Lymphatic Channels Research Articles

AGA Clinical Practice Update on the Utility of Endoscopic Submucosal Dissection in T1b Esophageal Cancer: Expert Review

AGA Clinical Practice Update on the Utility of Endoscopic Submucosal Dissection in T1b Esophageal Cancer: Expert Review

Axillary reverse mapping and lymphaticovenous bypass: Lymphedema prevention through enhanced lymphatic visualization and restoration of flow.

A lymphedema (LE) prevention surgery (LPS) paradigm for patients undergoing axillary lymphadenectomy (ALND) was developed to protect against LE through enhanced lymphatic visualization during axillary reverse mapping (ARM) and refinement in decision making during lymphaticovenous bypass (LVB). A retrospective analysis of a prospective database was performed evaluating patients with breast cancerwho underwent ALND, ARM, and LVB from September 2016 to December 2018. Patient and tumor characteristics, oncologic and reconstructive operative details, complications and LE development were analyzed. LPS was completed in 58 patients with a mean age of 51.7 years. An average of 14 lymph nodes (LN) were removed during ALND. An average of 2.1 blue lymphatic channels were visualized with an average of 1.4 LVBs performed per patient. End to end anastomosis was performed in 37 patients and a multiple lymphatic intussusception technique in 21. Patency was confirmed 96.5% of patients. Adjuvant radiation was administered to 89% of patients. Two patients developed LE with a median follow-up of 11.8 months. We report on our experience using a unique LPS technique. Refinements in ARM and a systematic approach to LVB allows for maximal preservation of lymphatic continuity, identification of transected lymphatics, and reestablishment of upper extremity lymphatic drainage pathways.

Lymphatic Metastasis of Virulent Extracellular Bacteria Drives Systemic Infection

Lymphatic vessels carry fluid from tissues back to the bloodstream through filtering lymph nodes that limit infection and restrict passage of pathogens; ability to exploit these conduits is ascribed only to cancer cells and a small number of, principally intracellular, pathogens. Here, we report that Streptococcus pyogenes and other extracellular bacteria rapidly escape a local infection site and enter the blood circulation via the lymphatics, passing through sequential draining lymph nodes, and transiting in inter-nodal efferent lymphatic vessels, not blood vessels. Notably, S. pyogenes remain extracellular within lymphatic vessels and lymph nodes. By subverting innate immune responses to infection foci in lymph nodes, metastatic S. pyogenes replicate and seed intense bacteremia and systemic disease. Our findings identify extracellular lymphatic metastasis as the primary route of bacterial dissemination that provides both a survival niche and a conduit to reach the bloodstream and distant tissues for a range of bacteria.

CONSERVATIVE MANAGEMENT OF CHYLOUS ASCITES AFTER ONCOLOGICAL SURGERY FOR PERIPHERAL NEUROBLASTIC TUMORS IN PEDIATRIC PATIENTS

Chylous ascites may complicate the postoperative course of abdominal surgery mainly due to the iatrogenic disruption of the lymphatic channels during extensive retroperitoneal dissection. Sparse data are available regarding treatment; however, in many cases a recommended first-line treatment approach is by way of enteral feeding, consisting of a formula high in medium-chain triglycerides (MCTs) together with a complete total parenteral nutrition teamed with somatostatin (or an equivalent). Nonetheless, the ligation of chylous fistulae, together with the application of Fibrin glue, as well as the creation of peritoneal-venous shunts have also been documented. The aims of this study are to document incidence of postoperative chylous ascites following resection of abdominal peripheral neuroblastic tumors, evaluate efficacy of the management of chylous ascites, and investigate the main risk factors. A survey was carried out over a span of six years, from March 2010 to March 2016 at Giannina Gaslini Children's Hospital involving seventy-seven children with resections of peripheral neuroblastic tumors. Incidence rate of postoperative chylous ascites following a normal diet was 9% (n=7). Treatment using total parenteral nutrition with octreotide resulted in a complete recovery from chylous ascites within a 20 day period without recurrence. Length of operative time, nephrectomy, and the extension of lymphadenectomy were all significantly associated with a higher incidence of postoperative chylous ascites (p<0.05) which also lengthened hospital stay (p<0.05) and possibly delayed beginning adjuvant chemotherapy.

Signaling pathways and inhibitors of cells from patients with kaposiform lymphangiomatosis.

Kaposiform lymphangiomatosis (KLA) is a rare lymphatic anomaly with significant morbidity and mortality. KLA is characterized by diffuse multifocal lesions comprised of focal areas of "kaposiform" spindled cells accompanying malformed lymphatic channels. The goal of this study was to identify activated signaling pathways in cells isolated from three KLA patients for the purpose of testing new therapies. Cells were obtained from the lungs of one patient isolated at autopsy and the spleen of two patients removed in surgery due to disease complications. A protein kinase array was performed on the KLA cell lysates and normal lymphatic endothelial cells. Higher activation of key signaling pathways in the KLA cells, including PRAS40, AKT1/2/3, and ERK-1/2, was identified by protein kinase array and confirmed by Western blot analysis. This indicated a role for highly activated PI3K-AKT and MAPK-ERK-1/2 signaling pathways in KLA cells. Cell proliferation studies assessed PI3K inhibitors (LY294002; BYL719), AKT inhibitor ARQ092, mTOR inhibitor rapamycin, and MAPK inhibitor U0126. These studies demonstrated that PI3K-AKT-mTOR and MAPK signaling are important mediators of KLA cell proliferation. BYL719 and rapamycin were more effective at inhibiting KLA cell proliferation than U0126. Our studies using cells from KLA patient lesions demonstrate that these cells are highly proliferative and the PI3K-AKT-mTOR and MAPK pathways are promising therapeutic targets. Development and clinical trials of PI3K, AKT, and MAPK inhibitors for cancer treatment and the data in this study lend support for early clinical trials assessing the efficacy of these inhibitors in KLA patients.

Skin-recirculating NK cells express α4β1 integrin, E-selectin ligand, and produce IFNγ

Abstract NK cells are increasingly recognized as important players of skin immunity in health and during skin diseases, including skin cancers and autoimmunity. Despite their importance, little is known about the functional and migratory properties of skin-associated NK cells. Here, we employed afferent lymph vessel cannulation in sheep to assess NK cells re-entering the lymphatic system from the skin. NK cells (CD3−Nkp46+) consistently comprised 2–5% of total lymphocytes traveling in afferent lymph. The majority of skin-recirculating NK cells expressed perforin and readily produced IFNγ upon stimulation, indicating continuous recirculation of pro-inflammatory NK cells through unperturbed skin. Skin lymph NK cells expressed high levels of α4β1 integrin, similar to other circulating NK cells including those in blood and mesenteric lymph. Furthermore, a subset of lymph-borne NK cells expressed E-selectin ligand (CLA), suggesting a preference to return to skin in a manner similar to skin-homing T cells. Consistent with organ-selective as opposed to ubiquitous homing we observed that skin-recirculating NK cells lacked the gut-homing molecule, α4β7 integrin. In chemotaxis assays, skin-draining NK cells responded strongly to CCL21, a ligand for ‘tissue exit receptor’ CCR7, suggesting that NK cells use CCR7 to egress from skin via lymph. Our results support a model in which skin-specific NK cells with proinflammatory properties continuously survey the skin and are readily available for potential NK memory responses. Additional studies are underway to further assess the function and tissue tropism of skin-draining NK cells.

Wide local excision prior to sentinel lymph node biopsy for primary melanoma of the head and neck.

Previous wide local excision prior to sentinel lymph node biopsy (SLNB) may have the potential to disrupt lymphatic channels, thus incorrectly identifying the sentinel node. The purpose of this study was to investigate: (1) regional recurrence rates of prior wide local excision compared to other biopsy techniques and (2) survival outcomes in patients with melanoma of the head and neck. Between the years 2000 and 2016, 391 cases were reviewed with a median follow-up time of 30 months in a large tertiary care center. Biopsy practices included shave, punch, wide local excision, and narrow margin excisional/Mohs, and associations with time to local or regional relapse and death from melanoma were evaluated. Main outcomes included identification of sentinel lymph nodes, overall survival, and melanoma-specific survival. Of the 391 patients, biopsy patterns were as follows: 77 (19%) unknown biopsy, 30 (8%) prior wide local excision (WLE), 105 (27%) narrow margin excisional biopsy, 69 (18%) punch biopsy, and 110 (28%) shave biopsy. SLNB was successfully identified in all 30 patients whom had a prior WLE. There were 50 regional recurrences in the neck and 27 local recurrences with the median (IQR) at 1.2 years and 1.0 years, respectively. Multivariable associations of type of prior biopsy, depth of invasion, and nodal status with time to regional recurrence, local recurrence, overall survival, and melanoma-specific survival were not significantly different. Sentinel lymph node biopsy for melanoma of the head and neck can be successfully performed in patients after previous wide local excision.

The Impact of Taxane-based Chemotherapy on the Lymphatic System.

Breast cancer-related lymphedema affects 700,000 breast cancer survivors in the United States. Although taxane-based chemotherapy regimens are commonly used in the treatment of breast cancer, the impact of taxanes on the lymphatic system remains poorly understood. This study aims to examine the influence of taxane-based chemotherapy on lymphatic function in breast cancer patients. A retrospective review of a prospectively-maintained database was performed. Consecutive patients with node positive breast cancer who underwent preoperative indocyanine green (ICG) lymphangiograms were identified. Information including patient demographics, baseline measurements, cancer characteristics, and treatment information were retrieved. Preoperative ICG lymphangiography videos were analyzed and lymphatic contractility was quantified for each subject. Multiple regions of interest were selected on each lymphatic channel and signal intensity was recorded for 3 minutes to generate contractility curves. Each lymphatic contraction was identified using a novel, systematic, and algorithmic approach. Twenty-nine consecutive patients with unilateral node-positive breast cancer were included for analysis. Average patient age was 54.5 (13) years and mean BMI was 26.8 kg/m (4). The mean lymphatic contractility of patients who received taxane-based neoadjuvant chemotherapy was 0.7 contractions/minute (c/m) (n = 19) compared to 1.1 c/m in those who received no neoadjuvant therapy (n = 10), (P = 0.11). In subgroup analysis, patients who reported taxane induced neuropathy demonstrated significantly lower lymphatic contractility values than those who were asymptomatic or did not receive any chemotherapy (P = 0.018). In this study, we used a novel method for quantifying and evaluating lymphatic contractility rates in routine ICG lymphangiograms. Diminished lymphatic contractility was noted in patients who received taxane-based neoadjuvant chemotherapy compared with those who did not. Taxane-based neoadjuvant chemotherapy may adversely affect the lymphatic system in the breast cancer population. A larger patient cohort with longer follow-up time is needed to validate this finding and evaluate any potential association with breast cancer-related lymphedema development.

Capillary Lymphatic Venous Malformations are caused by Endothelial‐Specific Gain‐of‐Function Mutations in the PIK3CA Gene

Capillary lymphatic venous malformations (CLVM) are complex congenital vascular malformations characterized by aberrant vessels and soft tissue overgrowth (figure 1). CLVM are first detected in utero during late embryonic development and enlarge with time. Previous studies show that somatic, mosaic mutations in the 110‐kD catalytic □‐subunit of phosphoinositide‐3 kinase (PIK3CA) are present in CLVM lesions. These hotspot mutations are known to promote cell proliferation and angiogenesis in cancer. Since targeted molecular therapies for CLVM are lacking, patients require repeated sessions of sclerotherapy and surgical debulking over their lifetime. Therefore, there is a significant need to understand the pathogenesis of CLVM in order to develop therapies that target etiology rather than manage symptoms.This study uses patient‐derived cell lines from affected tissue to accomplish two aims: 1) Characterize disease pathogenesis by studying proliferation and signaling in the cell type expressing PIK3CA mutations and 2) Generate a patient‐derived xenograft model which recapitulates the histology of patient lesions.We isolated cells from the resected CLVM tissue of nine patients and cultured them in endothelial growth medium. Cells were separated into CD31+ (endothelial) and CD31‐ (non‐endothelial) populations via immunomagnetic bead sorting. By Sanger sequencing for PIK3CA hotspot mutations, we found that mutations are localized to endothelial cells (EC) in 8/9 patient lesions. This novel finding suggests that PIK3CA‐mutated EC drive CLVM pathogenesis and therefore are the cell‐of‐interest in therapeutic studies.To test this hypothesis, we evaluated AKT, a downstream effector of PI3K, via immunoblotting. We found that CLVM‐EC exhibit constitutive and significantly elevated phosphorylation of AKT (p&lt;0.05) compared to healthy donor EC. Additionally, proliferation studies revealed that CLVM‐EC proliferate 5‐fold faster compared to donor EC, even in the absence of growth factors (p&lt;0.05).Finally, we generated a xenograft murine model of CLVM by injecting patient‐derived CLVM‐EC (suspended in Matrigel□) subcutaneously into the flanks of immunocompromised mice. Healthy donor EC served as a control. Lesions were dissected at day 10, fixed, embedded in paraffin, and stained with hematoxylin and eosin. We found that patient‐derived CLVM‐EC form enlarged vascular and lymphatic channels in the xenograft model, and xenograft lesions resemble the histology of patient lesions.This pre‐clinical xenograft model will be important in identifying FDA‐approved inhibitors that selectively attenuate CLVM growth and may be advanced to clinical trial.Support or Funding InformationNIH‐R01HL117952, Ohio Physiological SocietyThis abstract is from the Experimental Biology 2019 Meeting. There is no full text article associated with this abstract published in The FASEB Journal.

Dendritic Cells and T Cells Interact Within Murine Afferent Lymphatic Capillaries.

Afferent lymphatic vessels contribute to immunity by transporting antigen and leukocytes to draining lymph nodes (LNs) and are emerging as new players in the regulation of peripheral tolerance. Performing intravital microscopy in inflamed murine ear skin we found that migrating dendritic cells (DCs) and antigen-experienced effector T cells spend considerable time arresting or clustering within afferent lymphatic capillaries. We also observed that intralymphatic T cells frequently interacted with DCs. When imaging polyclonal T cells during an ongoing contact-hypersensitivity response, most intralymphatic DC-T cell interactions were short-lived. Conversely, during a delayed-type-hypersensitivity response, cognate antigen-bearing DCs engaged in long-lived MHCII-(I-A/I-E)-dependent interactions with antigen-specific T cells. Long-lived intralymphatic DC-T cell interactions reduced the speed of DC crawling but did not delay overall DC migration to draining LNs. While further consequences of these intralymphatic interactions still need to be explored, our findings suggest that lymphatic capillaries represent a unique compartment in which adaptive immune interaction and modulation occur.

Skin incision versus laser - the influence of different techniques on scar formation and lymphatic drainage in rats. A preliminary report.

IntroductionThe constantly rising number of skin malignancies and increasing cancer awareness encourage more people to visit outpatient clinics in order to have various skin lesions removed. Despite the fact that scarring is a physiological response to any excision procedure, minimizing the size of it is a goal of every good practitioner. Therefore the question arises whether different techniques used to remove skin lesions may impact the formation and quality of skin scars.AimTo perform an evaluation of skin scars formed by laser and surgical incisions and their influence on lymphatic outflow in rats.Material and methodsFive male rats were used. Using methylene blue, the migration of dye through lymphatic channels of the lower extremity was measured. Afterwards, transverse incisions were made distally using laser and a surgical blade. Wounds were left to heal by secondary intention. After 4 weeks dye migration assessment was repeated and tissue samples were obtained for microscopic evaluation.ResultsWounds after surgical incisions healed entirely. Wounds after laser treatment had not healed, with a visible area of granulation tissue and hair loss. Significantly worse dye migration was observed in rat extremities after laser therapy than after surgical incision (p = 0.007).ConclusionsThe results of the study show that the size of the scar can depend on the incision technique used. Larger scars after laser therapy limit the lymphatic flow of the skin, which may have an adverse effect on mapping sentinel lymph nodes. However, this hypothesis requires further research.

Intussusceptive lymphangiogenesis in vascular transformation of lymph node sinuses

Numerous lymphatic anastomosing channels in the lymph nodes are the most demonstrative finding of the rare lesion termed “vascular transformation of lymph node sinuses” (VTS). The mechanism of lymphatic vessel formation in VTS has not been studied. Vessel intussusception contributes to vascular expansion, and intraluminal pillars/posts, interstitial tissue structures or larger pillars (ITSs) and folds are the hallmarks of this process in blood vessels. The aim of this work is to assess whether these hallmarks of intussusception occur in VTS lymphatic vessels, indicating intussusceptive lymphangiogenesis. For this purpose, specimens of five cases of VTS were used for serial histological sections, immunohistochemistry and immunofluorescence in confocal microscopy, which enabled us to demonstrate the 3D image that defines the pillars. The studies showed a) meshworks of lymphatic vessels, which form complex loops, resembling sinuses of lymph nodes, b) presence of intralymphatic pillars, ITSs and folds, with a cover of lymphatic endothelial cells expressing podoplanin and a varying-sized connective core (e.g. collagen), and c) increase of vessel meshwork and linear arrangement, splitting and fusion of ITSs, pillars and folds, with remodelling and segmentation. In conclusion, the development of lymphatic vessel loops, ITSs, pillars and folds with segmentation in VTS supports intussusceptive lymphangiogenesis. This mechanism of intussusception is of interest because it participates in VTS histogenesis, contributes to general knowledge of intussusceptive lymphangiogenesis, which has received less attention than intussusception in blood vessels, and provides a basis for further studies in other lymphatic conditions.

The Effects of Deep Oscillation Therapy for Individuals with Lower-Leg Pain

Purpose: Lower extremity (LE) pain accounts for 13-20% of injuries in the active population. LE pain has been contributed to inflexibility and fascial restrictions. Deep oscillation therapy (DOT) has been proposed to improve range of motion and reduce pain following musculoskeletal injuries. Therefore, our objective was to determine the effectiveness of DOT on ankle dorsiflexion range of motion (ROM) and pain in individuals with and without lower-leg pain. Methods: We used a single blind, pre-post experimental study in a research laboratory. Thirty-two active participants completed this study. Sixteen individuals reporting lower-leg pain and sixteen non-painful individuals completed the study. Participants received a single session of DOT performed by one researcher to their affected limb or matched limb. The intervention parameters included a 1:1 mode and 70-80% dosage. The intervention began by stimulating the lymphatic channels at the cisterna chyli, the inguinal lymph node, and the popliteal lymph node at a frequency of 150 Hz all for a minute each. Next, the researcher treated the triceps surae complex for 11 minutes at three different frequencies. Finally, the participant was treated distal to the popliteal lymph node at 25 Hz for 5 minutes. The main outcome measures included pain using the VAS and ankle dorsiflexion ROM with the weight-bearing lunge test (WBLT). Statistical analyses included descriptive statistics and F-test comparisons between and within groups. Results: The average WBLT measures for all participants increased 0.6 cm, which not to the minimal detectable change for passive ankle dorsiflexion ROM. Significant differences from pre-post measures were identified for pain on the VAS. Conclusion: While increases in ROM were identified, the difference was not clinically important. DOT was successful in decreasing lower-leg pain

Successful Immunoglobulin Replacement with Subcutaneous Immunoglobulin Therapy in a Patient with Primary Intestinal Lymphangiectasia

Primary intestinal lymphangiectasia is a rare disorder which characterized by impaired small intestinal lymph drainage. There is loss of proteins from dilated lymphatic channels located in the mucosa, submucosa or subserosa which is results with loss of gammaglobulins and lymphocytes, leading to impaired humoral and cellular immunity. Herein, we present a 61-year-old patient with immunodeficiency secondary to Primary intestinal lymphangiectasia (PIL), in whom we could attain effective and stable IgG levels only by subcutaneous IgG replacement rather than intravenous IgG. Our experience suggests that Subcutaneous Immunoglobulin (SCIG) replacement resulted in more stable levels of IgG in the presented patient with PIL. We concluded that SCIG should be the preferred route of immunoglobulin replacement therapy in secondary hypogammaglobulinemia due to protein losing enteropathy, especially in PIL.

Intraoperative Detection of Efferent Lymphatic Vessels Emerging from Lymph Node during Lymphatic Microsurgery.

Although the usefulness of efferent lymphaticovenular anastomosis (ELVA) in lymphatic microsurgery has been reported, the optimal method to distinguish efferent from afferent lymphatics is not yet established. We propose a novel technique to detect efferent lymphatics appropriate for anastomosis. In total, 62 groin lymph nodes (LNs) of 46 limbs were divided into four groups based on the findings of indocyanine green lymphography: n = 15 in normal, 15 in dermal backflow stage 0, 18 in stage I, and 14 in stage II groups. The target LN and afferent lymphatic connecting it were preoperatively detected using ultrasonography. Intraoperatively, 0.05 mL patent blue dye was slowly manually injected from the afferent lymphatic; the lymphatic(s) subsequently stained was diagnosed as the efferent lymphatic(s) emerging from the node. The success rates of efferent lymphatic detection, sizes of LN, and diameter of efferent lymphatics were compared among the groups. Both LN size and diameter of efferent lymphatic were significantly larger in the stage 0 and I groups than the other groups (p < 0.01). Efferent lymphatic could be stained in 13, 13, 18, and 9 LNs in the normal and stage 0, I, and II groups, respectively. A significant difference was observed between the stage I and II groups regarding the success rate of efferent lymphatic detection (p = 0.04). Efferent lymphatics could be detected using patent blue dye in 85.5% of the cases. The patients in early-stage lymphostasis might be the most appropriate candidates for ELVA.

Splenic Lymphangioma: A Rare Tumour of Spleen in Adults

Splenic Lymphangioma is a rare, benign, cystic lesion arising from malformations of splenic lymphatic channels. They are usually found in paediatric population and rarely in adults. Isolated lesions are asymptomatic and detected incidentally. However larger lesions present with abdominal discomfort, loss of appetite or a palpable mass. Surgical removal of spleen remains the treatment of choice. A 25-year-old, unmarried female presented 2 months history of pain epigastrium. Abdominal ultrasonography revealed a well defined hypoechoic area in relation to the lower pole of spleen with normal splenic and portal vein. Computed tomography with contrast enhancement showed mild splenomegaly with multiple hypodense lesions with peripherally enhancing rim and decreased central attenuation with likely possibility of angiosarcoma of spleen. JMS 2018: 21 (2):122-124

Surgical Management of Lower Extremity Lymphedema: A Comprehensive Review.

Lymphedema refers to the accumulation of protein-rich fluid in the interstitial spaces. This can occur secondary to congenital malformation of the lymphatic channels or nodes or as a result of an insult that damages appropriately formed channels and nodes. Stagnant, protein-rich lymph initiates an inflammatory response that leads to adipocyte proliferation, fibrous tissue deposition, and increased susceptibility to infections. The end result is permanent disfigurement and dermal changes. Early and accurate diagnosis is essential, since lymphedema is a chronic and progressive problem. When lymphedema affects the lower extremity, it is important to manage it in a way that preserves function and mobility. Early diagnosis also allows for a proactive rather than reactive approach to treatment and utilization of novel physiologic procedures, such as lymphovenous anastomosis and vascularized lymph node transfer. Such interventions slow down disease progression and reduce morbidity by allowing the surgeon to salvage the remaining functional lymphatic channels. When physiologic procedures fail or when faced with a delayed presentation, the addition of excisional procedures can provide a more comprehensive treatment of this debilitating disease. The aim of this article is to review the most current concepts in the surgical management of lower extremity lymphedema.

Vascular Endothelial Growth Factor-C Expression in Servical Squamous Cell Carcinoma of Patients with Neoadjuvant Chemotherapy

Background : Uterine cervical carcinoma is the most gynecological malignancy in women worldwide. The most common type of cervical carcinoma histology is squamous cell carcinoma and has a better prognosis than adenocarcinoma. Neoadjuvant chemotherapy is the management of early-stage cervical carcinoma before radical hysterectomy is performed. In addition to clinical-pathological factors, biomolecular markers are now being developed and used as parameters for evaluating chemotherapy responses. Vascular Endothelial Growth Factor-C is a VEGF derivative that plays a role in the process of vasculogenesis, limphangiogenesis, and the formation of new lymphatic channels which play an important role in metastasis. This study aimed to examine the effect of Paxus-Carboplatin chemotherapy in decreasing VEGF-C in squamous cell cervical carcinoma tissue. Subjects and Method : This was a quasi experiment study conducted at Department of Obstetrics and Gynecology and Pathology Anatomy Laboratory of Dr. Moewardi Hospital/ Faculty of Medicine, Universitas Sebelas Maret. 25 tissue samples of squamous cell stage IB2-IIA2 cervical carcinoma immunohistochemistry VEGF-C expression was carried out before and after Paxus-Carboplatin chemotherapy was given. The data were analyzed by Wilcoxon test. Results: VEGF-C expression in squamous cell cervical carcinoma tissue after chemotherapy was lower (mean = 4.20) than before chemotherapy (mean = 6.16) and it was statistically significant (p<0.001). Conclusion: Neoadjuvant chemotherapy decreases VEGF-C in squamous cell cervical carcinoma tissue. Correspondence: Uswatun Khasanah Kartikasari. Department of Obstetrics and Gynecology, Faculty of Medicine, Universitas Sebelas Maret/ Dr. Moewardi Hospital, Surakarta. Mobile: 081391444425. Email: uswatunkk@gmail.com Indonesian Journal of Medicine (2019), 4(1): 40-45 https://doi.org/10.26911/theijmed.2019.04.01.07

ULTRASTRUCTURAL ORGANIZATION OF THE LYMPHATIC CAPILLARIES IN CONJUNCTIVA AND THE LYMPHATIC CHANNELS IN HUMAN CHOROID

The aim of this work was a comparative study of the ultrastructural organization of lymphatic structures in the choroid and conjunctiva of the human eye. Material and methods. Samples of the choroid and conjunctiva of the human eye, obtained perioperatively, were studied by immunohistochemical analysis using specific antibodies to endothelial cells markers of blood and lymphatic vessels, and electron microscopic studies, morphometric processing and statistical analysis of the results were performed. Results and discussion. Within simultaneous immunohistochemical staining of conjunctiva and choroid samples using antibodies to markers of lymphatic vessels (LYVE-1, Prox1, podoplanin) the positively stained typical lymphatic vessels have been revealed in the conjunctiva structure and positively stained channels with narrow elongated cells, fibroblasts and pigment cells in choriocapillar layer of the choroid and the transition zone between choroid and sclera. Electron microscopic study revealed that cells expressing lymphatic markers and forming lymphatic channels in the choroid have an ultrastructural organization that is differ from typical lymphatic vascular endothelial cells: they do not have stropic filaments, contain a greater volume density of the granular endoplasmic reticulum membranes, and a lower volume density of mitochondria and micropinocytotic vesicles. The data obtained indicate that the lymphatic pathways of the intraocular fluid outflow in the human eye choroid have organ-specific structural features.

Лімфопостачання та архітектоніка лімфатичного русла лімфатичних вузлів у свині свійської

Лімфопостачання та архітектоніка лімфатичного русла лімфатичних вузлів у свині свійської