Introduction: Lymphedema is a condition of the lymphatic system characterized by tissue swelling of body parts especially the limbs as a result of fluid retention. This debilitating condition may result in morbidity a...Introduction: Lymphedema is a condition of the lymphatic system characterized by tissue swelling of body parts especially the limbs as a result of fluid retention. This debilitating condition may result in morbidity and immobility, incapacitating and causing economic burdens as well as affects the individual’s physiological and psychological well being. Aim: The aim of the review is to expound extensively on lymphedema and its associated complications and their management. Methods: Information was obtained by searching on-line literatures, published articles and news reports on lymphedema, causes, diagnoses, complications and personal clinical experience. Also patients’ data were obtained from Komfo Anokye Teaching Hospital Plastic Surgery Consulting Room and Surgical Operative Records in Kumasi, Ghana. Results: Extensive information was obtained from the various sources which formed the basis of this article highlighting especially the complications which include infections and lymphangiosarcoma resulting from long-standing untreated lymphedema.Conclusion: Since management of the condition is possible, patients are encouraged to seek early treatment when they experience any form of swelling. Long-standing lymphedema may result in serious complications includinginfections: cellulitis, lymphangitis and lymphangiosarcoma resulting from severe cases of untreated lymphedema.展开更多
Background The development of angiosarcoma in oedematous tissue is referred to as Stewart-Treves syndrome （STS）. This rare and fatal complication is associated with chronic post mastectomy lymphoedema and radiothera...Background The development of angiosarcoma in oedematous tissue is referred to as Stewart-Treves syndrome （STS）. This rare and fatal complication is associated with chronic post mastectomy lymphoedema and radiotherapy for breast cancer. Angiosarcoma spread is facilitated by the formation of blood vessels （angiogenesis） and lymph vessels （lymphangiogenesis）. In the future antiangiogenic therapy may improve the poor outcome of current treatments. There was evidence that blocking the angiogenenesis would inhibit progression of angiosarcoma. It seems reasonable to hypothesize that blocking the lymphangiogenesis may yield similar results. Although angiosarcomas commonly derive from blood vessels, in case of STS angiosarcomas chronic lymphoedema may suggest its lymphatic origin. The goal of this study was to visualize interstitial space and lymphatics in the central and peripheral regions of STS angiosarcoma. Methods On tissue samples obtained from STS angiosarcoma we have performed： first colour stereoscopic lymphography to visualise the morphology of lymphatic vessels and extracellular spaces, second immunohistochemical staining specific for lymphatic vessels endothelium （LYVE-1） and blood endothelial cells （CD31, factor VIII） and prolymphangiogenic vascular endothelial growth factor （VEGF-C） for precise identification of lymphatic endothelia. STS angiosarcoma morphology was assessed by comparison of pictures obtained on lymphography, microscopy and confocal microscopy. Results STS angiosarcomas present heterogenous morphology with areas dominated by hemangiosarcoma and lymphangiosarcoma structures. STS angiosarcoma expressed phenotypes of both blood and lymphatic endothelia. LYVE-1 and VEGF-C is expressed by STS angiosarcoma and may be used to discriminate tumour differentiation. Morphology of lymphatic vessels and spaces in the tumour suggest absence of their normal lymphatic function. Conclusions Our results confirmed both hemangio- and lymphangiogenic origin of STS angiosarcoma. Expression of VEGF-C makes STS angiosarcoma a good candidate for targeted antilymphangiogenic therapy. However, morphology of intratumoral lymphatics on colour lymphography suggested their impaired function, which can hamper drug distribution.展开更多
文摘Introduction: Lymphedema is a condition of the lymphatic system characterized by tissue swelling of body parts especially the limbs as a result of fluid retention. This debilitating condition may result in morbidity and immobility, incapacitating and causing economic burdens as well as affects the individual’s physiological and psychological well being. Aim: The aim of the review is to expound extensively on lymphedema and its associated complications and their management. Methods: Information was obtained by searching on-line literatures, published articles and news reports on lymphedema, causes, diagnoses, complications and personal clinical experience. Also patients’ data were obtained from Komfo Anokye Teaching Hospital Plastic Surgery Consulting Room and Surgical Operative Records in Kumasi, Ghana. Results: Extensive information was obtained from the various sources which formed the basis of this article highlighting especially the complications which include infections and lymphangiosarcoma resulting from long-standing untreated lymphedema.Conclusion: Since management of the condition is possible, patients are encouraged to seek early treatment when they experience any form of swelling. Long-standing lymphedema may result in serious complications includinginfections: cellulitis, lymphangitis and lymphangiosarcoma resulting from severe cases of untreated lymphedema.
文摘Background The development of angiosarcoma in oedematous tissue is referred to as Stewart-Treves syndrome （STS）. This rare and fatal complication is associated with chronic post mastectomy lymphoedema and radiotherapy for breast cancer. Angiosarcoma spread is facilitated by the formation of blood vessels （angiogenesis） and lymph vessels （lymphangiogenesis）. In the future antiangiogenic therapy may improve the poor outcome of current treatments. There was evidence that blocking the angiogenenesis would inhibit progression of angiosarcoma. It seems reasonable to hypothesize that blocking the lymphangiogenesis may yield similar results. Although angiosarcomas commonly derive from blood vessels, in case of STS angiosarcomas chronic lymphoedema may suggest its lymphatic origin. The goal of this study was to visualize interstitial space and lymphatics in the central and peripheral regions of STS angiosarcoma. Methods On tissue samples obtained from STS angiosarcoma we have performed： first colour stereoscopic lymphography to visualise the morphology of lymphatic vessels and extracellular spaces, second immunohistochemical staining specific for lymphatic vessels endothelium （LYVE-1） and blood endothelial cells （CD31, factor VIII） and prolymphangiogenic vascular endothelial growth factor （VEGF-C） for precise identification of lymphatic endothelia. STS angiosarcoma morphology was assessed by comparison of pictures obtained on lymphography, microscopy and confocal microscopy. Results STS angiosarcomas present heterogenous morphology with areas dominated by hemangiosarcoma and lymphangiosarcoma structures. STS angiosarcoma expressed phenotypes of both blood and lymphatic endothelia. LYVE-1 and VEGF-C is expressed by STS angiosarcoma and may be used to discriminate tumour differentiation. Morphology of lymphatic vessels and spaces in the tumour suggest absence of their normal lymphatic function. Conclusions Our results confirmed both hemangio- and lymphangiogenic origin of STS angiosarcoma. Expression of VEGF-C makes STS angiosarcoma a good candidate for targeted antilymphangiogenic therapy. However, morphology of intratumoral lymphatics on colour lymphography suggested their impaired function, which can hamper drug distribution.
