Mesenteric cystic lymphangioma in adults: a rare entity presenting as acute abdomen - a report of two cases

ABSTRACT Lymphangiomas are rare benign tumors that mainly involve the head and neck region in pediatric patients. Lymphangiomas of the small bowel mesentery in adults are rarer. We present two cases of mesenteric lymphangioma with acute abdominal pain on presentation. Case 1: A 38-year-old female presented with abdominal pain, vomiting, fever, and difficult evacuation. On abdominal examination, she had an ill-defined, tender lump, and radiological findings raised a possibility of perforation peritonitis. Thus, exploratory laparotomy was planned. Per-operatively, a mesenteric mass was found, which, on histopathological evaluation, was found to be a mesenteric lymphangioma involving the bowel. Case 2: A 27-year-old male presented with abdominal pain and difficult evacuation. Radiological evaluation revealed a multilobulated lesion involving the mesentery and with differential diagnoses of mesenteric fibromatoses and inflammatory pseudotumor. Histopathological assessment of the resected mass revealed a lymphangioma that was limited to the mesentery. Owing to their rarity and non-specific presentation, mesenteric lymphangiomas are often misdiagnosed on clinical examination and imaging. Thus, histopathological examination is the gold standard to reach a definitive diagnosis.

Identification and preservation of arm lymphatics in axillary lymph node dissection to prevent arm lymphedema: a single center randomized controlled trial / 中华肿瘤杂志

Objective: To evaluate the feasibility of identification and preservation of arm lymphatics (DEPART) in axillary lymph node dissection (ALND) for breast cancer to prevent arm lymphedema. Methods: A randomized controlled study method was used. Two hundred and sixty-five patients who underwent breast cancer surgery at the Department of Thyroid and Breast Surgery, Zhongnan Hospital of Wuhan University from November 2017 to June 2018 were included, and the patients were randomly divided into ALND+ DEPART group (132 patients) and standard ALND group (133 patients) by random number table method. In the ALND+ DEPART group, indocyanine green and methylene blue were injected as tracers before surgery, and the arm sentinel nodes was visualized by staged tracing during intraoperative dissection of axillary lymph nodes. Partial frozen sections were made of arm lymph nodes >1 cm in length and hard and suspicious of metastasis, and arm lymph nodes and lymphatic vessels were selectively preserved. Patients in the standard ALND group underwent standard ALND. Objective and subjective indexes of arm lymphedema were evaluated by 5-point circumference measurement and Norman questionnaire. Results: Among 132 breast cancer patients in the ALND+ DEPART group, 121 (91.7%) completed DEPART. There were no statistically significant differences in age, body mass index, pathological type, dissection number of axillary lymph node, N stage, TNM stage, molecular typing, and regional radiotherapy between the ALND+ DEPART and standard ALND groups (P>0.05). At a median follow-up of 24 months, assessment by the 5-point circumference measurement showed that the incidence rates of lymphedema in the ALND+ DEPART and standard ALND groups were 5.0% (6/121) and 15.8% (21/133), respectively, with statistically significant differences (P=0.005). Assessment by the Norman questionnaire showed that the incidence rates of lymphedema in the ALND+ DEPART and standard ALND groups were 5.8% (7/121) and 21.8% (29/133), respectively, with a statistically significant difference (P<0.001). No local regional recurrence was observed in either group during the follow-up period. Conclusion: For breast cancer patients with positive axillary lymph nodes, the administration of DEPART during ALND can reduce or avoid the occurrence of arm lymphedema without compromising oncology safety.

Persistent Malfunction of Glymphatic and Meningeal Lymphatic Drainage in a Mouse Model of Subarachnoid Hemorrhage

Subarachnoid hemorrhage (SAH) is a devastating cerebrovascular event that often is followed by permanent brain impairments. It is necessary to explore the pathogenesis of secondary pathological damages in order to find effective interventions for improving the prognosis of SAH. Blockage of brain lymphatic drainage has been shown to worsen cerebral ischemia and edema after acute SAH. However, whether or not there is persistent dysfunction of cerebral lymphatic drainage following SAH remains unclear. In this study, autologous blood was injected into the cisterna magna of mice to establish SAH model. One week after surgery, SAH mice showed decreases in fluorescent tracer drainage to the deep cervical lymph nodes (dcLNs) and influx into the brain parenchyma after injection into the cisterna magna. Moreover, SAH impaired polarization of astrocyte aquaporin-4 (AQP4) that is a functional marker of glymphatic clearance and resulted in accumulations of Tau proteins as well as CD3⁺, CD4⁺, and CD8⁺ cells in the brain. In addition, pathological changes, including microvascular spasm, activation of glial cells, neuroinflammation, and neuronal apoptosis were observed in the hippocampus of SAH mice. Present results demonstrate persistent malfunction of glymphatic and meningeal lymphatic drainage and related neuropathological damages after SAH. Targeting improvement of brain lymphatic clearance potentially serves as a new strategy for the treatment of SAH.

The use of human mature cystic ovarian teratoma as a model to study the development of human lymphatics / 대한해부학회지

The angiogenic theory to the development of human lymphatics is not clear. The objective of this study was to investigate the development of human lymphatics. Semi-thin and thin paraffin sections from human mature cystic ovarian teratoma tissues were studied using light and electron microscopy. Lymphatics were formed by the differentiation of mesenchymal cells that gradually acquired morphological features of endothelial cells. It is suggested that in human mature cystic ovarian teratoma the lymphatic endothelium develops from mesenchymal cells, and not from cells derived from mature endothelium of a preexisting vein or lymphatic.

Anatomy of the lymphatic drainage of the upper limb and breast and its role in lymphedema prevention after breast cancer treatment / Anatomía del drenaje linfático del miembro superior y de la mama y su papel en la prevención del linfedema después del tratamiento del cáncer de mama

The surgical treatment of breast cancer has been enhanced throughout the years in order to offer oncologically safer and more effective results with lower esthetic impact and fewer sequelae. The lymphedema of the upper limb is still an iatrogenic result of great incidence and morbidity after this treatment. A possible existence of independent breast and upper limb lymphatic pathways has become the issue of many researchers willing to minimize its occurrence. This review aims to compare the lymphatic pathways in the axilla described by traditional anatomy books and recently published articles about Axillary Reverse Mapping (ARM). With this purpose, a comparative table was made with the descriptions found in books and articles, a statistic table of the data collected, a flowchart of anastomoses among nodes and an analytical drawing of the most statistically mentioned drained areas. It was observed that there is great variability in the descriptions of drainage and anastomoses among the lymph nodes in the references used, so there should be a consensus of a universal description which also assembles possible anatomical variations. Furthermore, the findings brought about by recent studies show possible anastomoses among pathways and lymph nodes, however they have not been taken into consideration when ARM was initially proposed. Therefore, the axillary resection with the preservation of the posterior and lateral axillary lymph nodes is theoretically possible to avoid lymphedema of the upper limb, but the development of an updated universal description that involves all possible anatomical variations will provide a safer and more effective treatment.

El tratamiento quirúrgico del cáncer de mama ha mejorado a lo largo de los años con el fin de ofrecer resultados oncológicamente más seguros y eficaces con menor impacto estético y menos secuelas. El linfedema del miembro superior es todavía un resultado iatrogénico de gran incidencia y morbilidad después de este tratamiento. La posible existencia de vías linfáticas de mama y de los miembros superiores independientes se ha convertido en un tema central de muchas investigaciones para lograr minimizar su ocurrencia. Esta revisión tiene como objetivo comparar las vías linfáticas en la axila descritas en los libros de anatomía tradicionales con artículos recientemente publicados sobre Mapeo Reverso Axilar (MRA). Con este fin, se realizó un cuadro comparativo con las descripciones y un diagrama de flujo de las anastomosis entre los nodos, además de un dibujo analítico de las áreas drenadas estadísticamente más mencionadas. Se observó que existe una gran variabilidad en las descripciones sobre el drenaje y las anastomosis entre los nodos linfáticos, por lo que la descripción universal no debería ser considerada un consenso debido a que también presenta posibles variaciones anatómicas. Por otra parte, los resultados producidos por los estudios recientes muestran posibles anastomosis entre las vías y los nodos linfáticos, sin embargo, no se han tomado en consideración cuando se propuso inicialmente el MRA. Por lo tanto, la resección axilar con la preservación de la parte posterior y los nodos linfáticos axilares laterales es teóricamente posible para evitar el linfedema del miembro superior, pero el desarrollo de una descripción universal actualizada, que incluya todas las posibles variaciones anatómicas, proporcionará un tratamiento más seguro y eficaz.

Carcinomatosis linfática y embolismo tumoral pulmonar / Lymphangitic Carcinomatosis and Pulmonary Tumor Embolism

La linfangitis carcinomatosa es un trastorno relativamente poco común caracterizado por la infiltración difusa de los vasos linfáticos pulmonares por cáncer metastásico. Es una manifestación tardía que implica mal pronóstico. El diagnóstico puede ser difícil y requiere de un alto índice de sospecha. La embolia pulmonar tumoral es la presencia de múltiples acúmulos de células tumorales en las pequeñas arterias, arteriolas y capilares septales del pulmón. La oclusión de la microvasculatura pulmonar por células tumorales y trombos asociados puede producir una entidad clínica subaguda y progresiva que se asemeja a la enfermedad tromboembólica . Algunas modalidades de imágenes pueden ayudar a definir el diagnóstico, especialmente gammagrafía pulmonar de ventilación-perfusión y su característico patrón de múltiples defectos de perfusión sub- segmentarios periféricos sin alteraciones ventilatorias o en la angiografía. El tratamiento no ha sido ampliamente estudiado, ya que el diagnóstico por lo general no se realiza hasta después de la muerte. Se realiza una revisión de la literatura sobre la evaluación y el diagnóstico de estas dos entidades clínicas poco frecuentes.

Lymphangitic carcinomatosis is a relatively uncommon disorder characterized by diffuse infiltration of the pulmonary lymphatics by metastatic cancer. It is a late manifestation of malignancy that implies bad prognosis. The diagnosis can be difficult and requires a high degree of suspicion. Microscopic pulmonary tumor embolism is the presence of multiple aggregates of tumor cells in the small pulmonary arteries, arterioles and septal capillaries. Occlusion of the pulmonary microvasculature by tumor cells and associated thrombi can produce a subacute and progressive clinical entity that resembles thromboembolic disease. Some imaging studies may help to define the diagnosis, especially the ventilation-perfusion lung scan and its typical pattern of multiple peripheral sub-segmental perfusion defects without ventilatory abnormalities or the angiography. Treatment for this entity has not been extensively studied, since the diagnosis is usually made postmortem. We provide a review of the literature about the evaluation and diagnosis of these two infrequent clinical entities.

Study of the distribution and morphologic feature of the renal lymphatics / 安徽医科大学学报

Objective To observe the fine distribution and morphologic feature of the intrarenal lymphatics. Meth-ods 20 Wistar rats were involved in this study and nephridial tissues were obtained from each animal. Double im-munofluorescence was applied to detect the lymphatic distribution by using Podoplanin and CD34. Renal tissues were obtained from the cortex, medulla and junctional zone,and put in 3% glutaric dialdehyde stationary liquid for transmission electron microscope to observe the fine distribution and morphologic feature of the intrarenal lymphat-ics. Results Under immunofluorescence double staining, lymphatic capillary appeared anomalism, large lumina, thin wall and located in connective tissue region. Cortilymph obviously exceeded medulla lymph in rats. Under e-lectron microscope, the basal lamina of lymphatic was discontinuity. A lot of lysosome and vesicles existed in the endothelial of capillary lymphatics. Many of the vesicles liberated in cytoplasm. The intercellular junctions of the renal lymphatics were held in close apposition. Conclusion The intercellular junctions of the renal lymphatics are held in close apposition by adhesion devices. A lot of lysosomes and vesicles exist in the endothelial of capillary lymphatics, which are the base for renal to transport big molecules and fluids.

Pharyngeal lymphatic ring: anatomical review

The tonsils form part of a circular band of adenoid tissue which guards the opening into the digestive andrespiratory tubes, known as Waldeyer’s ring. The anterior part of the ring is formed by the submucouslymphoid clusters (lingual tonsil) on the posterior part of the tongue; the lateral portions consist of thepalatine tonsils and the lymphoid tissue in the vicinity of the auditory tubes, while the ring is completedbehind by the pharyngeal tonsil on the posterior wall of the pharynx. In the intervals between these mainsmaller collections of lymphoid tissue are found. This paper intends to give to the clinician an anatomicalreview about the subject.

A method to evaluate lymphatic drainage of macromolecular tracer in cerebrospinal fluid / 中国药理学通报

Aim To establish a method to evaluate lymphatic drainage of macromolecular tracer in cerebrospinal fluid in rats.Methods Rat cervical lymphatic blockade(CLB)models were established by occlusion of cervical lymphatic tubes and removal of cervical lymphatic nodes.The rats were divided into non CLB(normal controls) and CLB groups.~(125)I-labeled human serum albumin(~(125)I-HSA)was injected into the left lateral cerebral ventricle,and blood samples were collected and ~(125)I-HSA concentrations were detected continually within 24 hours.Concentration-time curve was drawn according to the single compartment model in pharmacokinetics.Parameters of pharmacokinetics such as area under curve(AUC),maximum concentration(C_(max)),transfer rate constant K_a and peak time(T_(max))were derived.The AUC,C_(max),K_a,and T_(max) regarding the lymphatic drainage of ~(125)I-HSA were calculated based on the differences between the two groups.Results AUC,C_(max),K_a of ~(125)I-HSA by lymphatic drainage were 51.97 mg·L~(-1)·h~(-1),2.91 mg·L~(-1),and 0.64 h~(-1),respectively.The proportion of AUC,C_(max),K_a of ~(125)I-HSA by lymphatic drainage to those of drained by both arachnoid granulations and lymphatics was 71.53%,44.02%,58.18%,respectively.T_(max) in CLB group(8.36±0.82 h)was much longer than that in non CLB group(3.57±0.54 h).Conclusions A method to evaluate lymphatic drainage of macromolecular tracer in cerebrospinal fluid in rats is successfully established.The lymphatic drainage pathway plays an important role in eliminating macromolecular substances in cerebrospinal fluid.

Visualization of Subconjunctival Lymphatics and Its Significance

PURPOSE: To observe and characterize subconjunctival lymphatics in patients with subconjunctival hemorrhages. METHODS: Patients who visited our clinic with subconjunctival hemorrhage resulting from ocular trauma, or subconjunctival injection of gentamicin and betamethasone during a cataract operation, were included in this study. Subconjunctival hemorrhages and subconjunctival lymphatics were observed using slit lamp biomicroscopy. RESULTS: Apparent dilated lymphatics were found in one patient with subconjunctival hemorrhage after rubbing of the eye; thin lymphatics were found in 10 patients with traumatic subconjunctival hemorrhages; and apparent dilated lymphatics were found in 10 patients after subconjunctival injection. Slit lamp biomicroscopy using a green filter allowed easy visualization of subconjunctival lymphatics. CONCLUSIONS: Subconjunctival lymphatics, which are not visible in normal ocular conditions, are evident on subconjunctival hemorrhages, especially after subconjunctival drug injection.

Clinico-pathological Characteristics of Congenital Pulmonary Lymphangiectasis: Report of Two Cases

Congenital pulmonary lymphangiectasis (CPL) is a rare, poorly documented disease, characterized by abnormal dilatation of pulmonary lymphatics without lymphatic proliferation. This disease is seen almost exclusively in infancy and early childhood. It can usually be divided into primary (congenital) and secondary forms. The primary form presents in neonates, and the patients mostly die due to the respiratory distress, shortly after birth. The authors experienced two cases of primary CPL in a 13-day-old male neonate and a one-day-old male neonate, showing prominent lymphatic dilatation in the septal, subpleural, and peri-bronchial tissue throughout both lungs. The latter case was associated with congenital cardiac anomaly including single ventricle. These are unique cases of CPL in Korea of which the diagnosis was established through post-mortem examination. Therefore, the authors report these two cases with primary CPL with a review of the literature.

The Investigation of the Relation Between the Expression of Podoplanin and the Lymphatical Metastasis in the Human Colonic Carcinoma / 医学研究杂志

Objective To provide the morphology data for the study on the molecular mechanism of tumor metastasis,we observed the expression of podoplanin on the blood vessels and lymphatics in the human colonic carcinoma.Methods We observed the expression of podoplanin on the blood vessels and lymphatics in the colonic carcinoma from the patients of the operation in the defferent stages with the methods of HE staining and podoplanin immunohistochemistry staining. Results Podoplanin has not been stained,but podoplanin was positively expressed on the colonic carcinoma lymphatics.And, The podoplanin expression positive rate of the colonic carcinoma were increased along with the increase of tumor stages and occurence of lymph nodes metastasis. Conclusion Podoplanin choosed to express in lymphatics in the colonic carcinoma and could correctly distinguish the blood vessels and lymphatic vessels,could be regarded as the specific marker to mark lymphatic vessel. And, The podoplanin expression positive rate of the colonic carcinoma were increased along with the increase of tumor stages and occurence of lymph nodes metastasis.It indicates,It was correlated with colonic carcinoma lymphatical metastasis that the count of lymphatic vessels were increased in the colonic carcinoma along with the tumor advancing.

The fine distribution and ultrastructure of intramural lymphatics in rats' rectum / 解放军医学杂志

Objective Observe the fine distribution and morphologic feature of the intramural lymphatics in rats' rectum and to provide the morphological evidence for studying the mechanism of lymphous metastasis of rectum carcinoma.Methods The intramural lymphatics of rectum in rats were studied by light and electron microscopy to obtain some data regarding their fine distribution.Results The intramural capillary lymphatics of rats' rectum were observed in deep lamina propria of tunica membrane and the dermal papilla layer of anal pectin. The intramural capillary lymphatics and lymphatics were both observed in tela submucosa, reticular layer, hypodermis and intermuscular and serosa. The capillary lymphatics in rectums' wall have the similar ultrastructure feature to normal ones. Three kinds of endothelial cells junctions are overlapping-junctions, embedding-junctions and end-to-end-type junctions. About 21% of cell-junctions are opening types. There are normal organelles and many vesicals in the endothelial of capillary lymphatics. Conclusion The distribution of lymphatics in every layer of dentate line upwards are similar to other digestive tubes'. The distribution of lymphatics in anal pecten of rats' rectum are similar to cutis. The results show that big molecule substance and tissue hydrolysate are transporting mainly by opening-junction of endothelial cells and the vesicle system.

Focal Nodular Hyperplasia with Aberrant Lymphatics: A Case Report / 대한간학회지

No abstract available.

Parapelvic Renal Cyst (Pericalyceal Lymphangiectasis): A case report

Parapelvic renal cyst, also designated as pericalyceal lymphangiectasis, is an unusual lesion that is usually brought to light during surgery for ureteropelvic junction obstruction or recurrent pyelonephritis. Grossly, the renal pelvis is enveloped by a multilocular cystic mass filled with clear fluid. This lesion is confined to the peripelvic tissues and does not extend into the parenchyma, which, however, may show the effects of hydronephrosis or pyelonephritis. A 50-year-old man presented with hydronephrosis. An ultrasonography revealed hydronephro-sis of the left kidney. Intravenous pyelography and DMSA ("Tc-Dimercaptosuccinic acid) scan showed nonfunctioning kidney of the same side. Simple left nephrectomy was done. The renal pelvis was mildly dilated and a cyst was found buldging into the renal pelvis. The content was watery clear and the cyst was not connected to the renal pelvis or calyces. The cyst was round unilocular and lined by attenuated single layer of endothelial cells. The endothelial cells showed no reactivity to factor-VIII related antigen. With these findings, we concluded that this cystic lesion is basically lymphatic cyst and hydronephrosis was caused by the compression of pelvic out-flow of the kidney.

Trans-Lymphatic Infusion of Immunochemical Drugs in the Treatment of Lymphatic Metastases / 介入放射学杂志

Purpose:To investigate the effectiveness of intralymphatic infusion of anti- cancer agents and cytokines in the treatmrnt of malignancy.Materials anti methods:23 patients suffering from advanced metastatic cancers anti 2 primary lymphomas,unresponsble to the standard therapies or intra-arterial chemotherapy,were treated with lymphatic injections of an- ticancer ddrugs or combiation with biochemotherapy.Results:Follow-up study about one month after the therapy,comparing with findings on lymthatic radiographies anti computed tomographic scans,revealed decrease of lymphnodes in size in 23 cases.Conclusion:This therapeutic ap- proach proved to be an effective and safe method for the palliative treatment of advanced lym- phatic metastases and lymphomas.The procedure was feasible without serious compllications.

A STUDY ON LYMPHATIC SYSTEM OF THE RENAL PEDICLE IN CHINESE / 解剖学报

159 kidneys from infant and neonatal cadavers were dissected under stereoscope.The study showed that there were a lot of lymphatics(11.11?2.48) originating fromthe lymphatic network of renal sinus.The lymphatics of renal pedicle variedslightly in diameter (0.25-0.40 mm).The mean value of the diameter oflymphatics in the renal pedicle was 4mm.The mean value of the ratio ofdiameter of lymphatics to that of renal vein on the same side is 90.47%.Therewere positive correlation between them.The renal lymph nodes were scattered singlyin number in each kidney.

OBSERVATION OF THE CORROSION CASTS OF STOMACH LYMPHATICS IN THE RABBIT / 解剖学报

The three-dimensional organization and anastomoses of lymphatics in the rabbit stomach were demonstrated by scanning electron microscopy of lymphatic corrosion casts. Casting medium is the diluted low viscosity Mercox used for intraparenchymatous injection into the mucosal, submucosal, muscular and serous layers of the stomach. The lymphatic capillaries with blind ends were found in the deep mucosa and the lymphatic capillary networks and lymphatic plexus were observed in all the submucosal, muscular and serous layers. The distinct imprints which correspond to the bicuspid valves of lymphatics and the oval or fusiform impressions of the endothelial nuclei were seen on the casts.

MORPHOLOGICAL AND STRUCTURAL CHARACTERISTICS OF THE PERITONEAL LYMPHATIC CAPILLARY NETWORKS / 解剖学报

Objective Peritoneal lymphatic features are studied to provide necessary data for understanding transport capabilities of the endothelial and mesothelial cells. Methods Enzyme\|histochemical staining methods were employed to investigate organization of the lymphatic networks and their endothelial ultrastructures in the monkey peritoneum using light,scanning and transmission electron microscopy. Results 5' Nase positive initial lymphatics showed extensive network,obvious valve like structures and numerous blind ends.The calibre of lymphatics with extremely irregular lumen varied greatly from 40 to 120?m.Lymphatic endothelium was usually separated from mesothelium by a small quantity of loose connective tissue,or they directly contacted each other in some areas.No basal lamina occurred between the peritoneum and the lymphatics originating from milky spots in the omentum and mesovarium.Milky spots are oval or round visible bodies aggregated by macrophages and lymphocytes.Both the endothelium of lymphatic lacunae and the mesothelium that forms the peritoneal stomata,represent a strong 5' Nase activity.Abundant microfibrils attached the stomatal edge. Conclusion The distribution and structure of peritoneal initial lymphatics reveal significant regional variations,and lymphatic endothelium has a close morphological and functional relationship with the mesothelium. [

THE MORPHOLOGICAL OBSERVATION OF LYMPHATICS IN TRANSPLANT TUMOR IN MICE CAUSED BY H22 / 解剖学报

Objective To study the morphological changes of lymphatics in transplant tumor of mice. Methods H22 cells were inoculated under the armpit skin of KM mice. Tumor was obtained two weeks after inoculation. HE staining was used to observe the development of tumor. 5'-nase-alpase double staining was performed to observe blood vessels and lymphatics. Ultrastructures of lymphatics were observed with electron-microscopy. Results Tumor occurred in all the mice. Under microscope there was none of lymphatics in the center of the tumor, a few lymphatics and a lot of blood vessels could be seen in periphery of tumor. Under TEM damage of the organelles could be seen in the endothelial cell of lymphatics. Conclusion Neonatal lymphatics can be seen in transplant tumor caused by H22.