Successful management of lymphangiosarcoma in a puppy using a tyrosine kinase inhibitor.

A puppy was diagnosed with lymphangiosarcoma associated with lymphedema based on lymphography and histopathology. The lesions resolved after toceranib therapy, and the dog remains in remission 1 year later. This is the first report of a successful outcome following oral toceranib as first-line therapy for lymphangiosarcoma in a dog.

Gestion réussie d'un lymphangiosarcome chez un chiot à l'aide d'un inhibiteur de la tyrosinekinase. Un chiot a été diagnostiqué avec un lymphangiosarcome associé à un lymphoedème en se basant sur une lymphographie et l'histopathologie. Les lésions se sont résorbées après un traitement au tocéranib et le chien demeurait en rémission un an plus tard. Il s'agit du premier rapport d'un résultat favorable après le recours au tocéranib oral comme traitement de premier recours pour le lymphangiosarcome chez un chien.(Traduit par Isabelle Vallières).

Stewart-Treves Syndrome on the Lower Extremity Associated to Idiopathic Chronic Lymphedema Visualized on FDG PET/CT.

Angiosarcomas are highly malignant and rare tumors of vascular or lymphatic endothelial cell origin with a poor prognosis. Lymphangiosarcoma associated with chronic lymphedema is known as Stewart-Treves syndrome. Stewart-Treves syndrome is primarily described in patients with lymphedema of an upper extremity occurring after breast cancer surgery including radical axillary lymph node dissection and subsequent radiotherapy. It is rarely described in the presence of idiopathic chronic lymphedema of the lower extremities. We present a case of lymphangiosarcoma visualized on F-FDG PET/CT, where Stewart-Treves syndrome is secondary to probably a combination of idiopathic chronic lymphedema of the lower extremities and systemic immunosuppressive treatment.

Lymphangiosarcoma of the scalp.

BACKGROUND: Lymphangiosarcoma is a rare, aggressive malignancy that originates from the endothelial cells lining lymphatic vessels and carries an extremely poor prognosis. Its clinical and histologic features are often indistinguishable from angiosarcoma. OBJECTIVE: We sought to better characterize the clinical and histologic features of lymphangiosarcoma. METHODS: Case report and review of the literature. RESULTS: A number of immunohistochemical markers, including Von Willebrand factor, Ulex europaeus agglutinin 1, CD31, VEGFR-3, D2-40, Prox-1, can be used to help differentiate lymphatic from vascular tissue. CONCLUSIONS: Recent characterization of several new biologic markers has allowed greater differentiation between these tumors and may provide new therapeutic targets for treatment.

Distant metastases in a young woman with Stewart-Treves syndrome demonstrated by an FDG-PET/CT scan.

This 17-year-old woman had chronic congenital lymphedema in the left lower extremity since childhood. She underwent surgeries to remove excessive lymphedematous tissues more than 15 times previously. Histopathology of the specimen from the recent surgery revealed angiosarcoma; therefore, FDG-PET/CT scan was arranged to determine the extent of tumor spread, and distant metastases were discovered. Stewart-Treves syndrome is angiosarcomas that arise secondary to chronic lymphedema. Because of the high lethality of this condition, the FDG-PET/CT scan may be a clinically useful imaging modality to detect the possible malignant transformation earlier for patients with chronic lymphedema.

Stewart-Treves syndrome and the use of positron emission tomographic scanning.

In this article, we provide an account of two rare cases of Stewart-Treves syndrome, that is, cutaneous angiosarcoma secondary to lymphedema, treated at our center. Unusually, both occurred in the lower extremity. The first case was treated initially with a wide local excision, followed by a further re-excision, and eventually an above-the-knee amputation because of recurrence. In the second case, a hindquarter amputation was undertaken after a positron emission tomographic scan, which revealed the extent and spread of the lesions. In cases of cutaneous angiosarcoma, a positron emission tomographic scan can be extremely helpful in demonstrating the extent of subcutaneous spread and planning surgical management.

Imaging findings in pancreatic neoplasia and nodular hyperplasia in 19 cats.

Pancreatic neoplasia in cats is rare and associated with a poor prognosis, but pancreatic nodular hyperplasia is a common incidental finding. The purpose of this study was to describe radiographic and ultrasonographic findings in cats with pancreatic neoplasia or nodular hyperplasia. Fourteen cats (age 3-18 years) were diagnosed with malignant pancreatic tumors: carcinoma/adenocarcinoma (n = 11), lymphoma (n = 1), squamous cell carcinoma (n = 1), and lymphangiosarcoma (n = 1). The most common radiographic findings were an abdominal mass or mass effect (6/6) and lack of serosal margin detail (4/6). On ultrasound, the most common finding was a focal pancreatic mass or nodule, with a size range from 0.4 cm to more than 7.0 cm (8/14). Lymphadenopathy (7/14) and abdominal effusion (7/14) were frequently seen. Five cats (age 10-16 years) with adenomatous/nodular hyperplasia had an abdominal mass or mass effect as the most common radiographic finding (3/3). On ultrasound, all cats had multiple hypoechoic nodules between 0.3 and 1.0 cm associated with the pancreas. Other common findings were pancreatic thickening (2/5), lymphadenopathy (2/5), and abdominal effusion (2/5). The only imaging finding unique to malignant pancreatic tumors was the presence of a single pancreatic nodule or mass exceeding 2cm in at least one dimension (4/14). Although there was a tendency for neoplastic lesions to manifest as single larger lesions and for nodular hyperplasia to manifest as multiple smaller lesions, there was overlap of the imaging findings in both entities. Radiographs and ultrasound can complement but not replace cytology and histopathology in the diagnosis of feline pancreatic neoplasia.

[Sonographic imaging of lymphatic vessels compared to other methods]. / Apport de l'échographie à l'imagerie des vaisseaux lymphatiques par rapport aux autres méthodes.

This paper reviews for the first time the normal and abnormal appearances of lymphatic channels of the skin using ultrasound. After a review of anatomy and histology, the authors present the current imaging modalities available for lymph vessel imaging. The ultrasound examination is presented with a description of the author's technique as well as the technical requirements of the ultrasound unit (12 MHz linear probe with a resolution of 400 microns). They present the ultrasound appearance of normal lymphatic channels and their relationships to the dermis, hypodermis and lymph nodes, and at last the ultrasound appearance of abnormal lymphatic pathways

[A case of the Stewart-Treves syndrome (post-mastectomy angiosarcoma) with special reference to a radiological study].

Reported is the case of a 54-year-old female manifesting the Stewart-Treves syndrome (a postmastectomy angiosarcoma.) The patient had developed an angiosarcoma in her lymphoedematous right shoulder and lower neck develop ten years after a radical mastectomy for a papillo-tubular adenocarcinoma of the right mammary gland. Radiologically, a well-enhanced tumor was revealed by computed tomography, which angiographically had more stains and tumor vessels than usual for a mammary carcinoma and less than usually seen in a cavernous hemangioma. Histologically, this tumor showed less of a luminal differentiation than a conventional angiosarcoma and resembled a fibrosarcoma. Computed tomography and angiography were found useful in achieving a diagnosis and the subsequent therapy for this Stewart-Treves syndrome.

Lymphangiosarcoma of the edematous thigh after radiation therapy for carcinoma of the vulva.

A 66-year-old patient was treated with external radiation therapy for an advanced carcinoma of the vulva. Seven years later, a lymphangiosarcoma developed in her edematous lower extremity. Lymphangiosarcomas have been reported to occur in postmastectomy patients; however, this is only the third case in a patient with a gynecologic primary malignancy. In anticipation of possible increased use of radiation therapy in vulvar carcinoma, gynecologists should be aware of this rare, highly aggressive neoplasm.

Long-term development of a primary lung sarcoma, probably lymphangiosarcoma--a case report.

A small primary lung lesion had remained unchanged in size over a period of 8 years. Within the ensuing 2 years rapid tumor growth occurred. On operation the surgical specimen revealed a tumor mass of 87.2 cm3. Within 6 months after resection, the tumor occurred on the same side. Extensive tumor infiltration of the chest wall prevented any further surgery. The histo-morphologic picture of both lesions was consistent with a lymphangiosarcoma without evidence of high grade malignancy. The patient died of cardio-respiratory insufficiency due to extension of the tumor mass. Unfortunately no autopsy was performed. Tumor growth rates, macroscopic reconstruction and electron microscopic evaluations are presented. This case report again points out that size and long-time stability of solitary lung nodules are not necessarily reliable criteria for assessing prognosis.

[Roentgen diagnosis of the posterior part of the base of the skull]. / Röntgendiagnostik der hinteren Schädelbasis.

Since the cranial nerves and the base of the skull are spatially close to each other, certain complexes of symptoms and signs give a very accurate indication of the possible location of the lesion. Basing on such neurologic-topical structuralisation, lesions of the cerebrellopontine angle, the foramen jugulare, the clivus and of the foramen magnum are discussed systematically. The various techniques of radiological imaging or examination are assessed in accordance with their diagnostic ranking, and characteristic constellations of findings are described.

Lymphangiosarcoma after filarial infection.

A case of lymphangiosarcoma of a lower extremity is described in a patient with chronic lymphedema of that leg from a filarial infection in childhood. Histologically, the neoplasm resembled lymphangiosarcomas that arise in arms that become lymphedematous after mastectomies, but was different in that it also contained areas of calcification consistent with prior filarial infection. Calcifications were also present in muscle uninvolved by the lymphangiosarcoma of this case. The prolonged survival of this patient is unlike that of most patients with lymphangiosarcoma, which is generally shorter. Although lymphedema after filariasis is common, this is the first case of a lymphangiosarcoma arising in chronic lymphedema of filarial origin.

[The diagnosis of carcinoma of the breast in relation to growth rate (author's transl)]. / Die Diagnose des Mammakarzinoms unter dem Aspekt der Wachstumsrate

The doubling time (DT) was estimated quantitatively for 16 carcinomas of the breast according to the method described by Collins and co-workers in 1956. This is based on the concept of constant and exponential growth. Observation interval for these mammographically confirmed tumors was between 83 and 1,034 days. The DT was calculated to vary from 45 to 260 days; in order to reach a diameter of 1 cm. after 30 divisions would require a period of 3.7 to 21.4 years. Mammography frequently demonstrates small, clinically occult, tumours. Axillary lymph node metastases are relatively rare from small tumours; growth rate of 70% of breast carcinomas in such that an annual clinical and radiological check-up will prove to be the best means of reducing mortality from carcinoma of the breast. The risk inherent in the radiation resulting from annual mammography is acceptable in women over 35 years. This leaves the problem of rapidly growing carcinomas which would escape early diagnosis by early examinations. Half-yearly examinations of women in high risk groups (1. Previous mastectomy for carcinoma, 2. Biopsy-proven mastopathy with atypical proliferation) comprising about 30% of carcinomas with a short doubling time would appear to be reasonable.

[Lymphography in childhood (author's transl)]. / Lymphographie bei Kindern

Fifty-one lymphograms were performed in children; the indications, technique and results are discussed. Indications are the search for retroperitoneal involvement in lymphogranulomatosis, lympho-sarcoma and reticulum cell sarcoma; in the search for metastases from malignant tumours, particularly abdominal neuroblastoma, soft tissue sarcomas of the abdomen and lower extremities, testicular tumours and malignant melanomas and finally, for primary lymph-oedema and lymphangiomas. Technique is the same as for adults, but requires particular manual dexterity. Children under six years require general anaesthesia. Amongst 28 children with malignant lymphomas, pathological changes in the retroperitoneal lymph nodes were found in seven. In six, this resulted in a change of the staging. Five out of 16 lymphograms in children with malignant tumours showed evidence of lymph node metastases. All six lymphangiograms in children with lymphoedema and lymphangiomas were abnormal.