diseases Research Center, Research Institute for Gastroenterology and Liver Diseases, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Amir Sadeghi
- Gastroenterology and Liver Diseases Research Center, Research Institute for Gastroenterology and Liver Diseases, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Pardis Ketabi Moghadam
- Gastroenterology and Liver Diseases Research Center, Research Institute for Gastroenterology and Liver Diseases, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Peyman Taheri
- Medical School, Mashhad University of Medical Sciences, Mashhad, Iran
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6
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Tay WC, Chia HY, Cheng SWN. Acquired lymphangioma circumscriptum of the vulva (secondary to lymphatic obstruction) occurring ten years after a hysterectomy and radiotherapy: A case report. Taiwan J Obstet Gynecol 2023; 62:184-186. [PMID: 36720539 DOI: 10.1016/j.tjog.2022.06.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/01/2022] [Indexed: 01/30/2023] Open
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7
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Rapp JB, White AM, Otero HJ, Biko DM. Computed tomography of the airways and lungs in congenital heart disease. Pediatr Radiol 2022; 52:2529-37. [PMID: 34562108 DOI: 10.1007/s00247-021-05186-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Revised: 07/21/2021] [Accepted: 08/12/2021] [Indexed: 10/20/2022]
Abstract
The presence of airway and lung disease in children with congenital heart disease is commonly observed with both cardiac CT angiography and routine chest CT. In this review we discuss abnormalities encountered on CT imaging of the chest beyond the heart and central vasculature, focusing on the airways, lung parenchyma and peripheral vasculature. Preoperative and postoperative findings are reviewed as well.
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8
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Barrera CA, Johnson AM, Rychik J, Biko DM, Degenhardt K, Moldenhauer JS, Victoria T. Prognostic value of the nutmeg lung pattern/ lymphangiectasia on fetal magnetic resonance imaging. Pediatr Radiol 2021; 51:1809-1817. [PMID: 33856503 DOI: 10.1007/s00247-021-05061-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Revised: 02/10/2021] [Accepted: 03/16/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND A nutmeg lung pattern on magnetic resonance imaging (MRI) is an imaging finding associated with pulmonary lymphangiectasia. However, the prognostic value of the nutmeg lung pattern is unknown. OBJECTIVE To evaluate the clinical associations of nutmeg lung indicating lymphangiectasia on fetal lung MRI and its relationship with early mortality in fetuses with primary and secondary lymphangiectasia. MATERIALS AND METHODS We retrospectively identified all pregnant patients with a fetal MRI performed for indication of evaluating for pulmonary lymphangiectasia from 2006 to 2019. Two readers evaluated the fetal MRIs and interobserver agreement was calculated. Multivariable logistic regression models were performed to estimate the association of the echocardiographic findings and the presence of nutmeg lung. Kaplan-Meier and Cox regression analyses were performed to evaluate association with mortality in the first 30 days of life. Survival analysis was defined as mortality or orthotopic heart transplant at 30 days of age. P<0.05 was considered significant. RESULTS Our sample included 53 fetuses. Forty-seven (89%) had congenital heart disease (CHD) and 6 (11%) were diagnosed postnatally with primary lymphangiectasia. Interobserver agreement was 0.83. Pulmonary vein congestion on echocardiography was the strongest predictor of nutmeg lung (odds ratio [OR]=12.0, P=0.002). Ten fetuses reached the outcome of heart transplantation (n=1) or death (n=9) within the first 30 days of life. In fetuses with CHD, survival of those with nutmeg lung was significantly lower than in those without (P<0.001). Nutmeg lung was an independent risk factor for 30-day mortality (hazard ratio [HR]: 6.1, P=0.01). CONCLUSION Nutmeg lung pattern on fetal MRI is an independent risk factor associated with 30-day mortality in fetuses with CHD.
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Affiliation(s)
- Christian A Barrera
- Department of Radiology, Children's Hospital of Philadelphia, 3401 Civic Center Blvd., Philadelphia, PA, 19104, USA.
| | - Ann M Johnson
- Department of Radiology, Children's Hospital of Philadelphia, 3401 Civic Center Blvd., Philadelphia, PA, 19104, USA.,Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Jack Rychik
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.,Division of Cardiology, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - David M Biko
- Department of Radiology, Children's Hospital of Philadelphia, 3401 Civic Center Blvd., Philadelphia, PA, 19104, USA.,Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Karl Degenhardt
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.,Division of Cardiology, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Julie S Moldenhauer
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.,Center for Fetal Diagnosis and Treatment, Children's Hospital of Philadelphia, Philadelphia, PA, USA.,Department of Surgery, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Teresa Victoria
- Department of Radiology, Children's Hospital of Philadelphia, 3401 Civic Center Blvd., Philadelphia, PA, 19104, USA.,Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
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9
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Silvestre-Torner N, Imbernón-Moya A, Martínez-García M, Burgos-Lázaro F. Acquired Cutaneous Lymphangiectasia: Dermoscopic Evidence from White-Yellowish Lacunae. Dermatol Pract Concept 2021; 11:e2021062. [PMID: 34414012 DOI: 10.5826/dpc.1103a62] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/10/2020] [Indexed: 10/31/2022] Open
Affiliation(s)
- Nicolás Silvestre-Torner
- Department of Dermatology. Hospital Universitario Severo Ochoa. Avenida de Orellana, Leganés, Madrid, Spain
| | - Adrián Imbernón-Moya
- Department of Dermatology. Hospital Universitario Severo Ochoa. Avenida de Orellana, Leganés, Madrid, Spain
| | - Marta Martínez-García
- Department of Dermatology. Hospital Universitario Severo Ochoa. Avenida de Orellana, Leganés, Madrid, Spain
| | - Fernando Burgos-Lázaro
- Department of Pathology. Hospital Universitario Severo Ochoa. Avenida de Orellana, Leganés, Madrid, Spain
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10
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El Haddar Z, Sbia Y, Rkain M, Benajiba N, Babakhouya A. Complicated primary intestinal lymphangiectasia (Waldmann's disease) in a child successfully treated with octreotide: A case report from a low-resource setting. Ann Med Surg (Lond) 2021; 68:102588. [PMID: 34401115 DOI: 10.1016/j.amsu.2021.102588] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Revised: 07/18/2021] [Accepted: 07/25/2021] [Indexed: 12/17/2022] Open
Abstract
Introduction and importance The primary intestinal lymphangiectasia is a rare exudative enteropathy of unknown etiology that affects the lymphatic system. It causes lymphedema and malabsorption syndrome by the escape of the lymph and its elements into the intestinal lumen. Case presentation A female patient, diagnosed at the age of 11 with Waldmann's disease, has initially manifested chronic diarrhea with a stature-ponderal delay at the age of 6 months old; she was treated for a long time as celiac disease patient. Edematous syndrome, chronic diarrhea, staturo-ponderal delay and asymmetric lymphedema of the upper limb are the main clinical symptoms in this case. In addition, the exclusion of secondary intestinal lymphangiectasia was important for the diagnosis. Before and during her follow-up, the patient presented two complications of the disease: warts and osteomalacia. The patient did not respond to treatment with the low-fat diet; therefore, the need to add treatment with octreotide was necessary, which has given quite pleasant results. Octreotide was the therapeutic choice to treat the patient as she was resistant to the appropriate regimen with clinical improvement; nevertheless, certain biological elements of lymphatic leakage persisted. Discussion Waldmann's disease is rare. It can be responsible, besides the typical signs, for complications including warts and osteomalacia. The histopathological study of intestinal biopsies may be normal if lymphangiectasias are localized. The treatment is based on a nutritional diet associated with octreotide. During the patient's follow-up, the evolution after almost two years of the introduction of octreotide compared to the diet alone showed improved outcomes. Conclusion The treatment of Waldmann's disease is based on an adapted diet and octreotide. This case highlighted the importance of the long term follow-up in this disease. Waldmann's disease is a rare entity of unknown etiopathogenesis that affects the lymphatic system. It causes lymphedema and malabsorption syndrome by an escape of the lymph into the intestinal lumen. Octreotide associated to an appropriate nutritional regimen improves outcomes.
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11
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Zhang L, Ocansey DKW, Liu L, Olovo CV, Zhang X, Qian H, Xu W, Mao F. Implications of lymphatic alterations in the pathogenesis and treatment of inflammatory bowel disease. Biomed Pharmacother 2021; 140:111752. [PMID: 34044275 DOI: 10.1016/j.biopha.2021.111752] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Revised: 05/06/2021] [Accepted: 05/19/2021] [Indexed: 02/07/2023] Open
Abstract
Inflammatory bowel disease (IBD) is characterized by intense immune dysregulation, gut microbiota imbalance, and intestinal epithelium destruction. Among the factors that contribute to the pathogenesis of IBD, lymphatics have received less attention, hence less studied, characterized, and explored. However, in recent years, the role of the lymphatic system in gastrointestinal pathophysiology continues to be highlighted. This paper examines the implications of lymphatic changes in IBD pathogenesis related to immune cells, gut microbiota, intestinal and mesenteric epithelial barrier integrity, and progression to colorectal cancer (CRC). Therapeutic targets of lymphatics in IBD studies are also presented. Available studies indicate that lymph nodes and other secondary lymphatic tissues, provide highly specialized microenvironments for mounting effective immune responses and that lymphatic integrity plays a significant role in small intestine homeostasis, where the lymphatic vasculature effectively controls tissue edema, leukocyte exit, bacterial antigen, and inflammatory chemokine clearance. In IBD, there are functional and morphological alterations in intestinal and mesenteric lymphatic vessels (more profoundly in Crohn's disease [CD] compared to ulcerative colitis [UC]), including lymphangiogenesis, lymphangiectasia, lymphadenopathy, and lymphatic vasculature blockade, affecting not only immunity but gut microbiota and epithelial barrier integrity. While increased lymphangiogenesis is primarily associated with a good prognosis of IBD, increased lymphangiectasia, lymphadenopathy, and lymphatic vessel occlusion correlate with poor prognosis. IBD therapies that target the lymphatic system seek to increase lymphangiogenesis via induction of lymphangiogenic factors and inhibition of its antagonists. The resultant increased lymphatic flow coupled with other anti-inflammatory activities restores gut homeostasis.
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Affiliation(s)
- Lu Zhang
- Key Laboratory of Medical Science and Laboratory Medicine of Jiangsu Province, School of Medicine, Jiangsu University, Zhenjiang 212013, Jiangsu, PR China
| | - Dickson Kofi Wiredu Ocansey
- Key Laboratory of Medical Science and Laboratory Medicine of Jiangsu Province, School of Medicine, Jiangsu University, Zhenjiang 212013, Jiangsu, PR China; Directorate of University Health Services, University of Cape Coast, Cape Coast, Ghana
| | - Lianqin Liu
- Key Laboratory of Medical Science and Laboratory Medicine of Jiangsu Province, School of Medicine, Jiangsu University, Zhenjiang 212013, Jiangsu, PR China
| | - Chinasa Valerie Olovo
- Key Laboratory of Medical Science and Laboratory Medicine of Jiangsu Province, School of Medicine, Jiangsu University, Zhenjiang 212013, Jiangsu, PR China; Department of Microbiology, University of Nigeria, Nsukka 410001, Nigeria
| | - Xu Zhang
- Key Laboratory of Medical Science and Laboratory Medicine of Jiangsu Province, School of Medicine, Jiangsu University, Zhenjiang 212013, Jiangsu, PR China
| | - Hui Qian
- Key Laboratory of Medical Science and Laboratory Medicine of Jiangsu Province, School of Medicine, Jiangsu University, Zhenjiang 212013, Jiangsu, PR China
| | - Wenrong Xu
- Key Laboratory of Medical Science and Laboratory Medicine of Jiangsu Province, School of Medicine, Jiangsu University, Zhenjiang 212013, Jiangsu, PR China
| | - Fei Mao
- Key Laboratory of Medical Science and Laboratory Medicine of Jiangsu Province, School of Medicine, Jiangsu University, Zhenjiang 212013, Jiangsu, PR China.
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12
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Ishida A, Yamane Y, Koyama Y, Honda M, Kondo M, Murakawa Y, Tanito M. Conjunctival Chemosis and Annular Ciliochoroidal Detachments Detected by Anterior-Segment Optical Coherence Tomography in a Case of Systemic Lupus Erythematosus. Case Rep Ophthalmol 2021; 12:154-158. [PMID: 33976674 PMCID: PMC8077491 DOI: 10.1159/000514527] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Accepted: 01/17/2021] [Indexed: 11/21/2022] Open
Abstract
A 61-year-old Japanese woman presented to our hospital for treatment of systemic serositis associated with systemic lupus erythematosus (SLE). At the initial ophthalmologic examination, her best-corrected visual acuity was 1.2 and 0.6 in her right and left eyes, respectively. Slit-lamp examination showed marked chemosis in both eyes (OU). Swept source-based, anterior-segment optical coherence tomography (AS-OCT) clearly showed conjunctival elevations corresponding to the chemosis in all scan directions OU. In some scans, hyporeflective spaces with luminal structures corresponding to dilated lymphatic channels and nonluminal structures corresponding to interstitial fluid accumulation were seen clearly under the conjunctival epithelium and/or in the parenchyma. In all scan directions, the supraciliary space was seen clearly, suggesting the presence of an annular ciliochoroidal detachment. Fundus examinations showed retinal edema temporal to the optic nerve head and subfoveal serous retinal detachments OU. Ocular effusions resolved by 2 weeks after the start of steroid pulse therapy, and pleural effusions and ascites resolved and pericardial effusion decreased by 2 months. AS-OCT can be useful for understanding the mechanism(s) of the less common anterior-segment ocular manifestations of SLE.
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Affiliation(s)
- Akiko Ishida
- Department of Ophthalmology, Shimane University Faculty of Medicine, Izumo, Japan
| | - Yukari Yamane
- Department of Ophthalmology, Shimane University Faculty of Medicine, Izumo, Japan
| | - Yasurou Koyama
- Department of Ophthalmology, Shimane University Faculty of Medicine, Izumo, Japan
| | - Manabu Honda
- Department of Rheumatology, Shimane University Faculty of Medicine, Izumo, Japan
| | - Masahiro Kondo
- Department of Rheumatology, Shimane University Faculty of Medicine, Izumo, Japan
| | - Yohko Murakawa
- Department of Rheumatology, Shimane University Faculty of Medicine, Izumo, Japan
| | - Masaki Tanito
- Department of Ophthalmology, Shimane University Faculty of Medicine, Izumo, Japan
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13
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Kumar R, Anand U, Priyadarshi RN. Lymphatic dysfunction in advanced cirrhosis: Contextual perspective and clinical implications. World J Hepatol 2021; 13:300-314. [PMID: 33815674 PMCID: PMC8006079 DOI: 10.4254/wjh.v13.i3.300] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Revised: 01/31/2021] [Accepted: 03/10/2021] [Indexed: 02/06/2023] Open
Abstract
The lymphatic system plays a very important role in body fluid homeostasis, adaptive immunity, and the transportation of lipid and waste products. In patients with liver cirrhosis, capillary filtration markedly increases, primarily due to a rise in hydrostatic pressure, leading to enhanced production of lymph. Initially, lymphatic vasculature expansion helps to prevent fluid from accumulating by returning it back to the systemic circulation. However, the lymphatic functions become compromised with the progression of cirrhosis and, consequently, the lymphatic compensatory mechanism gets overwhelmed, contributing to the development and eventual worsening of ascites and edema. Neurohormonal changes, low-grade chronic inflammation, and compounding effects of predisposing factors such as old age, obesity, and metabolic syndrome appear to play a significant role in the lymphatic dysfunction of cirrhosis. Sustained portal hypertension can contribute to the development of intestinal lymphangiectasia, which may rupture into the intestinal lumen, resulting in the loss of protein, chylomicrons, and lymphocyte, with many clinical consequences. Rarely, due to high pressure, the rupture of the subserosal lymphatics into the abdomen results in the formation of chylous ascites. Despite being highly significant, lymphatic dysfunctions in cirrhosis have largely been ignored; its mechanistic pathogenesis and clinical implications have not been studied in depth. No recommendation exists for the diagnostic evaluation and therapeutic strategies, with respect to lymphatic dysfunction in patients with cirrhosis. This article discusses the perspectives and clinical implications, and provides insights into the management strategies for lymphatic dysfunction in patients with cirrhosis.
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Affiliation(s)
- Ramesh Kumar
- Department of Gastroenterology, All India Institute of Medical Sciences, Patna 801507, Bihar, India
| | - Utpal Anand
- Department of Surgical Gastroenterology, All India Institute of Medical Sciences, Patna 801507, Bihar, India
| | - Rajeev Nayan Priyadarshi
- Department of Radiodiagnosis, All India Institute of Medical Sciences, Patna 801507, Bihar, India
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14
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Barrera CA, Victoria T, Escobar FA, Krishnamurthy G, Smith CL, Moldenhauer JS, Biko DM. Imaging of fetal lymphangiectasias: prenatal and postnatal imaging findings. Pediatr Radiol 2020; 50:1872-1880. [PMID: 33252755 DOI: 10.1007/s00247-020-04673-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2019] [Revised: 02/25/2020] [Accepted: 03/31/2020] [Indexed: 12/22/2022]
Abstract
Lymphangiectasias are lymphatic malformations characterized by the abnormal dilation and morphology of the lymphatic channels. The classification and treatment of these disorders can be challenging given the limited amount of literature available in children. Various imaging modalities are used to confirm suspected diagnosis, plan the most appropriate treatment, and estimate a prognosis. Prenatal evaluation is performed using both prenatal US imaging and fetal MRI. These modalities are paramount for appropriate parental counseling and planning of perinatal care. During the neonatal period, chest US imaging is a useful modality to evaluate pulmonary lymphangiectasia because other modalities such as conventional radiography and CT display nonspecific findings. Finally, the recent breakthroughs in lymphatic imaging with MRI have allowed us to better classify lymphatic disorders. Dynamic contrast-enhanced lymphangiography, conventional lymphangiography and percutaneous lymphatic procedures offer static and dynamic evaluation of the central conducting lymphatics in children, with excellent spatial resolution and the possibility to provide treatment. The purpose of this review is to discuss the normal and abnormal development of the fetal lymphatic system and how to best depict it by imaging during the prenatal and postnatal life.
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Affiliation(s)
- Christian A Barrera
- Department of Radiology, Children's Hospital of Philadelphia,, 3401 Civic Center Blvd., Philadelphia, PA, 19104, USA.
| | - Teresa Victoria
- Department of Radiology, Children's Hospital of Philadelphia,, 3401 Civic Center Blvd., Philadelphia, PA, 19104, USA
| | - Fernando A Escobar
- Department of Radiology, Section of Interventional Radiology, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Ganesh Krishnamurthy
- Department of Radiology, Section of Interventional Radiology, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Christopher L Smith
- Division of Cardiology, Children's Hospital of Philadelphia, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Julie S Moldenhauer
- Center for Fetal Diagnosis and Treatment,, Children's Hospital of Philadelphia, Philadelphia, PA, USA
- Department of Surgery, Perelman School of Medicine,, University of Pennsylvania, Philadelphia, PA, USA
| | - David M Biko
- Department of Radiology, Children's Hospital of Philadelphia,, 3401 Civic Center Blvd., Philadelphia, PA, 19104, USA
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15
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Abstract
Canine protein-losing enteropathies occur commonly in small animal practice, and their management is often challenging with a long-term survival rate of only about 50%. Recent studies have investigated prognostic factors that may determine outcome in individual cases. In particular, systemic complications such as hypercoagulability, vitamin D3 deficiency, and tryptophan deficiency may play an important role and should be investigated in severely affected cases in order to maximize outcome.
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Affiliation(s)
- Karin Allenspach
- Veterinary Clinical Sciences, College of Veterinary Medicine, Iowa State University, 1809 South Riverside Drive, Ames, IA 50010, USA.
| | - Chelsea Iennarella-Servantez
- Veterinary Clinical Sciences, College of Veterinary Medicine, Iowa State University, 1809 South Riverside Drive, Ames, IA 50010, USA
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16
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AbdullGaffar B, Bashir M. Patterns of Mycobacterium avium-intracellulare complex infection in duodenal endoscopic biopsies in HIV/AIDS patients. Ann Diagn Pathol 2020; 49:151638. [PMID: 33069083 DOI: 10.1016/j.anndiagpath.2020.151638] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Revised: 09/01/2020] [Accepted: 09/27/2020] [Indexed: 11/25/2022]
Abstract
Mycobacterium avium-intracellulare complex (MAIC) is a nontuberculous opportunistic infection in immunocompromised patients. Involvement of the gastrointestinal tract (GIT) is usually part of a disseminated disease in AIDS patients with a low CD4 count, however with standard antiretroviral therapy (ART), a localized presentation is more likely. It can affect any part of the GIT, mostly the duodenum and typically as patches. Incomplete or refractory ART for HIV-strains, therapy-related side effects, noncompliant or incomplete treatment to previous MAIC infections, superimposed complications and comorbid opportunistic infections may result in atypical clinical, endoscopic and histopathologic manifestations. We performed a retrospective review study retrieving cases of MAIC in duodenal endoscopic biopsy. We found five cases of MAIC in HIV/AIDS patients. They were males with an average age of 40-years. They showed different histopathologic features, variable patterns of MAIC-histiocytic infiltrates, and varying intensity of intracellular acid-fast positive bacilli. Enterocytes vacuolization and transepithelial elimination were also observed. Three cases were associated with cytomegalovirus and cryptococcal infections. A case was complicated by lymphangiectasia-associated protein-losing enteropathy. Initially, three cases were morphologically missed. Ziehl-Neelsen stain helped reach the correct diagnosis. Pathologists have an important role in patients' management by guiding clinicians to the correct diagnosis. Pathologists should be aware of these different histopathologic manifestations, their potential pitfalls, look for certain helpful clues complemented with multiple levels and special stains. In particular, AFB stains are mandatory in all mucosal biopsy specimens from HIV/AIDS patients regardless of their appearances.
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Affiliation(s)
| | - Mohamed Bashir
- Gastroenterology Unit, Rashid Hospital, Dubai, United Arab Emirates
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17
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Martiano M, Chantalat L, Simon M, Fourgeaud C, Vignes S. Des vésicules cutanées. Rev Med Interne 2020; 41:637-638. [PMID: 32359817 DOI: 10.1016/j.revmed.2020.03.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2020] [Accepted: 03/06/2020] [Indexed: 11/17/2022]
Affiliation(s)
- M Martiano
- Unité de Lymphologie, site constitutif du Centre national de référence des maladies vasculaires rares (lymphœdèmes primaires), Hôpital Cognacq-Jay, 15 rue Eugène Millon, 75015 Paris, France
| | - L Chantalat
- Unité de Lymphologie, site constitutif du Centre national de référence des maladies vasculaires rares (lymphœdèmes primaires), Hôpital Cognacq-Jay, 15 rue Eugène Millon, 75015 Paris, France
| | - M Simon
- Unité de Lymphologie, site constitutif du Centre national de référence des maladies vasculaires rares (lymphœdèmes primaires), Hôpital Cognacq-Jay, 15 rue Eugène Millon, 75015 Paris, France
| | - C Fourgeaud
- Unité de Lymphologie, site constitutif du Centre national de référence des maladies vasculaires rares (lymphœdèmes primaires), Hôpital Cognacq-Jay, 15 rue Eugène Millon, 75015 Paris, France
| | - S Vignes
- Unité de Lymphologie, site constitutif du Centre national de référence des maladies vasculaires rares (lymphœdèmes primaires), Hôpital Cognacq-Jay, 15 rue Eugène Millon, 75015 Paris, France.
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18
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Uzzo RN, Bloom E, Peters A, Parab M, Masic S, Kutikov A. Refractory hypertension due to unilateral renal lymphangiectasia: An uncommon case with a surgical solution. Urol Case Rep 2020; 32:101177. [PMID: 32322527 PMCID: PMC7171455 DOI: 10.1016/j.eucr.2020.101177] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Accepted: 03/26/2020] [Indexed: 11/23/2022] Open
Abstract
We describe a case of unilateral renal lymphangiectasia (RLM) in a 30-year-old male with severe, refractory hypertension (HTN) and end-organ effects despite five anti-hypertensives. After diagnostic testing, the patient ultimately underwent a successful right laparoscopic nephrectomy with significant improvement of HTN. We review the literature regarding the pathophysiology and management strategies of HTN in patients with renal lymphangiectasia. Renal lymphangiectasia (RLM) is an uncommon cause of secondary hypertension. RLM is diagnosed using conventional imaging which notes dilated perinephric and/or peri-pelvic lymphatic channels. RLM is believed to be an uncommon benign and congenital developmental malformation of the renal sinus lymphatics. Clinically the condition is most often asymptomatic, but symptoms may include flank pain, hematuria, ascites, weight loss, HTN, or other vague constitutional symptoms. Antihypertensive therapy is the mainstay of treatment, but refractory drainage and/or nephrectomy may improve BP control.
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Affiliation(s)
- Robert N Uzzo
- Department of Surgery, Division of Urology, Fox Chase Cancer Center - Temple University Health System, USA
| | - Evan Bloom
- Department of Surgery, Division of Urology, Fox Chase Cancer Center - Temple University Health System, USA
| | - Andrew Peters
- Division of Cardiology, Heart and Vascular Institute - Temple University Health System, USA
| | - Meena Parab
- Department of Anatomic Pathology, Fox Chase Cancer Center - Temple University Health System, USA
| | - Selma Masic
- Department of Surgery, Division of Urology, Fox Chase Cancer Center - Temple University Health System, USA
| | - Alexander Kutikov
- Department of Surgery, Division of Urology, Fox Chase Cancer Center - Temple University Health System, USA
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19
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Leducq S, Caille A, Barbarot S, Bénéton N, Bessis D, Boccara O, Bursztejn AC, Chiaverini C, Dompmartin A, Droitcourt C, Gissot V, Goga D, Guibaud L, Herbreteau D, Le Touze A, Léauté-Labrèze C, Lorette G, Mallet S, Martin L, Mazereeuw-Hautier J, Phan A, Plantin P, Quéré I, Vabres P, Bourgoin H, Giraudeau B, Maruani A. Topical sirolimus 0.1% for treating cutaneous microcystic lymphatic malformations in children and adults (TOPICAL): protocol for a multicenter phase 2, within-person, randomized, double-blind, vehicle-controlled clinical trial. Trials 2019; 20:739. [PMID: 31847908 PMCID: PMC6918625 DOI: 10.1186/s13063-019-3767-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2019] [Accepted: 09/29/2019] [Indexed: 12/12/2022] Open
Abstract
Background Cutaneous microcystic lymphatic malformations (CMLMs) are rare conditions in children and adults. They present as clusters of vesicles full of lymph and blood to various extents, inducing maceration, esthetic impairment, pain, and impaired quality of life. The treatment is challenging. Sirolimus is an inhibitor of mammalian target of rapamycin (mTOR) involved in angio-lymphangiogenesis. Topical sirolimus has recently been reported as effective in a few reports of patients with CMLMs. The objective is to compare the efficacy and safety of a 12-week application of 0.1% topical sirolimus versus topical vehicle in CMLMs in children and adults. Methods This French blinded multicenter within-person randomized controlled phase 2 trial aims to include 55 patients aged ≥ 6 years who have a primary CMLM. The CMLM will be divided into two equal areas that will be randomly allocated to 0.1% topical sirolimus or topical vehicle applied for 12 weeks. At the end of the 12-week period, the patient/parent will treat the whole area of CMLM with 0.1% topical sirolimus on remaining lesions, for eight more weeks. Patients will be seen at week 20 (treatment will be stopped) and at month 12 to evaluate long-term efficacy. The primary outcome will be improvement of the CMLM in the area treated with topical sirolimus compared to the area treated with topical vehicle by the investigator physician (blinded to the treatment) with the Physician Global Assessment score at week 12. Secondary outcomes will include: assessment of efficacy by independent experts on the basis of standardized photographs; impact on quality of life; efficacy for oozing, bleeding, erythema, and thickness evaluated by the investigators; and global efficacy as well as efficacy for functional and aesthetic impairment evaluated by the patient. Systemic passage of sirolimus will be measured at weeks 6, 12, and 20, and at week 16 for CMLMs ≥ 900 cm2. Discussion For patients with CMLMs, topical sirolimus could be a non-invasive and well-tolerated therapeutic option. If the trial demonstrates efficacy and safety of this treatment, this result will lead to a real change in the management of this condition, and 0.1% sirolimus cream would become the first-line treatment. Trial registration ClinicalTrials.gov, NCT03972592. Registered on 3 June 2019. EU Clinical Trials Register EudraCT, 2018–001359-11.
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Affiliation(s)
- Sophie Leducq
- INSERM U1246 -SPHERE « MethodS in Patients-centered outcomes and HEalth REsearch », University of Nantes, University of Tours, 37000, Tours, France. .,Department of Dermatology and Reference Center for Rare Diseases and Vascular Malformations (MAGEC), CHRU Tours, Avenue de la République, 37044, Tours, Cedex 9, France. .,Clinical Investigation Center, INSERM 1415, CHRU Tours, 37000, Tours, France.
| | - Agnès Caille
- INSERM U1246 -SPHERE « MethodS in Patients-centered outcomes and HEalth REsearch », University of Nantes, University of Tours, 37000, Tours, France.,Clinical Investigation Center, INSERM 1415, CHRU Tours, 37000, Tours, France
| | - Sébastien Barbarot
- Department of Dermatology, University Hospital Center of Nantes, 44000, Nantes, France
| | - Nathalie Bénéton
- Department of Dermatology, Hospital Center of le Mans, 72037, le Mans, France
| | - Didier Bessis
- Department of Dermatology, University Hospital Center of Montpellier, 34000, Montpellier, France
| | - Olivia Boccara
- Department of Dermatology and Reference center for genodermatoses and rare skin diseases (MAGEC), University Hospital Necker-Enfants Malades, 75015, Paris, France
| | - Anne-Claire Bursztejn
- Department of Dermatology, University Hospital Center of Nancy, 54000, Nancy, France
| | - Christine Chiaverini
- Department of Dermatology, University Hospital Center of Nice, 06000, Nice, France
| | - Anne Dompmartin
- Department of Dermatology, University Hospital Center of Caen, 54000, Caen, France
| | - Catherine Droitcourt
- Department of Dermatology, University Hospital Center of Rennes, 35000, Rennes, France
| | - Valérie Gissot
- Clinical Investigation Center, INSERM 1415, CHRU Tours, 37000, Tours, France
| | - Dominique Goga
- Department of Maxillo-Facial surgery, CHRU Tours, 37044, Tours, Cedex 9, France
| | - Laurent Guibaud
- University Hospital Center of Lyon, Consultation Multidisciplinaire Lyonnaise des Angiomes, 69229, Lyon, Cedex 2, France
| | | | - Anne Le Touze
- Department of Pediatric Surgery, CHRU Tours, 37000, Tours, France
| | | | - Gérard Lorette
- Department of Dermatology and Reference Center for Rare Diseases and Vascular Malformations (MAGEC), CHRU Tours, Avenue de la République, 37044, Tours, Cedex 9, France
| | - Stéphanie Mallet
- Department of Dermatology, University Hospital Center of Marseille, 13885, Marseille, Cedex 5, France
| | - Ludovic Martin
- Department of Dermatology, University Hospital Center of Angers, 49000, Angers, France
| | - Juliette Mazereeuw-Hautier
- Reference center for rare skin diseases, Department of Dermatology, University Hospital Center of Toulouse, Paul Sabatier University, 31059, Toulouse, France
| | - Alice Phan
- Department of Dermatology, University Hospital Center of Lyon, 69229, Lyon, Cedex 2, France
| | - Patrice Plantin
- Department of Dermatology, Hospital Center of Quimper, 29107, Quimper, France
| | - Isabelle Quéré
- Departement of Vascular Medicine, National Reference Centre for Rare Vascular Diseases, EA 2992 Research Team, University of Montpellier, University Hospital Center of Montpellier, 34000, Montpellier, France
| | - Pierre Vabres
- Department of Dermatology, University Hospital Center of Dijon, 21000, Dijon, France
| | - Hélène Bourgoin
- Department of Pharmacy, University Hospital Center of Tours, 37000, Tours, France
| | - Bruno Giraudeau
- INSERM U1246 -SPHERE « MethodS in Patients-centered outcomes and HEalth REsearch », University of Nantes, University of Tours, 37000, Tours, France.,Clinical Investigation Center, INSERM 1415, CHRU Tours, 37000, Tours, France
| | - Annabel Maruani
- INSERM U1246 -SPHERE « MethodS in Patients-centered outcomes and HEalth REsearch », University of Nantes, University of Tours, 37000, Tours, France. .,Department of Dermatology and Reference Center for Rare Diseases and Vascular Malformations (MAGEC), CHRU Tours, Avenue de la République, 37044, Tours, Cedex 9, France. .,Clinical Investigation Center, INSERM 1415, CHRU Tours, 37000, Tours, France.
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20
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Macki M, Anand SK, Jaratli H, Dabaja AA. Penile Lymphangioma: review of the literature with a case presentation. Basic Clin Androl 2019; 29:1. [PMID: 30705756 PMCID: PMC6348653 DOI: 10.1186/s12610-018-0081-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2018] [Accepted: 12/05/2018] [Indexed: 11/10/2022] Open
Abstract
Background Penile lymphangiomas are rare manifestations of lymphangiomas or lymphatic malformations which are more commonly found in the head or neck region of the body. Lymphangiomas are further categorized as lymphangioma circumscriptum, cavernous lymphangioma, cystic hygroma, or acquired lymphangiomas (also known as lymphangiectasia), based on their depth and etiology. Results A literature review revealed only 30 cases of penile lymphangioma between 1947 and March 30, 2018. Several causes were attributed to the acquired penile lymphangiomas, including trauma, phimosis, and infection. While penile lymphangiomas can be initially mistaken for an infection, a thorough history and physical examination is sufficient to clinically diagnose a lymphangioma of the penis. Historically, surgical excision has been the gold standard of treatment for this condition. When asymptomatic, patients may opt for conservative management with avoidance of mechanical trauma alone. Other physicians have revealed novel treatment plans to rid patients of their penile lymphangioma such as a staged laser procedure. Conclusion In this article, we elucidate the causes, symptoms, treatments, and outcomes associated with penile lymphangiomas found in the literature while also presenting the case of a 30-year-old African-American man diagnosed with acquired penile lymphangioma.
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Affiliation(s)
- Mohamed Macki
- Department of Neurosurgery, Henry Ford Hospital, 2799 West Grand Blvd, Detroit, MI 48202 USA
| | - Sharath Kumar Anand
- Department of Neurosurgery, Henry Ford Hospital, 2799 West Grand Blvd, Detroit, MI 48202 USA
| | - Hayan Jaratli
- Department of Pathology, Henry Ford Hospital, 2799 West Grand Blvd, Detroit, MI 48202 USA
| | - Ali A Dabaja
- 3Department of Vattikuti Urology Institute, Henry Ford Hospital, 2799 West Grand Blvd, Detroit, MI 48202 USA
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21
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Naymagon L, Ward S, Naymagon S, Navada S. Severe Protein-Losing Enteropathy Due to an Indolent Splenic Lymphoma: Case Report and Review of the Literature. Clin Lymphoma Myeloma Leuk 2019; 19:e165-e168. [PMID: 30685184 DOI: 10.1016/j.clml.2018.12.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/29/2018] [Revised: 12/20/2018] [Accepted: 12/26/2018] [Indexed: 11/28/2022]
Affiliation(s)
- Leonard Naymagon
- Department of Medicine, Division of Hematology and Medical Oncology, Icahn School of Medicine at Mount Sinai, New York, NY.
| | - Stephen Ward
- Department of Pathology, Molecular and Cell-Based Medicine, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Steven Naymagon
- Department of Medicine, Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Shyamala Navada
- Department of Medicine, Division of Hematology and Medical Oncology, Icahn School of Medicine at Mount Sinai, New York, NY
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22
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Soumah M, El Mouhadi S, Becker C, Arrivé L. Primary chylous vaginal discharge demonstrated with noncontrast magnetic resonance lymphography. Int J Gynaecol Obstet 2017; 138:229-230. [PMID: 28475249 DOI: 10.1002/ijgo.12198] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2017] [Revised: 03/16/2017] [Accepted: 05/02/2017] [Indexed: 11/09/2022]
Affiliation(s)
- Mariam Soumah
- Sorbonne Universités, UPMC Université Paris 06, Faculté de Médecine Pierre et Marie Curie, Paris, France.,Department of Radiology, Saint-Antoine Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Sanaâ El Mouhadi
- Sorbonne Universités, UPMC Université Paris 06, Faculté de Médecine Pierre et Marie Curie, Paris, France.,Department of Radiology, Saint-Antoine Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Corinne Becker
- Department of Thoracic Surgery, Hôpital Européen Georges Pompidou, Paris, France
| | - Lionel Arrivé
- Sorbonne Universités, UPMC Université Paris 06, Faculté de Médecine Pierre et Marie Curie, Paris, France.,Department of Radiology, Saint-Antoine Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
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23
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Abstract
The thoracic lymphatic disorders are a heterogeneous group of uncommon conditions that are associated with thoracic masses, interstitial pulmonary infiltrates, and chylous complications. Accurate diagnosis of the thoracic lymphatic disorders has important implications for the newest approaches to management, including embolization and treatment with antilymphangiogenic drugs. New imaging techniques to characterize lymphatic flow, such as dynamic contrast-enhanced magnetic resonance lymphangiogram, are redefining approaches to disease classification and therapy.
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Affiliation(s)
- Maxim Itkin
- Interventional Radiology, Hospital of the University of Pennsylvania, Penn Medicine, 1 Silverstein, 3400 Spruce Street, Philadelphia, PA 19104, USA.
| | - Francis X McCormack
- Division of Pulmonary, Critical Care and Sleep Medicine, University of Cincinnati, MSB 6165, 231 Albert Sabin Way, Cincinnati, OH 45267-0564, USA
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24
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Saul D, Degenhardt K, Iyoob SD, Surrey LF, Johnson AM, Johnson MP, Rychik J, Victoria T. Hypoplastic left heart syndrome and the nutmeg lung pattern in utero: a cause and effect relationship or prognostic indicator? Pediatr Radiol 2016; 46:483-9. [PMID: 26691156 DOI: 10.1007/s00247-015-3514-6] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2015] [Revised: 10/25/2015] [Accepted: 11/13/2015] [Indexed: 01/15/2023]
Abstract
BACKGROUND Hypoplastic left heart syndrome (HLHS) is the third most common cause of critical congenital heart disease in newborns, and one of the most challenging forms to treat. Secondary pulmonary lymphangiectasia has been recognized in association with HLHS, an appearance described on fetal MRI as the "nutmeg lung." OBJECTIVE To investigate the association of fetal nutmeg lung with HLHS survival. MATERIALS AND METHODS A retrospective search of the fetal MRI database was performed. The nutmeg lung pattern was defined as T2 heterogeneous signal with tubular structures radiating peripherally from the hila. Postnatal echocardiograms and charts were reviewed. RESULTS Forty-four fetal MR studies met inclusion criteria, of which 4 patients (9%) had the nutmeg lung pattern and 3 of whom also had restrictive lesions. Mortality in this nutmeg lung group was 100% by 5 months of age. Of the 40 patients without nutmeg lung, mortality/orthotopic heart transplant (OHT) was 35%. Of these 40 patients without nutmeg lung, 5 had restriction on echo, 3 of whom died/had OHT before 5 months of age (60% of patients with restriction and non-nutmeg lung). There was a significantly higher incidence of restrictive lesions (P = 0.02) and mortality/OHT (P = 0.02) in patients with nutmeg lung compared to those without. CONCLUSION The nutmeg lung MR appearance in HLHS fetuses is associated with increased mortality/OHT (100% in the first 5 months of life compared to 35% with HLHS alone). Not all patients with restrictive lesions develop nutmeg lung, and outcome is not as poor when restriction is present in isolation. Dedicated evaluation for nutmeg lung pattern on fetal MR studies may be useful to guide prognostication and aid clinicians in counseling parents of fetuses with HLHS.
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Affiliation(s)
- David Saul
- Radiology Department, The Children's Hospital of Philadelphia, 34th Street and Civic Center Boulevard, Philadelphia, PA, 10104, USA
| | - Karl Degenhardt
- Cardiac Center and Fetal Heart Program, The Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Suzanne D Iyoob
- Center for Fetal Diagnosis and Treatment, The Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Lea F Surrey
- Pathology Department, The Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Ann M Johnson
- Radiology Department, The Children's Hospital of Philadelphia, 34th Street and Civic Center Boulevard, Philadelphia, PA, 10104, USA
| | - Mark P Johnson
- Center for Fetal Diagnosis and Treatment, The Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Jack Rychik
- Cardiac Center and Fetal Heart Program, The Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Teresa Victoria
- Radiology Department, The Children's Hospital of Philadelphia, 34th Street and Civic Center Boulevard, Philadelphia, PA, 10104, USA.
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25
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Affiliation(s)
- Anand Srivastava
- Senior Advisor (Surgery & Urology), Army Hospital (R&R), Delhi Cantt, India
| | - Amit Agrawal
- Graded Specialist (Surgery & Urology), Army Hospital (R&R), Delhi Cantt, India
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26
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Abstract
Lymphangiectasia is characterized by vesicular dilation of lymphatic vessels and is generally a complication of radiotherapy or surgery of various malignant tumors such as breast and cervical cancers. Although it is not a precancerous disease, correct diagnosis is important to rule out Stewart-Treves syndrome which is defined as lymphangiosarcoma that develops in long-standing chronic postmastectomy lymphedema. Observation alone or many therapeutic options including cryosurgery, electrocauterization, sclerotherapy, and excision have been widely used in the management. Herein, a case of breast lymphangiectasia was presented as a late and rare complication of breast cancer-related therapies.
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Affiliation(s)
- Murat Özgür Kılıç
- Department of General Surgery, Turgut Özal University, Alparslan Türkeş Cad. No: 57, Emek, 06510 Ankara, Turkey
| | - Cenap Dener
- Department of General Surgery, Turgut Özal University, Ankara, Turkey
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27
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Lawless ME, Lloyd KA, Swanson PE, Upton MP, Yeh MM. Lymphangiomatous Lesions of the Gastrointestinal Tract: A Clinicopathologic Study and Comparison Between Adults and Children. Am J Clin Pathol 2015; 144:563-9. [PMID: 26386077 DOI: 10.1309/ajcpo8tw6emajsrp] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
OBJECTIVES Lymphangiomatous lesions involving the gastrointestinal (GI) tract remain incompletely characterized, and their clinical and histopathologic features have not been systematically evaluated. The distinction between a primary lymphatic malformation (lymphangioma) and a dilation of existing lymphatics (lymphangiectasia) is of clinical significance, since lymphangiectasia may occur in the setting of lymphatic obstruction due to an unsampled malignancy. We describe clinical and morphologic features of lymphangiomas of the GI tract in adult and pediatric populations and contrast them with lymphangiectasia. METHODS We performed a retrospective review of adult and pediatric lymphangiomas and lymphangiectasia involving the GI tract. RESULTS Thirty-six cases of lymphangioma and lymphangiectasia were retrieved, and clinical presentation and histologic features were compared. Lymphangiomas had distinct clinical presentations in adults and children, with adult lesions being more frequently asymptomatic and more frequently involving the superficial mucosal layers of the GI tract. Microscopically, lymphangiomas mostly consisted of confluent dilated spaces with a smooth muscle component. This appearance differed from lymphangiectasia, which lacked a complete distinct endothelial or smooth muscle lining and diffusely involved the mucosa and submucosa. CONCLUSIONS Morphologic features of GI tract lymphangiomas can be reliably distinguished from lymphangiectasia by clinical and pathologic characteristics.
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Affiliation(s)
- Margaret E. Lawless
- Department of Pathology, University of Washington School of Medicine, Seattle
| | - Kelly A. Lloyd
- Department of Pathology, University of Washington School of Medicine, Seattle
| | - Paul E. Swanson
- Department of Pathology, University of Washington School of Medicine, Seattle
| | - Melissa P. Upton
- Department of Pathology, University of Washington School of Medicine, Seattle
| | - Matthew M. Yeh
- Department of Pathology, University of Washington School of Medicine, Seattle
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28
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El-Etreby SA, Altonbary AY, Sorogy ME, Elkashef W, Mazroa JA, Bahgat MH. Anaemia in Waldmann’s disease: A rare presentation of a rare disease. World J Gastrointest Endosc 2015; 7:567-572. [PMID: 25992197 PMCID: PMC4436926 DOI: 10.4253/wjge.v7.i5.567] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2014] [Revised: 11/29/2014] [Accepted: 02/11/2015] [Indexed: 02/05/2023] Open
Abstract
A 32-year-old female presented with 5-year history of iron deficiency anemia, marked pallor and edema of both lower limbs. Laboratory investigations including complete blood count, blood film, iron studies, lipid profile, ascitic fluid analysis, test of stool for occult blood and alpha 1 anti-trypsin. Upper, lower gastrointestinal (GIT) endoscopies, and enteroscopy were performed. Imaging techniques as abdominal ultrasonography and computed tomography were done. Echocardiography, lymph node biopsy and bone marrow examination were normal. The case was diagnosed as Waldmann’s disease with protein losing enteropathy and recurrent GIT bleeding. Management started with low fat diet with medium chain triglyceride, octreotide 200 μg twice a day, tranexamic acid and blood transfusion. Then, exploratory laparotomy with pathological examination of resected segment was done when recurrent GIT bleeding occurred and to excluded malignant transformation.
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Abstract
The plant Angelica keiskei contains two main physiologically active flavonoid chalcones, 4-hydroxyderricin and xanthoangelol. Known as ashitaba in Japan, powder from the sap is widely consumed for its medicinal properties in Asia as a dietary supplement. Limited previously reported mammalian studies were without evidence of toxicity. GLP studies reported here, including a bacterial reverse mutation assay, a chromosome aberration assay, and an in vivo micronucleus assay are negative for genotoxicity. A GLP- compliant 90-day repeated oral gavage study of ashitaba yellow sap powder containing 8.45% chalcones in Sprague Dawley rats resulted in expected known physiological effects on coagulation parameters and plasma lipids at 300 and 1000 mg/kg/day. Ashitaba-related pathology included a dose-related male rat-specific alpha 2-urinary globulin nephropathy at 100, 300, and 1000 mg/kg/day and jejunal lymphangiectasia in both sexes at 1000 mg/kg/day. All other study parameters and histopathological changes were incidental or not of toxicological concern. Based on these studies ashitaba chalcone powder is not genotoxic with a NOAEL of 300 mg/kg in male and female rats.
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Rossi G, Cerquetella M, Antonelli E, Pengo G, Magi GE, Villanacci V, Rostami-Nejad M, Spaterna A, Bassotti G. The importance of histologic parameters of lacteal involvement in cases of canine lymphoplasmacytic enteritis. Gastroenterol Hepatol Bed Bench 2015; 8:33-41. [PMID: 25584174 PMCID: PMC4285930] [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] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/01/2014] [Accepted: 08/05/2014] [Indexed: 11/25/2022]
Abstract
BACKGROUND The most frequent form of inflammatory bowel disease (IBD) in dogs is represented histologically, by lymphoplasmacytic enteritis (LPE), a histological category, often associated with other morphologic alterations including lymphangiectasia (LE). However, literature data on this latter topic are quite scarce and have mostly been obtained in single reports or in small series. AIM We evaluated some morphologic parameters of intestinal villi and lacteals in a large cohort of dogs, and correlated them with serum albumin and cholesterol values. PATIENTS AND METHODS We investigated 136 dogs (94 with LPE, and 42 with gastrointestinal problems different from IBD) and analyzed their clinical, laboratory (albumin and cholesterol values), endoscopic, and histologic variables. RESULTS The LPE group showed significantly impaired clinical, laboratory, endoscopic, and histologic variables compared to controls. Affected dogs showed significant correlations between canine inflammatory bowel disease activity index (CIBDAI) scores and endoscopic and histologic variables. Moreover, the grade of hematologic changes were strongly related to the intestinal histologic variables, in particular those concerning villous and lacteals morphology. CONCLUSION Dogs with LPE had intestinal histologic abnormalities (height, width, height/width ratio, calculated for both villi and lacteals), whose degree correlated with the severity of hypoalbuminemia and hypocholesterolemia. Evaluation of endoscopic and histologic variables in association to the clinical findings may reveal useful insights for the pathogenesis of LPE and, hopefully, might lead to more targeted therapeutic approaches.
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Affiliation(s)
- Giacomo Rossi
- School of Biosciences and Veterinary Medicine, University of Camerino, 62024 Matelica (Macerata), Italy
| | - Matteo Cerquetella
- School of Biosciences and Veterinary Medicine, University of Camerino, 62024 Matelica (Macerata), Italy
| | | | - Graziano Pengo
- Veterinary practitioner, S. Antonio Clinic, 26020 Madignano (Cremona), Italy
| | - Gian Enrico Magi
- School of Biosciences and Veterinary Medicine, University of Camerino, 62024 Matelica (Macerata), Italy
| | | | - Mohammad Rostami-Nejad
- Gastroenterology and Liver Diseases Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Andrea Spaterna
- School of Biosciences and Veterinary Medicine, University of Camerino, 62024 Matelica (Macerata), Italy
| | - Gabrio Bassotti
- Gastroenterology Section, Department of Medicine, University of Perugia Medical School, 06156 Perugia, Italy
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Nassiri AA, Lotfollahi L, Bakhshayeshkaram M, Kiani A, Haghighi S, Alavi Darazam I, Rashidfarokhi F. Renal Lymphangiectasia: A Curious Cause of Pleural Effusion. Tanaffos 2015; 14:213-6. [PMID: 26858768 PMCID: PMC4745191] [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] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
Renal lymphangiectasia is a disorder of the lymphatic system of the kidneys, which can be congenital or acquired. Although the exact etiology remains unknown, an obstructive process resulting from several causes, including infection, inflammation or malignant infiltration, has been suggested to be responsible for the acquired form. This disorder may be associated with several pathologies. We report a case of a 24-year-old man with renal lymphangiectasia presenting with polycythemia, ascites and pleural effusion associated with hepatitis C virus (HCV) infection in an intravenous (IV) drug user. Our case is the first in the literature that shows an association between HCV infection and IV drug use.
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Affiliation(s)
- Amir Ahmad Nassiri
- Department of Nephrology and Dialysis, National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Legha Lotfollahi
- Department of Nephrology and Dialysis, National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mehrdad Bakhshayeshkaram
- Chronic Respiratory Diseases Research Center, NRITLD, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Arda Kiani
- Tracheal Diseases Research Center, NRITLD, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Shirin Haghighi
- Department of Hematology and Oncology, Ayatollah Taleghani Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Ilad Alavi Darazam
- Chronic Respiratory Diseases Research Center, NRITLD, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Farin Rashidfarokhi
- Telemedicine Research Center, NRITLD, Shahid Beheshti University of Medical Sciences, Tehran, Iran,Correspondence to: Rashidfarokhi F, Address: Department of Nephrology and Dialysis, NRITLD, Shahid Beheshti University of Medical Sciences, Tehran, Iran, Email address:
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Simmerson SM, Armstrong PJ, Wünschmann A, Jessen CR, Crews LJ, Washabau RJ. Clinical features, intestinal histopathology, and outcome in protein-losing enteropathy in Yorkshire Terrier dogs. J Vet Intern Med 2014; 28:331-7. [PMID: 24467282 PMCID: PMC4857982 DOI: 10.1111/jvim.12291] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2013] [Revised: 09/27/2013] [Accepted: 11/26/2013] [Indexed: 12/01/2022] Open
Abstract
Background A poorly understood protein‐losing enteropathy (PLE) disorder has been reported in Yorkshire Terrier dogs. Objectives To describe clinical features, intestinal histopathology, and outcome in Yorkshire Terrier dogs with PLE, and to identify variables predictive of outcome. Animals Thirty client‐owned Yorkshire Terrier dogs with PLE. Methods Retrospective study. Records of dogs with a diagnosis of PLE were reviewed. Intestinal histopathology was interpreted using the World Small Animal Veterinary Association gastrointestinal histopathology classification system. Discriminate analysis techniques were used to identify variables predictive of outcome. Results Females outnumbered males (20/30). Median age was 7 years (range 1–12). Common clinical signs were diarrhea (20/30), vomiting (11), ascites and abdominal distension (11), and respiratory difficulty (8). Histopathologic abnormalities included villous lymphatic dilatation, crypt lesions, villous stunting, and variable increases in cellularity of the lamina propria. All dogs were treated with glucocorticoids. Of 23 dogs with long‐term follow‐up, 9 had complete, and 3 had partial, resolution of signs, and 11 failed to respond to treatment. Median survival of responders was 44 months and of nonresponders was 12 months, with 4 dogs experiencing peracute death. Vomiting, monocytosis, severity of hypoalbuminemia, low blood urea nitrogen concentration, and villous blunting were predictive of survival <4 months. Conclusions In addition to classic GI signs, Yorkshire Terriers with PLE often show clinical signs associated with hypoalbuminemia and low oncotic pressure. Lymphatic dilatation, crypt lesions, and villous stunting are consistent histopathologic findings. Clinical outcomes are variable, but many dogs experience remission of clinical signs and prolonged survival.
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Affiliation(s)
- S M Simmerson
- Internal Medicine, Dogs and Cats Veterinary Referral and Emergency Hospital, Bowie, MD
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Watson VE, Hobday MM, Durham AC. Focal intestinal lipogranulomatous lymphangitis in 6 dogs (2008-2011). J Vet Intern Med 2013; 28:48-51. [PMID: 24205954 PMCID: PMC4895536 DOI: 10.1111/jvim.12248] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2013] [Revised: 08/07/2013] [Accepted: 09/25/2013] [Indexed: 11/28/2022] Open
Abstract
Background Lipogranulomatous lymphangitis is inflammation of the intestinal lymphatic vessels and surrounding tissues caused by chronic leakage of lipid‐laden chyle. Grossly, lipogranulomas are typically disseminated small masses on the serosa and surrounding lymphatic vessels and consist of epithelioid macrophages, multinucleated giant cells, and cholesterol. Lipogranulomatous lymphangitis is occasionally seen in patients with lymphangiectasia and protein‐losing enteropathy (PLE). Objectives To characterize the historical features, clinical signs, treatment, histopathology, and outcome of dogs with focal lipogranulomatous lymphangitis. Animals Six dogs with ultrasonographic evidence of focal, regional small intestinal masses, often with involvement of the adjacent mesentery, and a diagnosis of focal lipogranulomatous lymphangitis based on histopathology of biopsied masses. Results The median age of dogs was 6.9 years (range 3–10 years). All dogs had total protein, globulin, and albumin concentrations within the reference range at initial presentation and had intestinal masses identified on abdominal ultrasound examination. Histopathologic evaluation of lesions identified severe mural and mesenteric lipogranulomatous lymphangitis. Lymphangiectasia was noted in 5 cases and only in sections within the mass‐like lesion; tissue without lipogranulomas had minimal lymphangiectasia, suggesting a localized phenomenon. Postoperative outcomes ranged from remission of clinical signs with no subsequent treatment for 10–12 months in 2 dogs, postoperative management with medical and nutritional management in 3 dogs, and no outcome for 1 case. Conclusions and Clinical Importance This case series describes a unique mass‐like manifestation of intestinal lipogranulomatous lymphangitis and should be considered as a possible differential diagnosis in dogs with an intestinal mass.
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Affiliation(s)
- V E Watson
- Veterinary Pathology Department, University of Georgia College of Veterinary Medicine, Athens, GA
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Legras A, Mordant P, Le Pimpec-Barthes F, Riquet M. [Lymphangioma and lymphangiectasia]. Rev Pneumol Clin 2013; 69:272-277. [PMID: 23688723 DOI: 10.1016/j.pneumo.2013.04.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/15/2013] [Revised: 04/01/2013] [Accepted: 04/04/2013] [Indexed: 06/02/2023]
Abstract
Primary thoracic lymphatic diseases are both infrequent and probably under diagnosed. The two major forms are lymphangiomas and lymphangiectasias. Lymphangiomas are focal proliferation of well-differentiated lymphatic vessels. Childhood lymphangiomas may follow embryologic disorders. Adult lymphangiomas are more likely secondary to lymphatic obstruction. When associated with typical CT and MRI features, their surgical resection is not mandatory, whereas in case of diagnostic difficulties or related complications, surgical resection is the rule. Lymphangiectasias are congenital or acquired pathologic lymphatic dilatation from pleura and interlobular septa without any proliferation. These diseases can be limited to one pulmonary lobe, or can involve the whole lymphatic network. In case of communication between the lymphangiectasias and the thoracic duct, symptoms may include chyloptysis, chylothorax, and chylopericardium. Lymphangio MRI allows visualisation of the lymphangiectasis and thoracic duct. Surgical treatment may be required in case of resistance to medical treatment.
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Affiliation(s)
- A Legras
- Service de chirurgie thoracique, université Paris 5, hôpital européen Georges-Pompidou, Assistance publique-Hôpitaux de Paris, 20, rue Leblanc, 75015 Paris, France
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Abstract
A number of disorders have been described to cause protein losing enteropathy (PLE) in children. Primary intestinal lymphangiectasia (PIL) is one mechanism leading to PLE. Few syndromes are associated with PIL; Hennekam syndrome (HS) is one of them. The principal treatment for PIL is a high protein, low fat diet with medium chain triglycerides supplementation. Supportive therapy includes albumin infusion. Few publications have supported the use of octreotide to diminish protein loss and minimize hypoalbuminemia seen in PIL. There are no publications on the treatment of PIL with octreotide in patients with HS. We report two children with HS and PLE in which we used octreotide to decrease intestinal protein loss. In one patient, octreotide increased serum albumin to an acceptable level without further need for albumin infusions. The other patient responded more dramatically with near normal serum albumin levels and cessation of albumin infusions. In achieving a good response to octreotide in both patients, we add to the publications supporting the use of octreotide in PIL and suggest that octreotide should be tried in patients with PIL secondary to HS. To the best of our knowledge, this is the first case report on the use of octreotide in HS-associated PIL.
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Alders M, Mendola A, Adès L, Al Gazali L, Bellini C, Dallapiccola B, Edery P, Frank U, Hornshuh F, Huisman SA, Jagadeesh S, Kayserili H, Keng WT, Lev D, Prada CE, Sampson JR, Schmidtke J, Shashi V, van Bever Y, Van der Aa N, Verhagen JM, Verheij JB, Vikkula M, Hennekam RC. Evaluation of Clinical Manifestations in Patients with Severe Lymphedema with and without CCBE1 Mutations. Mol Syndromol 2012; 4:107-13. [PMID: 23653581 DOI: 10.1159/000342486] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/31/2012] [Indexed: 11/19/2022] Open
Abstract
The lymphedema-lymphangiectasia-intellectual disability (Hennekam) syndrome (HS) is characterised by a widespread congenital lymph vessel dysplasia manifesting as congenital lymphedema of the limbs and intestinal lymphangiectasia, accompanied by unusual facial morphology, variable intellectual disabilities and infrequently malformations. The syndrome is heterogeneous as mutations in the gene CCBE1 have been found responsible for the syndrome in only a subset of patients. We investigated whether it would be possible to predict the presence of a CCBE1 mutation based on phenotype by collecting clinical data of patients diagnosed with HS, with or without a CCBE1 mutation. We report here the results of 13 CCBE1 positive patients, 16 CCBE1 negative patients, who were clinically found to have classical HS, and 8 patients in whom the diagnosis was considered possible, but not certain, and in whom no CCBE1 mutation was identified. We found no statistically significant phenotypic differences between the 2 groups with the clinical HS phenotype, although the degree of lymphatic dysplasia tended to be more pronounced in the mutation positive group. We also screened 158 patients with less widespread and less pronounced forms of lymphatic dysplasia for CCBE1 mutations, and no mutation was detected in this group. Our results suggest that (1) CCBE1 mutations are present only in patients with a likely clinical diagnosis of HS, and not in patients with less marked forms of lymphatic dysplasia, and (2) that there are no major phenotypic differences between HS patients with or without CCBE1 mutations.
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Affiliation(s)
- M Alders
- Department of Clinical Genetics, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
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