Lymphedema in Mexico: A Clinical and Epidemiological Overview

Background: There is insufficient clear epidemiological and clinical knowledge about lymphedema patient’s population in Mexico, this limits its investigation. The objective of this study is to present basic lymphedema epidemiological data and its clinical characteristics based on the analysis of lymphedema patients’ data collected from a specialized rehabilitation clinic in Mexico. Methods: This is a cohort study developed between 2015 and 2021. The study was carried ou in a private clinic specialized in oncological and peripheral vascular patients’ rehabilitation. Clinical assessments and interviews were performed to collect each case’s clinical history, considering its medical characteristics, physical activity and functionality and socio-demographic information, classified in a matrix, and later statistically evaluated. Results: Among 446 lymphedema patients, gender distribution was represented by 81% female and 19% male with a mean age of 50.5 years (±44.5). The population was categorized into the following three different study groups according to diagnosis: Cancer-Related Lymphedema (CRL), Non-Cancer-Related Secondary Lymphedema (NCRSL) and Primary Lymphedema. 60.08% of the patients had CRL; 25.11% had NCRSL and 14.79% had Primary Lymphedema. Among the patients with CRL, 81% of them corresponded to breast cancer diagnosis, the rest were associated to 19 different cancer diagnoses. The most prevalent diagnosis was breast CRL 48.6%; phlebolymphedema 19.4%; congenital and praecox lymphedema 14.1%; lipo-lymphedema 4.8%. The BMI of 64% of the patients ranged in overweight and obesity. 37.6% of patients reported that had experienced pain in limbs affected by lymphedema and 45% of all patients reported some disability to perform one or more activities associated to their limb volume or limb discomfort. 82% of patients had no physical activity or performed less physical activity than what is suggested to their population group’s recommendation. Conclusion: This study stablishes a precedent on reporting the broadest available epidemiological and clinical data of lymphedema in Mexico. Further studies are needed to report with a higher precision the epidemiological, clinical, and demographical data about each etiological group for a better understanding of lymphedema in Mexico and Latin America.

Linfedema primário congênito em bovinos Red Angus / Primary congenital lymphedema in Red Angus cattle

Casos de linfedema congênito foram observados acometendo 12 terneiros cruza Red Angus na região Central do Rio Grande do Sul. Os terneiros afetados apresentavam graus variáveis de edema subcutâneo ao nascimento, envolvendo principalmente os membros pélvicos, mas também outras regiões do corpo. A injeção de solução a 5 por cento de azul de metileno no espaço interdigital dos membros pélvicos de três terneiros afetados e um controle, indicaram uma interrupção no fluxo da linfa, sugerindo uma falha dos linfáticos periféricos distais em contactar os troncos centrais. Na necropsia de três terneiros afetados, edema subcutâneo foi observado de modo variável nos membros pélvicos, prepúcio e abdômen ventral. Não foi observado edema nas cavidades orgânicas. Em dois casos, observou-se hipoplasia dos linfonodos poplíteos associadas à dilatação dos vasos linfáticos. Testes de DNA demonstraram que todos os terneiros afetados nasceram de vacas inseminadas pelo mesmo touro, sugerindo uma base genética para a doença. Levando em consideração que uma pequena porcentagem de terneiros nasceram de vacas inseminadas pelo touro suspeito, é provável que um modo autossômico recessivo esteja envolvido na hereditariedade da doença.

Cases of congenital lymphedema were observed affecting 12 cross Red Angus calves from the central region of the state of Rio Grande do Sul, Brazil. Affected calves presented variable degrees of subcutaneous edema at birth, involving mainly the hind limbs but also other body regions. The injection of methylene blue dye in 5 percent solution into the interdigital space of the hind limbs of three affected calves and one normal control indicated an interruption of the lymph flow in the affected calves; this suggests a failure of the distal peripheral lymphatics to connect with the central trunks. At necropsy of three affected calves subcutaneous edema was variably observed in the hind limbs, prepuce and ventral abdomen. Edema of body cavities was not observed. In two cases there was hipoplasia of the popliteal lymph nodes associated to dilatation of lymphatic vessels. DNA tests demonstrated that all affected calves were born from cows sired by the same bull suggesting an inherited basis for the disease. Considering the small percentage of affected calves born from cows sired by the suspect bull it is probable that an autosomal recessive mode of inheritance is involved.

A Case of Vulvar Lymphangiectasia secondary to Primary Lymphedema / 대한피부과학회지

Lymphangiectasia (acquired lymphangioma) is a rare disease that resembles congenital lymphangioma clinically and histopathologically. It usually occurs as a result of acquired lymphatic obstruction secondary to surgery, irradiation, recurrent infection, primary or secondary lymphedema, pressure, and scar due to chronic inflammation, etc. We herein report a case of vulvar lymphangiectasia of a 15-year-old female. She has suffered from swelling on both legs since the age of 5. She was presented because of multiple grouped vesicles and papules containing clear fluid, which resembled frog's spawn and has developed on the vulvar area since the age of 9.