Lymphangitic Melanomatosis: Case Report of Intralymphatic Spread of Melanoma in a 66-year-old Man.

ABSTRACT: Melanoma with lymphatic invasion has been associated with increased risk of metastasis, but the mechanisms and clinical implications are poorly understood. Although current reports have documented angiotropic spread of melanoma and suggest lymphatic spread of melanoma to increase the likelihood of metastasis, to our knowledge, lymphangitic metastatic melanoma resembling cutaneous carcinomatosis or presenting with facial hyperpigmentation has not been described. In this case report, we describe extensive cutaneous intralymphatic spread of melanoma, or lymphangitic melanomatosis, producing macular skin pigmentation in a 66-year-old man.

Study on prevalence and associated risk factors of epizootic lymphangitis in equine in Nagele Arsi town, southeastern Ethiopia.

Epizootic lymphangitis is a contagious, chronic and overwhelming disease of equids, characterized by chronic discharging skin nodules. This study was aimed to investigate the prevalence and associated risk factors of epizootic lymphangitis in equines at Nagele Arsi town, southeastern Ethiopia. A cross-sectional study using a random sampling technique was employed from December 2021 to June 2022 via clinical and microscopic examinations of the lesions. The overall prevalence of epizootic lymphangitis was 4.37% with a prevalence of 6.69%, 0.72%, and 0% in horses, donkeys, and mules, respectively. The sex, species, harness type, season, and body condition scores of equids have shown statistically significant differences (p < 0.05) with the prevalence of epizootic lymphangitis. Macroscopically, the lesions revealed varying degrees of nodule to ulcer on the sternum, limbs, face, and cervical region of the equine. Upon giemsa stain, fungal hyphae with a halo (unstained capsule-like) structure were observed. Histologically, pyogranulomatous inflammation with fibroplasia was appreciated. In conclusion, epizootic lymphangitis was rampant in the study area. This requires a detailed investigation incorporating a large sample size using fungal culture and other molecular techniques including PCR.

Risk Factors Associated with Adverse Outcomes after Ablative Surgery for Lymphedema.

BACKGROUND: Postmastectomy breast cancer lymphedema poses an important health threat. Historically, physical therapy was the exclusive treatment option. More recently, lymphedema surgery has revolutionized care. As a first-in-kind, multicenter report, the postmastectomy breast cancer patients' risk factors associated with postlymphedema ablative surgical outcomes were documented. METHODS: Using the New York Statewide Planning and Research Cooperative System database from 2010 to 2018, multivariable models identified the postmastectomy breast cancer lymphedema surgical patients' characteristics associated with major adverse outcomes and mortality. RESULTS: Of 65,543 postmastectomy breast cancer patients, 1,052 lymphedema surgical procedures were performed including 393 (37.4%) direct excisions and 659 (63.6%) liposuctions. Direct excision and liposuction surgical patients had median ages of 58 and 52 years, respectfully (p < 0.001). Although a 30-day operative mortality was rare (0.3%, all direct excisions), major adverse outcomes occurred in 154 patients (28.5% direct excision; 6.4% liposuction; p < 0.0001). Multivariable clinical outcomes model identified that patients with higher Elixhauser's score, renal disease, emergent admissions, and direct excision surgery had higher incidences of adverse outcomes (all p < 0.01). For those patients with 30-day readmissions (n = 60), they were more likely to have undergone direct excision versus liposuction (12.5 vs. 1.7%; p < 0.0001). The important risk factors predictive of future cellulitis/lymphangitis development included diabetes mellitus, Medicaid insurance, renal disease, prior cellulitis/lymphangitis, chronic obstructive pulmonary disease (COPD), and chronic steroid use (all p < 0.01). CONCLUSION: Lymphedema surgery carries a favorable risk profile, but better understanding the "high-risk" patients is critical. As this new era of lymphedema surgery progresses, evaluating the characteristics for adverse postoperative outcomes is an important step in our evolution of knowledge.

Acute Respiratory Failure Caused by Pulmonary Lymphangitic Carcinomatosis in a Patient With Lung Adenocarcinoma at Initial Diagnosis / Insuficiencia respiratoria aguda causada por linfangitis carcinomatosa pulmonar en un paciente con adenocarcinoma de pulmón desde el diagnóstico inicial

No disponible

Penile Lymphangioma Secondary to Sclerosing Lymphangitis/Mondor's Disease in an HIV-Positive Patient.

A 34-year-old man presented with a painless lesion of the glans present for more than 4 years. The patient became HIV-positive in 2011, and he has been treated with tenofovir, emtricitabine, and efavirenz. A CD4 count performed 4 months prior was 570 cells/mL3; syphilis, hepatitis B, and hepatitis C serologies performed on the same date were non-reactive.

Bronchoalveolar carcinoma as an unsuspected cause for worsening shortness of breath in a patient with metastatic breast cancer.

A 70-year-old woman with lung metastases from a breast cancer presented with worsening cough and dyspnoea. She recently had a pleurodesis for a malignant pleural effusion. Chest CT scans demonstrated various radiological changes leading to diagnostic challenges. Differential diagnoses included empyema, pleural disease progression, pulmonary oedema, pneumonitis, lymphangitis and atypical infections. She deteriorated despite a multimodality treatment strategy. Postmortem examination confirmed that lung changes were consistent with a bronchoalveolar carcinoma unrelated to the known metastatic breast cancer. The eventual knowledge of this diagnosis was reassuring to the treating medical team and a comfort to the relatives who witnessed the lack of response to standard treatment.

The Effect of a Regimen of Antifungal Cream Use on Episodes of Acute Adenolymphangitis (ADL) among Lymphedema Patients: An Application Using Marginal Structural Models.

Episodes of adenolymphangitis (ADL) are a recurrent clinical aspect of lymphatic filariasis (LF) and a risk factor for progression of lymphedema. Inter-digital entry lesions, often found on the web spaces between the toes of those suffering from lymphedema, have been shown to contribute to the occurrence of ADL episodes. Use of antifungal cream on lesions is often promoted as a critical component of lymphedema management. Our objective was to estimate the observed effect of antifungal cream use on ADL episodes according to treatment regimen among a cohort of lymphedema patients enrolled in a morbidity management program. We estimated this effect using marginal structural models for time varying confounding. In this longitudinal study, we estimate that for every one-unit increase in the number of times one was compliant to cream use through 12 months, there was a 23% (RR = 0.77 (0.62, 0.96)) decrease in the number of ADL episodes at 18 months, however the RR's were not statistically significant at other study time points. Traditionally adjusted models produced a non-significant RR closer to the null at all time points. This is the first study to estimate the effect of a regimen of antifungal cream on the frequency of ADL episodes. This study also highlights the importance of the consideration and proper handling of time-varying confounders in longitudinal observational studies.

Placa indurada con ulceración y necrosis en tórax / Ulcerated indurated necrotic plaque on the chest wall

No disponible

El sistema inmune en los linfedemas y linfangitis de los miembros inferiores / The immune system in lymphedema and lymphangitis of the lower limbs

El sistema inmune es el mecanismo de resistencia del organismo ante las infecciones. El sistema linfático juega un importante papel en el control fisiológico del fluido tisular y en la iniciación de la respuesta inmune. Nos proponemos describir la función de los componentes celulares del sistema inmune en las linfopatías de miembros inferiores no asociadas a cánceres tales como el linfedema y la linfangitis.Se revisaron las bases de datos PubMed, MedLine, SciELO, Clinical Key, Liliacs, Ebsco y artículos científicos publicados en revistas cubanas entre 2000-2015. Los estudios recientes muestran que el crecimiento de nuevos vasos linfáticos es una característica distintiva de las reacciones inflamatorias agudas y crónicas que caracterizan a las linfopatías, mediado por un incremento en el drenaje del fluido fuera del vaso y de células inflamatorias, así como de la modulación de las respuestas inmunes. Es apremiante continuar investigando, específicamente en lo concerniente al comportamiento de la inmunidad humoral y celular en los pacientes que padecen de linfedema o linfangitis, pues no se encontraron trabajos que aborden de manera específica la posible relación entre ambos. Se sugiere que las subpoblaciones de células T son un componente crítico en la respuesta celular inflamatoria crónica y subaguda en las linfopatías. La comprensión de la función reguladora del fluido linfático en la respuesta inflamatoria puede dar un importante paso en el desarrollo de tratamientos que puedan bloquear el inicio o la progresión de las consecuencias anómalas de las lesiones linfáticas(AU)

The immune system is the body´s mechanism of resistance to infections. The lymph system plays an important role in the physiological control of the tissue fluid and in the onset of the immune response. We intended to describe the function of the cell components of the immune system in the cancer-unrelated lymphopathies of the lower limbs such as lymphedema and lymphangitis. To this end, Pubmed, Medline, Scielo, Clinical Key, Liliacs, Ebsco and scientific articles published in Cuban medical journals from 2000 to 2015 were reviewed. The recent studies show that the growth of new lymphatic vessels is a distinctive characteristic of the acute and chronic inflammatory reactions of lymphopathies, mediated by increase of the fluid drainage outside the vessel and of inflammatory cells as well as the immune response modulations. It is urgent to continue studying this topic, mainly the behavior of the humoral and cell immunity in patients suffering from lymphedema or lymphangitis, since no research papers dealing with the possible relation between both aspects were found. It is suggested that the T-cell subpopulations are a key component of the chronic and sub-acute inflammatory response in lymphopaties. Hence, understanding of the regulating function of the lymph fluid in the inflammatory response may represent an important step in the development of therapies that might block the onset or progression of the anomalous consequences of lymphatic injures(AU)

Paracoccidioidomycosis: acute-subacute clinical form, juvenile type.

The authors report aspects of paracoccidioidomycosis, acute-subacute clinical form, juvenile type, in a 19-year-old female patient. Paracoccidioidomycosis, juvenile type, classically occurs in young patients, both sexes, with lymphoma-like aspects as initial presentation. However, following the natural history of the disease the lymph nodes assume patterns of infectious disease, as an abscess and fistulae. Systemic dissemination of the disease can occur and lethality and morbidity are significant in this clinical presentation.

Paracoccidioidomycosis: acute-subacute clinical form, juvenile type

Abstract: The authors report aspects of paracoccidioidomycosis, acute-subacute clinical form, juvenile type, in a 19-year-old female patient. Paracoccidioidomycosis, juvenile type, classically occurs in young patients, both sexes, with lymphoma-like aspects as initial presentation. However, following the natural history of the disease the lymph nodes assume patterns of infectious disease, as an abscess and fistulae. Systemic dissemination of the disease can occur and lethality and morbidity are significant in this clinical presentation.

Linfangitis flictenular en una embarazada / Flictenular Linfangitis in Pregnancy

La linfangitis es un fenómeno inflamatorio de los vasos linfáticos en cualquier sector del sistema linfático. Producida por agentes biológicos, los más frecuentes Staphylococcus y Streptococcus pyogenes. El diagnóstico se realizó en el Servicio de Cuidados Intensivos Perinatales del Hospital Lenin de Holguín, en una paciente saludable de 20 años, procedente del municipio Urbano Noris, con un embarazo de 29,4 semanas, tenía el antecedente de un traumatismo pequeño en un pie hacia 48 h, iniciando con toma del estado general, fiebre de 38,5 grados Celsius, dolor en el pie, acompañado de enrojecimiento y aparición de vesícula que aumentaron de tamaño rápidamente alcanzando de 5 a 6 cm, con una evolución desfavorable que la llevó a ingreso en Unidad de Cuidados Intensivos del Hospital Lenin, Holguín por una sepsis grave, fue necesario durante su evolución tratamiento antimicrobianos y quirúrgico junto a la aplicación de derivados hemáticos (plaquetas lisadas), lo que permitió conservar su miembro inferior y llegar al término de la gestación con un recién nacido de buen peso.(AU)

Lymphangitis is a disease known since Hippocrates time, is an inflammatory phenomenon of lymphatic vessels in any sector of the vascular system. The etiology of this acute disease is diverse, with those caused by biological agents the most connotation, and among them those caused by Staphylococcus and Streptococcus pyogenes. The diagnosis was made in a healthy 20 year- old pregnant patient (29.4 weeks of gestation). The patient had a history of a small injury on one foot during 48 hours. The general state of the patient was bad and began with fever of 38.5 degrees Celsius, foot pain accompanied by redness and increased occurrence of vesicle size quickly reaching 5-6 cm, with an unfavorable evolution that led to admission to Intensive Care Unit of Lenin, Holguin Hospital for severe sepsis. Antibiotics and surgical treatments with the use of blood products were necessary, for a satisfactory evolution, allowing to preserve the lower limb and reach the end of gestation with a newborn good weight.

Dermal Structure in Lymphedema Patients with History of Acute Dermatolymphangioadenitis Evaluated by Histogram Analysis of Ultrasonography Findings: A Case-Control Study.

BACKGROUND: Acute dermatolymphangioadenitis (ADLA) is a risk factor for increasing of edema and worsening severity. Reducing ADLA frequency is an important objective of lymphedema management because ADLA episodes are strongly associated with poor quality of life. Lymphedema changes dermal and subcutaneous structure, favoring ADLA; ADLA recurrence may be caused by structural change of the dermis. However, the structure of the skin following ADLA episodes has not been studied in depth. The aim of this study was to examine changes in the skin after episodes of ADLA in breast cancer-related lymphedema (BCRL) using histogram analysis of ultrasonography findings. METHODS AND RESULTS: This was a case-control study with matching for the duration of lymphedema. We compared 10 limbs (5 BCRL patients, Cases) with a history of ADLA and 14 limbs (7 BCRL patients, Controls) without. Ultrasonography was performed using a 20-MHz probe, and measurements were made at a site 10 cm proximal to the ulnar styloid process. We compared "skewness" of the images in the dermis from the histogram analysis. This study was approved by the Ethics Committee of Kanazawa University. Skewness was significantly different between the affected and unaffected limbs (p = 0.02). Cases showed a positive value (median 0.74, range -0.18 to 1.26), whereas Controls showed a negative value (median -0.21, range -0.45 to 0.31). CONCLUSIONS: Episodes of ADLA changed the distribution of echogenicity on imaging, which indicates a change in the collagen fibers in the dermis. These findings might contribute to improving the management of lymphedema and prevention of recurrent ADLA.

The relationship between coronal sulcus lymphangitis and IgE / Relación entre la linfangitis del surco coronario y la IgE

Objectives. To investigate whether there is a link between serum IgE levels in patients having diagnosis of coronal sulcus lymphangitis and this disease. The patients and method. The patients have been diagnosed clinically. The time of symptoms’ existence, allergy history and the history of a traumatic sexual relationship or masturbation have been investigated. The serum total IgE levels have been measured. Results. The study includes 27 patients. All patients have been diagnosed clinically. The age average is 36 (22-54). The time between the last sexual relationship or masturbation and the emergence of the symptoms is averagely 3 days (1-10). The symptoms emerged in shorter than 24 h in 6 patients. The symptoms emerged statistically earlier in patients having a traumatic sexual relationship or masturbation history (p: 0.0046). The level of serum IgE was over the threshold value in 8 patients (30%). The symptoms emerged statistically later in patients having high IgE level (p: 0.0004). Conclusions. The immunologic, traumatic and infectious reasons are responsible for the etiology of the coronal sulcus lymphangitis. In this study, the rate of the patients considered to be having immunologic reasons has been found as 30% (AU)

Objetivo. Investigar si existe una relación entre los niveles séricos de IgE en pacientes diagnosticados de linfangitis del surco coronario y este resultado. Pacientes y métodos. Los pacientes recibieron un diagnóstico clínico. Se investigaron la duración de los síntomas, antecedentes de alergias o de traumatismos durante el coito o la masturbación. Se midieron los niveles totales de IgE. Resultados. Se incluyeron 27 pacientes en el estudio. Todos habían recibido un diagnóstico clínico. La media de edad fue de 36 (22-54). El tiempo transcurrido desde la última relación sexual o masturbación y la aparición de los síntomas de 3 días de media (1-10). Los síntomas surgieron en menos de 24 horas para 6 pacientes. Los síntomas aparecieron antes de manera estadísticamente significativa en aquellos pacientes con antecedentes de coito o masturbación traumáticos (p: 0,0046). El nivel de IgE en sangre fue superior al valor de referencia en 8 pacientes (30%). Los síntomas aparecieron más tarde con significación estadística en los pacientes con niveles de IgE altos (p: 0,0004). Conclusión. Existen motivos inmunológicos, traumáticos e infecciosos que ocasionan la linfangitis del surco coronario. En el presente estudio se considera que la tasa de pacientes que contaban con motivos inmunológicos ascendía al 30% (AU)

La clínica manda / No disponible

No disponible

Metastatic Crohn's disease accompanying granulomatous vasculitis and lymphangitis in the vulva.

Metastatic Crohn's disease (CD) is an extremely rare extragastrointestinal manifestation of CD, and is characterized histopathologically by the presence of non-caseating granulomatous inflammation. Granulomatous vasculitis and lymphangitis have rarely been documented in metastatic CD. Herein, we report the first documented case of metastatic CD accompanied by both granulomatous vasculitis and lymphangitis in the vulva. A 35-year-old Japanese female with CD presented with multiple small nodules in her vulva. Biopsy was performed under a clinical diagnosis of genital warts. A histopathological study revealed marked lymphangiectasia in the papillary dermis. Within the dilated lymphatics, lymphocytes and aggregates of macrophages were present, which are typical features of granulomatous lymphangitis. Tiny non-caseating granulomas and granulomatous vasculitis were also observed. Accordingly, a diagnosis of metastatic CD accompanied by both granulomatous vasculitis and lymphangitis was made. The occurrence of cutaneous lesions in patients with CD is well known. Albeit extremely rare, lymphangiectasia has been reported in the vulva of CD patients that clinically mimicked viral warts, as in the present case. The diagnosis of metastatic CD in the present case was not difficult because characteristic histopathological features were present, and a clinical history of CD was available. However, a few cases of genital swelling associated with granulomatous inflammation prior to a diagnosis of gastrointestinal CD have been documented. Therefore, granulomatous vasculitis and lymphangitis in the external genitals should be considered as potential indication of metastatic CD even in cases without a history of gastrointestinal CD.

Rapidly lethal dermatomyositis associated with cutaneous lymphangitis carcinomatosa.

A 70-year-old woman with a recent diagnosis of dermatomyositis (DM) presented to the dermatology department for study of a probably paraneoplastic syndrome. On examination, we observed discrete, indurated, reddish, painful plaques and nodules on her abdomen and both thighs. A cutaneous biopsy from an abdominal nodule, performed as part of the paraneoplastic workup, was suggestive of cutaneous lymphangitis carcinomatosa, secondary to unknown malignancy. An extensive investigation to locate the site of the primary tumour revealed no specific findings. A course of palliative chemotherapy with cisplatin and 5-fluorouracil was then given, but the patient's condition deteriorated and 6 months after her initial observation the patient died. We describe this case because, to our knowledge, the association between DM and cutaneous lymphangitis carcinomatosa has not been described yet in the literature and to highlight that, DM can be a rapidly lethal disease.