Dilated Lymphatic Channels Research Articles

Retroperitoneal lymphatics on CT and MR

We report the CT and MRI appearances of dilated retroperitoneal lymphatic channels in six patients. In two patients, these dilated channels resembled a mass of confluent low-density lymph nodes on CT. On MR urography the lymphatic channels in all six patients were seen as a meshwork of multiple tubular, tortuous, fluid-filled structures in the retroperitoneum of the abdomen and pelvis. On axial T1W images, these channels were seen as numerous, interconnected small, nodular and streaky intensities and as a cloak of diffuse homogenous hyperintensity on T2W axial images. The lymphatic nature of these abnormalities was confirmed at surgery in one patient. In another patient, the calibre and number of the dilated retroperitoneal channels reduced following anti-filarial therapy. The remaining four patients presented with chyluria.

Mammographic, Sonographic, and Pathologic Characteristics of Burkitt's Lymphoma in a Patient Referred for Diagnostic Mammography

Case Report A 56-year-old HIV-seropositive woman was referred for mammographic evaluation of a rapidly enlarging, palpable, and tender mass in the axillary tail of the right breast. Physical examination revealed a visible right axillary tail mass with peau d’orange skin changes of the right breast (Figs. 1A and 1B). Mammography (Figs. 1C and 1D) showed a subtle band of increased density overlying the pectoralis muscle at the axillary tail. No calcifications were identified. There were no other mammographic findings. Sonography (Figs. 1E and 1F) showed a diffuse hypoechoic mass seen posterior to branching tubular structures, which corresponded to the mammographic and clinical findings. The branching tubular channels, which represent dilated lymphatic channels, are seen anterior to the mass. CT (Fig. 1G) showed involvement of the right axilla and chest wall. Sonographically guided fine-needle aspiration and core biopsy (Fig. 1H) specimens were obtained from the inferior axillary tail. Histology (Figs. 1I–1L) revealed Burkitt’s lymphoma, which is characterized by a diffuse lymphocytic infiltrate with a “starry sky” pattern. The cells were medium-sized with slightly irregular nuclei. The nucleus contained clumped chromatin and multiple prominent basophilic nucleoli. The tumor showed increased mitoses and numerous pyknotic nuclei and nuclear fragments, free or engulfed in the actively phagocytic histioA

Enamel hypoplasia of the primary dentition in a 4‐year‐old with intestinal lymphangiectasia

Intestinal lymphangiectasia (IL) is a rare disorder, and its incidence and prevalence is unknown for either Australia or world-wide. It is characterized by diarrhoea, mild steatorrhoea, oedema, enteric loss of protein (protein-losing enteropathy) and abnormal dilated lymphatic channels in the small intestine. Whilst oedema and diarrhoea are the predominant clinical features, other observed features include hypoalbuminemia, hypogammaglobulinemia, trace metal deficiency, hypocalcemia and chylous pleural effusions. While medical presentation of the condition has been reported widely, few descriptions of oral findings have been published. A search of Medline found two reports of dental findings in the permanent dentition in patients with IL. To date, there have been no reports on dental findings in the primary dentition. The primary dentition of a 4-year-old boy with IL had teeth with enamel defects which reflected the timing of enamel development and the period in which the disease was active. The present report highlights the need for early involvement of the dental team in the dental management of children with IL.

Papillary Endothelial Hyperplasia and Dilated Lymphatic Vessels in Bullous Pilomatricoma

This is a report of papillary endothelial hyperplasia in a 9-year-old girl with a pilomatricoma showing bullous appearance. Histologically, papillary proliferation of endothelial cells was found within dilated lymphatic endothelium-lined vascular channels overlying a pilomatricoma. The endothelial cells covering the papillae were of a lymphatic endothelial cell nature proved by immunohistochemistry and electron microscopy. Abundant fibrous long-spacing collagen was observed in the connective tissue and fibroblasts within papillae.

Lower-Extremity Lymphangiomatosis

Schultz, Karl MD1; Rosenberg, Andrew E. MD1; Ebb, David H. MD1; Mankin, Henry J. MD1 Author Information

Melkersson‐Rosenthal Syndrome

A 13 year‐old boy presented with a six‐month history of severe lip swelling. His past medical history was significant for eczema, multiple episodes of urticaria, and two episodes of anaphylaxis. Physical exam revealed severe cheilitis and labial angioedema. The cranial nerves were intact, and there was no evidence of a fissured tongue. A lip biopsy showed noncaseating granulomas throughout the dermis, with extension into the underlying skeletal muscle. Other features included dilated lymphatic channels, some closely approximating the granulomas, and a mild perivascular lymphoplasmacytic infiltrate. The epidermis was acanthotic with parakeratosis and focal acantholysis. Methenamine silver and acid‐fast stains were negative. A laboratory work‐up revealed an increased total eosinophil count, an increased serum IgE level, and a low complement C1q level. All other complement levels were normal. The patient also had an unremarkable chest x‐ray and a normal angiotensin converting enzyme level. This case represents the monosymptomatic form of Melkersson‐Rosenthal syndrome (MRS), also known as cheilitis granulomatosa Meischer. MRS is classically known as a triad of granulomatous cheilitis, facial nerve palsy, and fissured tongue. The onset of granulomatous cheilitis typically precedes the other symptoms, and when present alone, it is known as the monosymptomatic form of MRS.

Congenital cervical fibrosacroma with hydrops fetalis

Congenital cervical fibrosacroma with hydrops fetalis

Treatment of thoracic lymphangiomatosis

Lymphangiomas are rare benign neoplasms believed to be the result of abnormal development of the lymphatic system. They grow very slowly usually localised to one organ, but occasionally involve several...

Ultrasonographic diagnosis of subclinical filariasis.

Asymptomatic persons with lymphatic filariasis may harbor microfiliariae in the circulation, and despite the lack of symptoms, these patients may have occult pathologic lesions and renal abnormalities. Earlier investigators have shown that it is possible to detect live adult filarial worms and dilation of lymphatic channels with ultrasonography. It is also possible to assess response to therapy. Using sonography, we detected twirling motions in dilated lymph channels and characteristic sonographic findings associated with presence of adult filariae. On follow-up examination we also found evidence of loss of worm activity after chemotherapy.

Cavernous Lymphangioma of the Thorax

Cavernous lymphangiomas of the thorax are extremely rare. We encountered an 11-year-old boy with such a disorder. Magnetic resonance imaging (MRI) showed numerous small rounded and tubular structures within the mediastinal mass; we believe these represent dilated lymphatic channels.

Short-Term Antibiotic Treatment in Whipple’s Disease

We report the results of short-term antibiotic treatment in 19 patients with Whipple's disease (WD). The diagnosis was based on clinical features and on a characteristic small bowel biopsy. Patients received treatment for a mean of 7.9 weeks (range 4-20). Fourteen were treated with de-methyl-chlortetracycline (600 mg/day), and 1 also received chloramphenicol (1 g/day); 1 was treated with ampicillin (2 g/day), and 4 were treated with amoxicillin (1.5 g/day). In all patients, the clinical response was rapid and excellent, body weight increased significantly, diarrhea subsided, and fecal fat values returned to normal. Intestinal biopsies obtained after treatment was completed showed significant improvement based on a decrease in the number of macrophages staining positive with periodic acid-Schiff (PAS), normalization of villous structure, and decreased dilatation of lymphatic channels; free bacilli were absent, as shown both by light and electron microscopy. Seventeen patients have been followed for a mean of 99.4 months (range 6-300). Two died 30 and 72 months after diagnosis of Whipple's disease, 1 of laryngeal carcinoma and the other of colonic carcinoma. Fifteen patients are in excellent health. Three patients treated with tetracycline have had clinical and/or histologic relapses. In our experience, short-course antibiotic treatment with tetracycline or ampicillin and derivatives can be effective in WD, with few relapses and excellent outcome. No neurologic symptoms, either initially or during follow-up were observed.

Cheilitis granulomatosa: Report of six cases and review of the literature

Six cases of cheilitis granulomatosa, a rare inflammatory disorder of unknown origin, are reported. The condition produces nontender, persistent swelling of one or both lips and affects primarily young adults. Histologically, nonnecrotizing granulomatous inflammation is seen. The clinical findings and results of therapy in these six cases are presented. One patient was treated with hydroxychloroquine sulfate (Plaquenil) that stabilized the process. One of our patients had vesicular-appearing lesions. Microscopic examination showed the lesions to be dilated superficial lymphatic channels, a finding that to our knowledge has not been previously described.

Achondrogenesis type II (Langer–Saldino) in association with jugular lymphatic obstruction sequence

The prenatal diagnosis of achondrogenesis in association with cystic hygroma is described. Ultrasound findings of severe short-limbed dwarfism, decreased vertebral ossification, and normal ossification of the calvarium were all consistent with achondrogenesis type II. Although the unusual finding of associated cystic hygroma raised the suspicion of a concurrent chromosome abnormality, the karyotype of both fetal lymphocytes and fetal fibroblasts was normal. Autopsy confirmed dilated lymphatic channels in the basal endothelial layer of the skin, cystic hygroma, and coarctation of the aorta. Although previously unreported, we suggest that the features of this case of achondrogenesis indicate an association with lymphatic stasis and jugular lymphatic obstruction sequence in this syndrome.

Lymphedema of the lower abdominal wall in pregnancy

Two patients with lymphedema of the lower abdominal wall in late pregnancy are presented. Prominent tortuous, dilated lymphatic channels were observed clinically. Mechanical obstruction of lymphatic drainage is thought to be the cause. Both patients improved after delivery.

Conjunctival Myxoma: A Clinicopathologic Study

A 54-year-old white man had a slowly growing painless epibulbar mass that clinically mimicked a lymphangioma. Morphologically, the paucicellular tumor contained stellate and spindly cells, mast cells, and dilated lymphatic channels embedded in a loose collagenous matrix. The clinical differential diagnosis included lymphangioma, amelanotic nevus, lymphoma, reactive lymphoid hyperplasia, dermoid, lipoma, and botryoid rhabdomyosarcoma. Pathologically, lymphangioma, myxoid neurofibroma, and spindle cell lipoma were all considered. The authors discuss the clinical and histopathologic features of the various tumors, and confirmation of the diagnosis of conjunctival myxoma by differential alcian blue staining properties dependent on critical electrolyte concentration.

Lung histology in experimental drowning

Experiments were carried out on anesthetized rats which had to aspirate actively watery fluids of different osmolarities (range: freshwater--2.9% NaCl solution) by a tracheotomy tube. The cytologic and histological alterations which are to be found are mainly of osmotic origin. In aspiration of hypotonic solutions macroscopy shows the well-known emphysema aquosum. Corresponding to the structure of the respiratory system, the histological alterations show areolar limitations. The influx of fluids causes a wide range of reactions from the development of an alveolar-interstitial edema in combination with intracellular and intercellular vesiculation, karyolysis with swollen homogenized nuclei of the subendothelial, septal, and epithelial cells to a necrosis of all the cellular elements. A pronounced microangiopathy with edema of the vascular walls, a hydrops of the myocytes containing large vacuoles and perivascular edema with dilated lymphatic channels are likewise to be found. The alveolar macrophages are considerably increased. Sporadic ruptures of the alveolar walls and microhemorrhages occur. In salt water drowning alterations of the shape of both the erythrocytes (thorn-apple form) and the alveolar epithelium in combination with a striking of the pneumocytes and villous transformation prevail. Besides, these are capillary hyperemia and sludge. In a careful specimen analysis a differentiation of the findings between vital reactions and postmortem fluid impact is possible.

Progressive interstitial pulmonary lobar emphysema

Progressive pulmonary interstitial lobar emphysema is a complication of artificial ventilation in premature infants with RDS. Three cases are presented who developed a progressive form of PIPE. It is demonstrated that PIPE is caused by air escaping through alveolar leaks into the pulmonary lymphatic capillary system causing dilation of lymphatic channels. Because of its increasing compressive effect on adjacent lung areas PIPE requires rapid and effective therapy. Although several types of conservative approach are suggested, lobectomy is not indicated when prolonged ventilation with high pressures and high concentrations of oxygen have caused severe bronchopulmonary dysplasia.

Direct cannulation and injection lymphangiography of the canine cardiac and pulmonary efferent mediastinal lymphatics in experimental congestive heart failure.

Lymphangiograms were made in dogs with experimental congestive heart failure by cannulation of the left cardiac efferent (LCE), left pulmonary efferent (LPE), or cardiopulmonary lymphatic and injection of radiopaque medium. The lymphoangiograms showed cardiac enlargement and dilated mediastinal lymphatic channels consistent with an increase in lymph flow. By consecutive injections in the LCE and LPE, wer demonstrated that a common channel, the cardiopulmonary lymphatic, is opacified by injection in either the LPE or LCE. This common channel has been called the "cardiac lymphatic" and used for the collection of "cardiac" lymph. The authors' experiments suggest that this cardiopulmonary lymphatic carries both cardiac and pulmonary lymph.

Cystic Lymphangioma of the Spleen

Splenic cysts are uncommon, with fewer than 600 cases reported in the world literature. This report concerns a case of cystic lymphangioma of the spleen, consisting of a large splenic cyst with associated multiple, small, subcapsular cysts and lymphangiectasia. The cysts are lined by endothelium, and they conform to the characteristics of dilated lymphatic channels. Lymphangioma of the spleen is thought to arise from congenital obstruction of lymphatic flow, with subsequent dilatation of lymphatic channels. The diagnosis and treatment of splenic cysts are discussed and a new classification of splenic cysts is proposed.

Benign metastasizing uterine leiomyoma: Multiple lymph nodal metastases

AbstractA case of histologically benign lymph nodal metastases from a uterine Ieiomyoma in a 27‐year‐old woman is reported. It is postulated that fragments of a leiomyoma, detached at the time of endometrial curettage, entered dilated lymphatic channels in or adjacent to a large projecting submucous leiomyoma, and seeded several pelvic and para‐aortic lymph nodes. During an interval of 8 years, these grew slowly and did not infiltrate the perinodal tissues or give rise to secondary metastases.