Current researches of the role of dural immunity in neuroinfectious and neuroimmune diseases / 中华神经科杂志

Dura mater, rich in vasculature and immune cells, is the outermost layer of the central nervous system, and thus acts as the first barrier to protect brain. Meningeal lymphatic vessels and immune cells are main components of dural immunity, which respond to a variety of central nervous system diseases. Meanwhile, compared with brain parenchyma, dura mater communicates more with peripheral tissues and is more susceptible to medical interventions. Therefore, dura mater is a promising target to prevent, diagnose and treat intracranial diseases. Here dural immunity is clarified based on meningeal lymphatic vessels and dural immune cells, and current researches inquiring the role of dural immunity in infectious and immune diseases of central nervous system are summarized.

Avaliação imunohistoquímica dos vasos linfáticos em fígados humanos com hepatite crônica C - relação com variáveis histológicas / Immunohistochemical assessment of lymphatic vessels in human livers with chronic hepatitis c - relation to histological variables

ABSTRACT Background Viral hepatitis C is a significant public health challenge. The disease may remain clinically silent in both acute and chronic forms, and chronic infections may progress to advanced disease such as cirrhosis and hepatocellular carcinoma, requiring costly treatment, compromising the patient's quality of life and even leading to death. For this reason, it is one of the most frequent indications for liver transplantation. Although treatment with direct-acting antivirals represents remarkable progress, many patients are still infected and even those who cleared the viral infection must be followed due to their previous hepatic lesions, especially regarding the disturbances of lobular architecture and the sanguineal and lymphatic vessels. Objective To assess immunohistochemical aspects of lymphatic sprouts and mature lymphatic vascularity with histological variables of liver injury attributable to hepatitis C virus (HCV) and fatty disease. Methods The present study included 72 liver biopsies of cases with chronic hepatitis C. Morphologic changes reflecting "staging" and "activity" were analyzed. Immunohistochemical reactions were performed with monoclonal antibody D2-40 anti-podoplanin. Major histological variables were also semiquantified so as to enable the search for possible associations among histological and Immunohistochemical criteria, as well as with genotypes 1 and 3 of HCV. Results Histological findings showed that the different degrees of strutural changes were well represented in this casuistic. Intralobular/parenchymal necro-inflammatory activity was predominantly mild to moderate. Most cases did not show major evidences of fatty disease, which was found significantly higher in cases infected with HCV genotype 3. The amount of portal lymphatic sprouts increased along with the progression of structural changes, maximal at cirrhosis. Portal lymphatic sprouts as well as portal mature lymphatic vessels also showed an increase parallel to the increase in the degree of portal/septal inflammatory infiltrate. In the present study, no significant association was found between the proportion of portal lymphatic sprouts or portal mature lymphatic vessels and the degree of periportal/periseptal activity. No significant relations were detected between lymphatic sprouts/mature vessels and periportal or parenchymal inflammatory activity, nor with infections due to HCV genotype 1 or 3. Conclusion Visualization and semiquantitation of sprouts and mature lymphatic vessels were clearly yielded by Immunohistochemical staining with monoclonal antibody D2-40. The amount of lymphatics was increased along fibrogenic process, significantly related to progression of liver disease and maximal at cirrhosis. No significant relations were detected with necro-inflammatory activity at interface or in the parenchyma.

RESUMO Contexto A hepatite C é um relevante problema de saúde pública. A doença pode permanecer clinicamente silenciosa tanto na forma aguda como na crônica e as infecções crônicas podem progredir para doenças avançadas, tais como cirrose e carcinoma hepatocelular (CHC), requerendo tratamentos dispendiosos, comprometendo a qualidade de vida do paciente e até mesmo levando à morte. Por esta razão, é uma das indicações mais frequentes para o transplante hepático. Apesar da introdução do tratamento com antivirais de ação directa (AAD) representar um progresso notável, muitos pacientes não receberam o tratamento e continuam infectados, e mesmo aqueles que eliminaram a infecção viral devem ser seguidos devido às lesões hepáticas anteriores, especialmente no que diz respeito às alterações da arquitetura lobular e dos vasos sanguíneos e linfáticos. Objetivo Avaliar os aspectos imuno-histoquímicos dos brotos linfáticos e dos vasos linfáticos "maduros" com variáveis histológicas de lesão hepática atribuíveis ao vírus da hepatite C (VHC) e à doença gordurosa. Métodos O presente estudo incluiu 72 biópsias hepáticas em pacientes com hepatite C crônica. Foram analisadas alterações estruturais relativas a "estadiamento" e "atividade". Reações imuno-histoquímicas foram realizadas com anticorpo D2-40 anti-podoplanina. As principais variáveis histológicas também foram semiquantificadas, de modo a permitir a procura de possíveis associações entre os critérios histológicos e imunohistoquímicos, bem como com os genótipos 1 e 3 do VHC. Resultados Os achados histológicos mostraram que os diferentes graus de alterações estrutural estavam bem representados nesta casuística. A atividade necro-inflamatória lobular/parenquimatosa foi predominantemente leve à moderada. A maioria dos casos não apresentava grandes evidências de doença gordurosa, que foi encontrada significativamente mais elevada nos casos infectados com o genótipo 3 do VHC. A quantidade de brotos linfáticos portais aumentou com a progressão de alterações estruturais, sendo máxima na cirrose. Os brotos linfáticos portais, bem como os vasos linfáticos "maduros" portais também mostraram um aumento paralelo ao aumento do grau de infiltrado inflamatório portal/septal. No presente estudo, não foi encontrada qualquer associação significativa entre a proporção de brotos linfáticos portais ou vasos linfáticos maduros portais e o grau de atividade periportal/periseptal. Não foram detectadas relações significativas entre os brotos linfáticos/vasos maduros e a atividade inflamatória periportal ou atividade inflamatória parenquimatosa, nem com infecções devido ao genótipo 1 ou 3 do VHC. Conclusão A reação imunohistoquímica com anticorpo monoclonal D2-40 possibilitou a visualização e a semiquantitação de brotos e vasos linfáticos "maduros" nas amostras obtidas por biópsia hepática. A quantidade de linfáticos aumentou ao longo do processo fibrogênico, significativamente relacionada com a progressão da doença hepática e máxima na cirrose. Não foram detectadas relações significativas com a atividade necro-inflamatória periportal ou parenquimatosa.

New insights into aqueous humor outflow system and ophthalmic lymphatic drainage pathway / 中华实验眼科杂志

Glaucoma is the first irreversible blinding eye disease in the world, and vision loss due to glaucoma is related to the obstruction of the aqueous humor drainage channel, which leads to increased intraocular pressure and damage to the optic nerve.The relationship between the ocular lymphatic system and the aqueous humor drainage pathway is of important significance.Exploration of the generation and development of ocular lymphatic vessels and identification of the markers of ocular lymphatic vessels (LVs) are important for researching whether lymphatic pathways are involved in the aqueous humor outflow in glaucoma.Relationship between aqueous humor drainage system and ocular lymphatic drainage pathway can be elucidated from following aspects: (1)podoplanin is highly expressed in trabecular meshwork endothelial cells, while no expression of platelet-endothelial cell adhesion molecule (CD31) is found, suggesting that there is a close relationship between trabecular meshwork and LVs; (2)there are similarities in morphology, molecules and function between Schlemm canal and LVs, and Schlemm canal not only has some characteristics of LVs and blood vessels, but also some undiscovered characteristics of blood vessels and lymphatic endothelial cells; (3)the bulbar conjunctiva is rich in LVs, suggesting that the bulbar conjunctiva has active tissue drainage and immunoregulatory functions; (4)the sclera is mainly composed of collagen fibers and lacks real LVs, but many lymphatic vessel endothelial hyaluronic acid receptor 1 (LYVE-1)-positive macrophages around the scleral vessels are regulated by tissue-specific factors; (5)multiple lymphatic markers can be detected in ciliary body, and suspected LVs can be observed by electron microscopy; (6)various lymphatic markers can be expressed in a single choroidal cell, with LYVE-1 expressed highest.Research progress in the lymphatic system of LVs, lymphatic markers, and aqueous humor outflow was reviewed in this article.

The process in research of anatomy of brain lymphatic system and the relationship between it and Alzheimer's disease / 中华显微外科杂志

Conventional wisdom holds that the central nervous system (CNS) does not have lymphatic vessels or lymphatic circulation, and it lacks lymphatic pathways to clear brain metabolites. However, with the development of study in intracranial clearance, it has been discovered that there are lymphatic systems in CNS, including glymphatic pathway and it meningeal lymphatic vessels. It further reveals the exchange system between cerebrospinal fluid (CSF) and interstitial fluid (ISF). It also closely relates to the development of neurodegenerative diseases, age-related changes of brain, traumatic brain injury, circulatory diseases and tumors. In the past 10 years, the research in CNS has been a hot spot in life sciences. This article aims to explain the research progress from the aspects of the discovery of glymphatic system, anatomical structure and function, and relationship with Alzheimer's disease (AD).

Orbital lymphatic vessels: immunohistochemical detection in the lacrimal gland, optic nerve, fat tissue, and extrinsic oculomotor muscles / Vasos linfáticos orbitários: identificação imunohistoquímica na glândula lacrimal, no nervo óptico, no tecido adiposo e nos músculos extrínsecos oculomotores

ABSTRACT Purpose: To identify the lymphatic vessels in orbital specimens from human cadavers using light microscopy and immunohistochemical analysis. Methods: A postmortem study included 10 orbital specimens from 10 human cadavers. The orbital specimens were obtained no later than 12 hours after death. The orbital specimens were dissected into lacrimal gland, optic nerve, fat tissue, and oculomotor muscles. The histologic criteria to qualify as a lymphatic vessel were thin-walled channels of endothelium without a well-developed basal membrane and with an erythrocyte-free, irregular lumen. The immunohistochemical criteria were irregularly shaped, thin-walled vessels with an erythrocyte-free, irregular lumen and immunopositivity for podoplanin D2-40. Results: The lacrimal gland, optic nerve, fat tissue, and extraocular muscle sections were positively stained with podoplanin D2-40. Conclusions: This study demonstrated lymphatic vessels in the human orbit, more precisely, in the lacrimal gland, dura mater of the optic nerve, adipose tissue, and extrinsic oculomotor muscles via light microscopy and immunohistochemistry.(AU)

RESUMO Objetivos: Identificar vasos linfáticos em espécimes orbitários de cadáveres humanos através de microscopia óptica e análise imunohistoquímica. Métodos: Um estudo postmortem incluiu dez espécimes orbitários provenientes de dez cadáveres humanos. Todos os espécimes orbitários foram obtidos até 12 horas após a morte com uma técnica cirúrgica de exenteração orbitária e dissecados em glândula lacrimal, nervo óptico, gordura órbitária e músculos extraoculares. Para classificar como um vaso linfático, os critérios histológicos incluíram vasos endoteliais de parede única sem membrana basal bem desenvolvida, irregulares e lúmen sem hemácias, e os critérios imunohistoquímicos incluíram vasos endoteliais de parede única, com formato irregular e lúmen sem hemácias e reagentes a podoplanina D2-40. Resultados: As lâminas histológicas de glândula lacrimal, nervo óptico, tecido adiposo e músculos extraoculares reagiram positivamente a podoplanina D2-40. Conclusão: Este estudo demonstrou vasos linfáticos na órbita humana, mais exatamente, na glândula lacrimal, no nervo óptico, na gordura orbitária e nos músculos extrínsecos extraoculares via microscopia óptica e imunohistoquímica.(AU)

Linfangiectasia intestinal em adulto: relato de caso / Intestinal lymphangiectasia in an adult: case report

Resumo A linfangiectasia intestinal consiste em um grupo de doenças raras caracterizadas pela dilatação dos canais linfáticos. A fisiopatologia compreende a obstrução da drenagem linfática do intestino delgado com dilatação secundária dos vasos linfáticos mucosos, submucosos ou subserosos, que distorcem a arquitetura das vilosidades e conduzem à perda de linfa para a luz intestinal, levando à má absorção. Os vasos linfáticos afetados localizam-se primariamente no intestino delgado, que é atingido em extensão variável. A sua etiologia é ainda desconhecida. O relato a seguir apresenta um raro caso de linfangiectasia intestinal em paciente adulto.

Abstract Intestinal lymphangiectasia is a group of rare diseases characterized by dilation of lymphatic channels. Its pathophysiology comprises obstruction of small bowel lymphatic drainage with secondary dilation of mucosal, submucosal, or subserous lymphatic vessels, distorting villous architecture and causing loss of lymph into the intestinal lumen, leading to malabsorption. The affected lymphatic vessels are primarily located in the small intestine, which is affected to a varying extent. Its etiology is still unknown. The following report presents a rare case of intestinal lymphangiectasia in an adult patient.

Research progresses of imaging studies on preoperative prediction of microvascular invasion of hepatocellular carcinoma / 中国医学影像技术

Microvascular invasion (MVI) is one of invasive behaviors of hepatocellular carcinoma (HCC), related with the prognosis and post-treatment recurrence of HCC. Preoperative noninvasive and accurate prediction of MVI is of vital importance to select reasonable clinical treatment and improve patient's prognosis. At present, there are no recognized criteria for preoperative diagnosis of MVI in clinical practice. Preoperative imaging prediction of MVI has become a current research focus, and the relative research progresses were reviewed in this article.

Role of hepatic lymphangiogenesis in the progression of liver fibrosis / 临床肝胆病杂志

Liver fibrosis can progress to liver cirrhosis and end-stage liver disease, which may lead to poor prognosis. In addition to pathological angiogenesis and hepatic sinusoid remodeling, hepatic lymphangiogenesis also plays an important role in the progression of liver fibrosis. This article briefly describes lymphatic vessel markers and their expression in the liver, introduces the role of lymphangiogenesis in liver fibrosis, and reviews the role of liver macrophages (Kupffer cells) and lymphatic endothelial cells in lymphangiogenesis. It is pointed out lymphangiogenesis may become a potential target for the intervention of liver fibrosis, which plays an important role in the early treatment and reversal of liver fibrosis and the prevention of liver cirrhosis and end-stage liver disease.

Proximal ligation after the side-to-end anastomosis recovery technique for lymphaticovenous anastomosis

BACKGROUND: Lymphaticovenous anastomosis is an important surgical treatment for lymphedema, with lymphaticovenous side-to-end anastomosis (LVSEA) and lymphaticovenous end-to-end anastomosis being the most frequently performed procedures. However, LVSEA can cause lymphatic flow obstruction because of regurgitation and tension in the anastomosis. In this study, we introduce a novel and simple procedure to overcome this problem. METHODS: Thirty-five female patients with lower extremity lymphedema who underwent lymphaticovenous anastomosis at our hospital were included in this study. Eighty-five LVSEA procedures were performed, of which 12 resulted in insufficient venous blood flow. For these 12 anastomoses, the proximal lymphatic vessel underwent clipping after the anastomotic procedure and the venous inflow was monitored. Subsequently, the proximal ligation after side-to-end anastomosis recovery (PLASTER) technique, which involves ligating the proximal side of the lymphatic vessel, was applied. A postoperative evaluation was performed using indocyanine green 6 months after surgery. RESULTS: Despite the clipping procedure, three of the 12 anastomoses still showed poor venous inflow. Therefore, it was not possible to apply the PLASTER technique in those cases. Among the nine remaining anastomoses in which the PLASTER technique was applied, three (33%) were patent. CONCLUSIONS: Our findings show that achieving patent anastomosis is challenging when postoperative venous inflow is poor. We achieved good results by performing proximal ligation after LVSEA. Thus, the PLASTER technique is a particularly useful recovery technique when LVSEA does not result in good run-off.

Relationship between vascular endothelial growth factor C and lymphatic vessel density with clinicopathological features of the patients in stage Ⅱ colorectal cancer / 肿瘤研究与临床

Objective To investigate the relationship between vascular endothelial growth factor C (VEGF-C) and lymphatic vessel density (LVD) with clinicopathological features of the patients in stage Ⅱ colorectal cancer.Methods Fifty-seven tissues in stage Ⅱ colorectal cancer and 57 normal mucosal tissues in Shaanxi Provincial Cancer Hospital from January 2005 to December 2010 were collected.The expression of VEGF-C and LVD were detected by using immunohistochemical method.The relationship between VEGF-C and LVD with the clinicopathological features of colorectal cancer was analyzed.Results The expression of VEGF-C and LVD in cancer tissues was higher than that in normal tissues (6.80±1.24 vs.2.07±0.17,t =3.773,P =0.000;3.19±0.53 vs.1.84±0.26,t =2.276,P =0.025).There were statistical differences between VEGF-C and LVD in different tumor diameter (4.00±0.54 vs.11.26±2.89,t =-3.049,P =0.004;1.89±0.37 vs.5.27±1.12,t =-3.376,P =0.001) and relapse or metastasis (4.74±1.31 vs.10.62 ±2.39,t =-2.158,P =0.039;1.86±0.45 vs.5.65±1.06,t =-3.778,P =0.000).LVD in VEGF-C positive group was higher than that in VEGF-C negative group (4.16±0.64 vs.0.21±0.11,t =3.503,P =0.001).The expression of VEGF-C was positively correlated with LVD (r =0.892,P =0.000).Conclusions The expression of VEGF-C in stage Ⅱ colorectal cancer is correlated with LVD,as well as tumor size and relapse or metastasis.VEGF-C and LVD could also play important roles in the occurrence,development and metastasis in stage Ⅱ colorectal cancer.

Mechanism of the "negative development" of carbon nanoparticles for the parathy-roid gland in thyroidectomy through expression contrast of vascular-related markers / 中国肿瘤临床

Objective: To investigate the anatomical characteristics of the parathyroid lymphatic system and the mechanism of the"negative development"of the carbon nanoparticles for parathyroid gland in thyroidectomy.Methods:This retrospective study used parathyroid tissue samples from patients that were obtained from archival records in the pathology department,including 45 cases of normal parathyroid gland tissues that were accidentally resected in thyroidectomy,10 cases of parathyroid adenomas,and 7 cases of parathyroid carcinoma.Ten cases of normal thyroid tissues were selected as positive control.Immunohistochemistry was performed using the antibodies specific for lymphatic endothelium,such as D2-40 and LYVE-1,and antibodies specific for vascular endothelial cell such as CD31 and CD34,to distinguish them from each other.Results:A total of 62 parathyroid glands samples were stained with vas-cular markers CD31,CD34 and lymphatic markers D2-40,LYVE-1 respectively(partial samples were stained unsuccessfully).Vascular vessels in the CD31 staining group were detected in 50 of 58 examined glands and the positive rate was 86.2%.In the CD34 staining group,positive rate was 100%(60/60).The positive cells were found in the central,periphery and vascular hilum of the glands.Howev-er,lymph vessels in the D2-40 staining group were detected from 17 out of 59 examined glands,with the positive rate of 28.8%;In the LYVE-1 staining group,positive rate was 39.6%(23/58).The positive cells were found in the membrane or vascular hilum,less frequent or undetectable in the central portion.Conclusions:Most of the parathyroid glands of adults might lack a lymphatic network.Only a few adult parathyroid glands had minority lymph vessels,and these lymphatics generally localized at the membrane area or in the vas-cular hilum, which could be one of the main and anatomical mechanisms resulting in drainage failure or obstruction of carbon nanoparticles and thus in parathyroid"negative development."

Lymphatic vessel mapping in the upper extremities of a healthy Korean population

BACKGROUND: Intraoperative indocyanine green (ICG) lymphography can effectively detect functioning lymph vessels in edematous limbs. However, it is sometimes difficult to clearly identify their course in later-stage edematous limbs. For this reason, many surgeons rely on experience when they decide where to make the skin incision to locate the lymphatic vessels. The purpose of this study was to elucidate lymphatic vessel flow patterns in healthy upper extremities in a Korean population and to use these findings as a reference for lymphedema treatment. METHODS: ICG fluorescence lymphography was performed by injecting 1 mL of ICG into the second web space of the hand. After 4 hours, fluorescence images of lymphatic vessels were obtained with a near-infrared camera, and the lymphatic vessels were marked. Three landmarks were designated: the radial styloid process, the mid-portion of the cubital fossa, and the lower border of the deltopectoral groove. A straight line connecting the points was drawn, and the distance between the connected lines and the marked lymphatic vessels was measured at 8 points. RESULTS: There were 30 healthy upper extremities (15 right and 15 left). The average course of the main lymph vessels passed 26.0±11.6 mm dorsal to the styloid process, 5.7±40.7 mm medial to the mid-cubital fossa, and 31.3±26.1 mm medial to the three-quarters point of the upper landmark line. CONCLUSIONS: The main functioning lymphatic vessel follows the course of the cephalic vein at the forearm level, crosses the mid-cubital point, and travels medially toward the mid-axilla.

Expresión de Podoplanina en Mucosa Oral Normal, Displasia Epitelial Oral y Carcinoma Oral de Células Escamosas / Immunoexpression of Podoplanin in Normal Oral Mucosa, Epithelial Displasia and Oral Squamous Cell Carcinoma

RESUMEN: Evaluar la inmunoexpresión de podoplanina (PDPN) en el epitelio y vasos linfáticos en muestras de mucosa oral normal (MON), displasia epitelial oral (DEO) y carcinoma espinocelular oral (CECO). Estudio descriptivo de serie de casos. La muestra estuvo constituida por 19 casos de MON, 18 de DEO y 19 de CECO. Se consideraron positivas aquellas células con tinción de membrana y/o citoplasmático. Para la evaluación de PDPN epitelial se realizó un análisis semicuantitativo a través del producto entre la intensidad y porcentaje de células teñidas (immunoreactive score- IRS), mientras que para la evaluación de los vasos linfáticos, se determinó la densidad media vascular (DMV) a partir del promedio de la densidad linfática en tres campos ópticos por muestra. El mayor valor de IRS se observó en el grupo de CECO, seguido por DEO y el menor valor fue en el grupo de MON, con diferencias estadísticamente significativas al comparar CECO/DEO (p= 0,0200) y CECO/MON (p= 0,0078). Al comparar los valores de DMV según diagnóstico, se obtuvo que estos fueron bastante similares y no presentaron diferencias significativas entre sí (p= 0,4273). Finalmente, se analizó la relación entre los valores de IRS de podoplanina epitelial y la densidad media vascular de los linfáticos, a través del test de independencia de Spearman, el cual determinó que no hay un grado de asociación entre ambas variables (p= 0,2056). Conclusión: el IRS epitelial aumenta su valor al comparar muestras de MON, DEO y CECO. No existen diferencias significativas, en las muestras estudiadas, entre los valores de DMV linfática. No existe relación entre la expresión de PDPN epitelial y DMV linfática en muestras de DEO y CECO.

ABSTRACT: The objective of this study was to evaluate the expression of Podoplanin (PDPN) in epithelium and lymphatic vessels in normal oral mucosa (NOM), oral epithelial displasia (OED) and oral squamous cell carcinoma (OSCC). A descriptive case study was carried out. Nineteen histological samples diagnosed with NOM, 18 diagnosed with OED and 19 with OSCC. Immunopositive cells for PDPN were those that presented membrane and/or cytoplasmic staining. A semi-quantitative analysis of the stained sections was made according to the immunoreactive score (IRS) for the extension and intensity of epithelial cells, while the evaluation of lymphangiogenesis was made through the calculation of the mean vascular density (MVD). The results indicated the higher IRS value was in OSCC followed by OED and lowest in NOM, with significant differences between OSCC/OED (p= 0.0200) and OSCC/NOM (p= 0.0078). No differences in MVD were found between the studied samples (p= 0.4273). Finally, the correlation between the value of epithelial IRS and MVD was analyzed through Spearman Independence test, which determined there was no statistically significant relationship between the studied variables (p= 0.2056). In conclusion, epithelial IRS value is greater in OSCC samples than OED and NOM. There was no statistically significant difference in lymphatic MVD in the studied samples. There is no correlation between the epithelial PDPN expression and lymphatic MVD in OSCC and OED samples.

Methods and advances in the research of lymphatics in the head and neck / 中华耳鼻咽喉头颈外科杂志

The lymphatic system plays an important role in human health and disease. In addition to a role in the immune response, the lymphatics can also serve as a pathway for cancer metastasis.Head and neck squamous cell carcinoma (HNSCC) is one of the most common cancers.In the case where the primary focus has been controlled, cervical lymph node metastasis is one of the most important factors affecting the prognosis of head and neck cancer.Thus, understanding the anatomy of the lymphatic system is of paramount importance in predicting cancer metastasis and to perform proper lymph node dissection in cancer patients.The objective of this review is to summarize current imaging approaches that facilitate both basic science and clinical investigations of lymphatic vasculature.Mutation analysis of the laryngeal lymphatic system may provide a theoretical basis for the diagnosis and treatment of HNSCC.

Role of master transcriptional factor Prox-1 in lymphatic endothelial differentiation of Kaposiform hemangioendothelioma / 中华病理学杂志

Objective@#To analyze the clinical and pathological features of Kaposiform hemangioendothelioma (KHE), and to investigate the role of master transcriptional factor Prox-1 in the regulation of lymphatic differentiation.@*Methods@#Nine cases of KHE (during the period from October 2009 to June 2016) were collected with clinical and pathological data. H&E stained section review and immunohistochemietry using the Dako EnVision method were performed.@*Results@#There were 6 female and 3 male patients with age ranging from 2 months to 8 years (median 3 years and 4 months). The patients presented with either single subcutaneous soft tissue mass, or bone tumors, with the duration of disease onset ranging from 1 month to 1 year. The sites of involvement included the skins of neck (2 cases), nose root (1 case), inguinal (1 case), thigh root (1 case), humerus (2 cases), lumbar vertebrae(1 case), and mesentery (1 case). These tumors were histologically composed of nodules of densely packed spindle or ovoid cells and deformed small blood vessels in an invasive growth pattern. The tumor cells were immunohistochemically positive for both blood vessels and lymphatic endothelial markers, including Prox-1, the master transcriptional factor, and VEGFR-3. With followed-up from 1 to 60 months (median 26 months), two patients died of the disease, while the remaining patients were alive without recurrence.@*Conclusions@#KHE is a rare vascular tumor with at least partial lymphatic endothelial differentiation, in which Prox-1 may act as a master regulator for such differentiation. KHE is an aggressive tumor of intermediate malignant potential, with local invasion and recurrence tendency, and long term follow-up is required.

Retroperitoneoscopic renal pedicle lymphatic disconnection for chyluria via extra-adipose capsule / 北京大学学报(医学版)

Objective:To evaluate the clinical effect of retroperitoneoscopic renal pedicle lymphatic disconnection via extra-adipose capsule in the management of chyluria and to discuss the management of its complications.Methods:From August 2013 to June 2008,five patients with chyluria were admitted. All the patients were female,aged from 26 to 73 years,and disease course from 1 to 10 years.All the five patients had complained of intermittently voiding milky urine with varying degrees of weight loss,and fa-tigue,of whom two presented with flank pain and one with anemia.Their urine chyle tests were con-firmed to be positive.Preoperative cystoscopy found that chyluria was from the left side in 3 cases,and from the right side in 2 cases.Their proteinuria ranged from +to ++++.All the cases had been treated with the modified procedure by which lymphatic ligation was performed to hilar vessels and proximalureter via extra-adiposecapsule without disconnection of perirenal fat tissues.The operation time,intraoperative blood loss,postoperative intestinal function recovery,catheter time,drainage tube removal time and com-plications during operation were collected.Results:All the five cases were performed successfully.The operation time ranged from 75 to 170 minutes,mean (126.0 ±39.6)minutes,with the intraoperative blood loss 20 to 60 mL,mean (38.0 ±16.4)mL,and the postoperative intestinal function recovery time 1 to 3 days,mean (1.9 ±0.4)days.The catheter time was 1 to 4 days,mean (2.1 ±0.3)days and the drainage tube removal time ranged from 3 to 15 days,mean (9.3 ±1.8)days.Postoperatively lym-phorrhagia was found in two cases.No renal vessels injury occurred during operation.Chyluria of all the patients disappeared on the operation day with negative chyluria test after surgery.Furthermore,urine test revealed that proteinuria was totally negative.No recurrence was detected in our patients in the 9 to 31 months’follow-up.Conclusion:This modified procedure does not have to disconnect perirenal fat tissues and nephropexy during operation.It was characterized with shorter operation time,definitive effect and fewer complications.

Melkersson-Rosenthal Syndrome with Genitalia Involved in a 12-Year-Old Boy

Melkersson-Rosenthal syndrome (MRS) is an uncommon granulomatous disease characterized by the triad of relapsing facial paralysis, orofacial swelling, and fissured tongue. Genital swelling in MRS is rarely reported. We presented the first case of complete MRS with genital swelling in a child. Biopsy examinations of both the child's lower lip and penis showed noncaseating granuloma and intralymphatic granuloma infiltration. No symptoms or signs of other systemic disease (Crohn's disease or sarcoidosis) were observed after 2 years of follow-up. Genetic screening for CARD15/NOD2 in this patient showed negative, which further confirmed the diagnosis of MRS. Eleven other cases of suspected complete or incomplete MRS with genitalia involved were reviewed. Our case emphasizes the specific clinical feature of MRS with genitalia involved, which was genetically different from Crohn's disease and could be an independent entity. Lymphatic obstruction is responsible for localized edema in MRS.

Melkersson-Rosenthal Syndrome with Genitalia Involved in a 12-Year-Old Boy

Melkersson-Rosenthal syndrome (MRS) is an uncommon granulomatous disease characterized by the triad of relapsing facial paralysis, orofacial swelling, and fissured tongue. Genital swelling in MRS is rarely reported. We presented the first case of complete MRS with genital swelling in a child. Biopsy examinations of both the child's lower lip and penis showed noncaseating granuloma and intralymphatic granuloma infiltration. No symptoms or signs of other systemic disease (Crohn's disease or sarcoidosis) were observed after 2 years of follow-up. Genetic screening for CARD15/NOD2 in this patient showed negative, which further confirmed the diagnosis of MRS. Eleven other cases of suspected complete or incomplete MRS with genitalia involved were reviewed. Our case emphasizes the specific clinical feature of MRS with genitalia involved, which was genetically different from Crohn's disease and could be an independent entity. Lymphatic obstruction is responsible for localized edema in MRS.

Reduction of contractility and reactivity in isolated lymphatics from hemorrhagic shock rats with resuscitation

PURPOSE: To evaluate the changes of contractility and reactivity in isolated lymphatics from hemorrhagic shock rats with resuscitation. METHODS: Six rats in the shock group suffered hypotension for 90 min by hemorrhage, and resuscitation with shed blood and equal ringer's solution. Then, the contractility of lymphatics, obtained from thoracic ducts in rats of the shock and sham groups, were evaluated with an isolated lymphatic perfusion system using the indices of contractile frequency (CF), tonic index (TI), contractile amplitude (CA) and fractional pump flow (FPF). The lymphatic reactivity to substance P (SP) was evaluated with the different volume of CF, CA, TI and FPF between pre- and post-treatment of SP at different concentrations. RESULTS: The CF, FPF, and TI of lymphatics obtained from the shocked rats were significantly decreased than that of the sham group. After SP stimulation, the ∆CF (1×10-8, 3×10-8, 1×10-7, 3×10-7 mol/L), ∆FPF (1×10-8, 3×10-8, 1×10-7 mol/L), and ∆TI (1×10-8 mol/L) of lymphatics in the shock group were also obviously lower compared with the sham group. In addition, there were no statistical differences in CA and ∆CA between two groups. CONCLUSION: Lymphatic contractility and reactivity to substance P appears reduction following hemorrhagic shock with resuscitation. .

Role of lymphatic in cancer metastasis / 国际外科学杂志

Cancer patients always die from local or distant metastasis,Lymphangiogenesis and modification are the two most important factors who contribute to the lymphatic metastasis.So,this article summarize the informations about the role of lymphatic in the process of cancer metastasis on the aspect of molecular mechanism of lymphatic epithelium cells(LEC) in these years all around the world.